Expanding the Role of Community Pharmacies in Kenya: Integrating Diabetes, Hypertension, and Mental Health Care

 Corresponding author: Alan Omondi Odoyo. Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Lscense 4.0. Expanding the Role of Community Pharmacies in Kenya: Integrating Diabetes, Hypertension, and Mental Health Care Alan Omondi Odoyo 1, *, Hilda Ndunge Nyamai 2 and Kefa Obwama Makokha 3 1 Department of Pharmacy, Faculty of Health Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. 2 Faculties of Health Sciences, School of Nursing and Midwifery, East Africa, Aga Khan University, Nairobi, Kenya. 3 Nalan Pharmacy, Nairobi, Kenya. World Journal of Biology Pharmacy and Health Sciences, 2025, 24(02), 088-094 Publication history: Received on 26 September 2025; revised on 02 November 2025; accepted on 04 November 2025 Article DOI: https://doi.org/10.30574/wjbphs.2025.24.2.0983 Abstract Kenya faces a rising burden of non-communicable diseases (NCDs), accounting for 39% of Kenyan deaths, which represents a 12% increase since 2014. Hypertension affects about 24% of adults, and the prevalence of diabetes stands at 3%. Currently, despite the legal permission of community pharmacies in Kenya to dispense medicines, counsel patients, administer some vaccinations, and manage minor ailments, they remain underutilized in the prevention and management of various NCDs. There is growing rationale to integrate NCD care into pharmacies since, according to WHO, pharmacists are accessible “first point of contact” providers, and pharmacy-based models elsewhere have improved NCD control and efficiency. This commentary proposes an implementation framework wherein pharmacies are at the forefront of providing NCD health services, entailing routine screening (blood pressure, blood glucose, PHQ9 depression screens), lifestyle counseling, drug regimen adherence and refill support, medication therapy management, and digitally linking patients to health facilities. Realizing this requires pharmacist upskilling, policy reforms for expanded scope of practice, financing via Social Health Insurance Fund reimbursements to cover pharmacy refills and screenings, and digital integration and interoperability of such health services (mobile apps, e-referrals). Key recommendations include pilot programs to test pharmacy-led NCD health care, regulatory changes to permit clinical services, training programs, and sustainable financing (public/private partnerships, insurance reimbursement). Expanded pharmacy roles could improve early detection and control of diabetes, hypertension, and mental health disorders, decongest hospitals, and strengthen Kenya’s progress toward Universal Health Coverage (UHC). Keywords: Community pharmacy; Hypertension; Mental health Illnesses; Diabetes; Policy intervention; Pharmacy training 1. Introduction Most countries in sub-Saharan Africa are facing an unprecedented overhaul of their disease profile, from communicable diseases such as malaria, tuberculosis, and HIV to an epidemiological transition characterized by an increasing predominance of chronic, non-communicable diseases (NCDs). According to Gouda et al. [1], there is a growing burden of diabetes, chronic kidney disease, chronic respiratory diseases, cardiovascular disease, cancers, and mental and substance use disorders in sub-Saharan Africa. In Kenya, NCDs have escalated and led to many mortalities and morbidities. According to Karugu et al. [2], an estimated 1.8 million Kenyan adults (3.1%) had diabetes in 2019 (projected to exceed 2.2 million by 2030), whereas hypertension prevalence is approximately 24%. NCDs, including cardiovascular diseases and diabetes, are now the majority of Kenya’s disease burden, contributing 39% of deaths [3]. Mental health disorders, including depression, generalized anxiety disorders, and substance use disorders, also contribute significantly to morbidities; the Kenya Demographic and Health Survey (2022) reported 3.8% of Kenyan World Journal of Biology Pharmacy and Health Sciences, 2025, 24(02), 088-094 89 adults (15–49) to be having depression and anxiety symptoms [4]. Despite all these, 4 out of 5 hypertensives globally are undertreated, and most Kenyans lack access to adequate mental health services [4]. Workforce shortages and resource constraints create the most significant limitation to access to NCD care in Kenya's public health system. There are a few clinics that handle a huge patient workload, thus discouraging many patients with non-communicable diseases from seeking their services. Such patients may prefer to seek such services from community pharmacies, which are often closer to them and have created a good rapport and understanding with the pharmacists. These provide an untapped potential, because these pharmacies can be used to serve as local healthcare hubs for managing hypertension, diabetes, mental health disorders, and other NCDs. This commentary takes a dive into exploring the possible pathways that the government and other stakeholders can use to expand the scope and integrate community pharmacies in the management of NCDs, drawing from trends and patterns while being informed by the existing gaps. 2. Background and Context According to research by Gouda et al. [1], a large portion of the NCD burden in sub-Saharan Africa is caused by cardiovascular diseases, neoplasms, mental disorders, diabetes, and urogenital, blood, and endocrine diseases. Strokes are the leading cause of cardiovascular disease burden, which is explained by high rates of hypertension and a lack of effective treatment and control in the region [1]. Data shows that southern sub-Saharan Africa has the highest NCD burden, pointing to an urgent need to prepare and transform health services and delivery to alleviate the problem [1]. The primary position of a pharmacy over the years has been to dispense medicine, often prescribed by a physician or based on presenting conditions for uncomplicated cases. Pharmacists also have a duty to ensure that they dispense safe, effective, and quality medicine. However, as noted by Mishriky et al. [5], pharmacists now have an expanded role that may include giving advice to patients and playing the role of consulting on pharmacotherapy. An important point to note is that for most chronic illnesses, medicines remain the primary modality of treatment. This places pharmacists at an inevitable position in the management of NCDs, especially given the documented success of pharmacists’ interventions and medication management in improving medicine use, adverse effect and event detection, and overall adherence to prescribed regimen [5]. Kenya’s Pharmacy and Poisons Board (PPB) is responsible for licensing and regulating community pharmacies and outlets, which provide quick access to over-the-counter medications to many Kenyans. These pharmacies provide core services: dispensing medicines and advising on their use, ensuring drug safe storage and documentation, and counseling patients on medication adherence. Many also perform public health roles such as vaccinations and basic health education. For common minor ailments or preventive needs (e.g., vaccines, wound care), Kenyans often first consult a pharmacy. However, current practice rarely includes chronic disease screening or management, which remains centered in clinics and hospitals. The policy environment is evolving. Kenya’s NCD Strategic Plan 2020/21–2025/26 (launched 2021) commits to broader NCD screening and management in the health system [6]. Kenya’s Universal Health Coverage (UHC) Policy 2020–2030 which emphasizes equity and strengthening primary care and new financing schemes (Social Health Insurance Fund) explicitly plan pharmacy involvement: recent announcements note that chronic patients such as diabetics may refill prescriptions at registered pharmacies, and that the basic benefit packages will cover screenings for diabetes, hypertension and mental health disorders, among other NCDs. While significant strides have been made to bring sectoral reforms in addressing the various challenges and focusing on bringing healthcare closer to the people, gaps still exist. Research shows that limited data exchange between pharmacies and clinics, the integration and use of digital tools such as electronic records, and having a unified, comprehensive, and consistent way of capturing and sharing patient health data between all the health sector actors would help streamline healthcare delivery countrywide. Pharmacies are not currently incorporated into the broader healthcare system, pointing not only to the gaps but also to the opportunities to utilize them. 3. Rationale for Integration There is a high need for integrating community pharmacies in the management of NCDs in Kenya, as there have been overwhelming increases in such cases, while most efforts have been dedicated towards the management of communicable diseases, such as malaria and tuberculosis, in Kenya. Despite the UN SDG implementation plan to reduce premature death by 30% by 2030, NCD policy indicators outlined in the action plan indicate that countries in SubSaharan Africa lack the proper measures to achieve these targets [7,8]. This makes early detection and diagnosis of these diseases more likely [7,8]. The approach to decentralizing NCD management to community pharmacies also offers World Journal of Biology Pharmacy and Health Sciences, 2025, 24(02), 088-094 90 economic incentives in terms of efficiency. Issues such as hypertension and its complications, like stroke, require immediate, specialized intervention, as this could be a matter of life or death. Since most hospitals and clinics are often overwhelmed with high patient loads, redirecting stable chronic illness patients to pharmacies can reduce this burden and allow health facilities to focus on other treatments. Measures such as advice on lifestyle interventions, regular screening, and general medical checkups can be performed at community pharmacies, as these do not need specialized equipment. A good example of this is South Africa's CCMDD program, which uses private pharmacies as pick-up stations for chronic medications. This initiative significantly eased the strain on healthcare facilities and increased the number of stable patients collecting their HIV medications from pharmacies by 88%, demonstrating its effectiveness [9]. Additionally, the project saw a large majority of patients choosing to pick their medications from these pharmacies. Similar studies in low and middle-income countries show that there is a remarkable success of the use of pharmacy-based management of diabetes and hypertension, such as the one in Uganda, which significantly improved the control of blood pressure among the generations [7]. As the first line of action and entry for many patients into the healthcare system, community pharmacies are therefore poised as the best starting point for the management of hypertension, mental health disorders, and diabetes, among other NCDs. A report by Medtronic Labs [3] notes that there are also various social benefits of empowering pharmacies, not just in terms of policy but by action and orientation. This is because most pharmacists are found in proximity to patients, making follow-up, pharmacotherapy, and supervision more effective. Therefore, involving community pharmacies as a frontline defense in managing hypertension, mental health disorders, and diabetes is an idea whose time has come, especially in LMICs such as Kenya, whose disease burden profile is rapidly shifting. 4. Proposed Integration Framework Implementing the integration of pharmacy-based NCD care should be multi-tiered and can start from screening and monitoring, medication management, digital health integration, health promotion and counselling, and referral linkages. Governments and health ministries should focus on ensuring adequate screening and monitoring, which will not only improve access to health data and records but also provide a promising avenue for NCD mapping. Community pharmacies should be empowered to routinely check blood pressure and blood glucose using portable devices, and offer validated mental health screens such as PHQ-9 for depression. WHO and country guidelines support task-shifting basic screening to non-physicians. Using their proximity and frequent, unofficial interactions with patients, community pharmacies could use that opportunity to carry out quick blood glucose tests or patients on anti-hypertensives regularly tracking their blood pressures. The same monitoring would also enable better management of mental health disorders. This can start as a short, informal conversation with clients and then move to filling out a short questionnaire administered in a pharmacy consultation. Among the challenges that face the healthcare sector is the management of medication. This is a crucial part of the pharmaceutical supply chain management as its success rests on ensuring that the deserving patients get their drugs on time, use the drugs as advised, and there is sufficient follow-up to ensure adherence. Pharmacies have continued to be at the forefront in dispensing all kinds of medicines, and this role can securely and seamlessly be integrated into the management of NCDs. By giving them authority, pharmacies may take on this role by managing chronic therapy through refill programs and adherence support [10]. One critical step that the Kenyan government has initiated within its Universal Health Care scheme is the inclusion of community health volunteers in addressing common communicable diseases. This effort has led to a greater number of immunizations and vaccines across the country. This potential is enormous, particularly in rural at-risk populations who still hold mistrust of medicines and vaccinations [11]. This same model could be scaled up to pharmacists within the context of their practice. They are educated and trained personnel to at least a greater degree than health volunteers are, to try to assist patients in identifying and self-managing chronic NCDs. Pharmacists could also counsel and be on the front lines supporting early detection of mental health disorders, as well as assist with de-stigmatization for regular mental health patients. The community health volunteers have helped erode this skepticism and removed ignorance through civic education, building on the framework of social cohesion and trust that exists among members of the community [12]. Additionally, pharmacists can ensure proper management and adherence to the lifetime of taking medicines and monitoring patients since pharmacovigilance is inherent to pharmacists’ dispensing role. Technology plays a significant role in the integration of pharmacies into the control of NCDs. There is an increasing adoption of digital and innovative technologies in the drug supply chain and inventory management. Evidence shows that mobile digital tools, such as e-health platforms like the Digital Health Act’s sanctioned systems, can best be used to record and share patient metrics and data (with consent) with clinics. Outcomes of such integration would involve World Journal of Biology Pharmacy and Health Sciences, 2025, 24(02), 088-094 91 patients entering their home blood pressure readings into a smartphone app (or via USSD code) that the pharmacy monitors, and alerting pharmacists if levels become unsafe. Pharmacies could also offer or register patients to mHealth services such as SMS reminders, and M-TIBA health wallet for payments, as piloted in Kenya [13]. Notably, a Kenyan digital pilot showed that when patients self-monitor blood pressures at home and share data, control improved significantly (from 42% to 50% of hypertensives achieving target) [14]. Leveraging Kenya’s expanding digital health infrastructure through telehealth guidelines and patient registries will be key in scaling and ensuring quality assurance in the management of NCDs. Other parts of the integration framework include health promotion and counselling, and referral linkages. By taking advantage of the close relationship and ease of access that pharmacies offer at the community level, pharmacists should not only be empowered to educate patients on lifestyle changes such as exercise, diet change, and smoking and alcohol cessation, but also be empowered to make formal follow-up and reports that can be integrated into the national system and policy implementations [15]. The same should apply to mental health wellness, which will focus on building on their existing counselling roles. Further incorporation of non-pharmacological management modalities, such as psychotherapy, in routine care is also crucial. On referral linkages, there already exists an informal system where pharmacists informally refer patients to clinics. The integration should focus on formalizing this referral, where pharmacies maintain directories of local primary care clinics and specialists. Such would be made easier through the use of a form or an e-platform for context awareness. 5. Implementation Considerations Integration should consider policy regulation, training, capacity building, and financial sustainability to enhance healthcare delivery [16]. Training is the first and most crucial part of this process. It is important to note that community pharmacies in Kenya are highly diverse in terms of size, specialization, training, and integration. There are those small pharmacies, which feature limited drug options, and focus mainly on common communicable diseases. These are often individually run and operate at the most basic level of healthcare provision and mainly sell drugs based on a doctor's prescription. There are, however, larger pharmacies that are more advanced; they not only sell a broad spectrum of drugs but also carry out routine diagnostic tests such as HIV, malaria, and blood sugar, among others. Such establishments feature individuals with a Bachelor of Pharmacy degree or similar qualifications (PharmD). Such adequately trained pharmacists will be best placed to give professional and data-driven advice on non-pharmacological ways of managing some of these NCDs, including weight reduction, increased physical exercise, and dieting, among others [17]. Diabetes management interventions could include training on medical nutrition interventions, insulin injections (essentially not a commonplace for pharmacists locally), wound care ulcer management, diabetic foot management, release of pressure on the plantar surface, and referrals as necessary. Regulatory change is needed to broaden pharmacists’ scope. Kenya’s Pharmacy and Poisons Act (PPB) currently limits pharmacists to dispensing medications and counseling, which works against NCD management. There should be a revision in policy to allow pharmacies to perform basic NCD screening explicitly, issue repeat prescriptions for stable patients (under SHA/SHIF plans), and share information electronically under correct guidelines and safeguards. The new rules under Kenya’s Digital Health Act [18] provide a framework for patient data protection, which is a good starting point, but implementing e-referrals will need clear protocols on consent. Finally, the integration cannot be effective without the assessment and reconsideration of financial models and viability. As Gentilini et al. [7] note, there is a need for financial incentives to empower pharmacies to take up and manage NCDs, thereby acting as the first line of defense. Pharmacies should be integrated into the SHA system so that refills for NCD medications can be made from community pharmacies while proper reimbursements are made by the government. This can also be made possible through the expansion of the health capitation to include chronic care through initiatives such as subsidies and donor funding. 6. Challenges and Mitigation Integrating community pharmacies into the NCD care environment faces closely-linked legal, professional, datagovernance, and infrastructural barriers that can only be resolved through collaborative policy action. These barriers include existing regulatory conditions that limit pharmacists' clinical activities (e.g., prescribing, repeat dispensing), requiring the appropriate scope of practice reforms and explicit guidelines around whether repeat prescribing can be provided for clinically stable patients [9]. There is likely to be opposition from other physicians arguing for the dilution and confusion of professional roles. This opposition from some physicians can be mitigated through mandated inter- World Journal of Biology Pharmacy and Health Sciences, 2025, 24(02), 088-094 92 professional education and collaborative clinical governance arrangements, alongside public education that frames pharmacy services as a cornerstone in patient care. Data governance is another concern, especially for the proposed integration, which will mean that pharmacists are handling more patient data than before. This may raise concerns as presently, an elaborate framework for the handling of data from pharmacies is lacking. Robust, privacy-preserving health-information exchange and standardized datahandling protocols, underpinned by Kenya’s Digital Health Act, are essential for secure sharing of patient records and outcomes tracking, thus [18]. This can be extended to encompass pharmacies that will be mandated to handle such patient health data. Finally, there is a challenge of the uneven and highly diversified structure of pharmacies in Kenya. As noted earlier, pharmacies vary significantly in terms of expertise, infrastructure, management, and size. There are, therefore, challenges in having an all-encompassing framework of integration of all the pharmacies into NCD management. While some pharmacies are large, well-equipped, and run by qualified pharmacists with some modern equipment for routine diagnosis, there are other smaller, more remote ones that sometimes even lack basic amenities such as water and electricity. This may raise concerns about the integration preparedness. To counter the challenge of uneven pharmacy infrastructure, we argue for a phased roll-out beginning with well-equipped sites supported by government, insurers, or donor financing and accompanied by monitoring and evaluation to refine scale-up [19]. This can be done in tiers, as is seen with hospitals, where there are levels starting from community health centers to national referral hospitals. 7. Conclusion The disease pattern in sub-Saharan Africa, as well as other low and middle-income countries, has been shifting over the years from communicable diseases to noncommunicable diseases. There is an increasing number of NCD-related mortality and morbidity, with cardiovascular diseases, mental health illnesses, cancer, and diabetes being among the leading causes. Most developing countries, Kenya included, lack a robust health infrastructure to handle the increasing disease burden, with both public and private facilities being overwhelmed. The current policy environment limits the role of community pharmacies in helping tackle the NCD burden. This removes a crucial piece in the fight against these chronic diseases since, as the first line of defense and first contact point between patients and the healthcare system, pharmacies are best placed to manage not only the dispensing of medicine but also in pharmacotherapy, early diagnosis and detection, as well as counselling and ensuring medication adherence in NCD care. This makes these establishments valuable assets by virtue of their accessibility, integration into communities, strong trust and relationships, and good distribution. Kenya has made significant steps in decentralizing healthcare provision to rural areas through its universal healthcare. Incorporating pharmacies into the management of NCDs is the next and crucial step in bridging the gap between the management of communicable and noncommunicable diseases. This can be done through policy change to empower and increase the scope of the community pharmacies in the management of diabetes, hypertension, and mental health illnesses, so that community pharmacists can make use of the trust and proximity to patients to improve pharmaceutical operations. Changes in pharmacy training, incorporation into the national insurance system, and changes in policy are the important considerations to enable this integration. Regulatory challenges, professional resistance, and data management and privacy issues can be handled through inter-professional training, tighter data management systems, and expansion and revision of regulatory scope to further empower community pharmacists. Compliance with ethical standards Acknowledgments Special thanks to the invited reviewers. Disclosure of conflict of interest The authors declare that there are no conflicts of interest related to the preparation and publication of this manuscript. No financial, personal, academic, or institutional relationships have influenced the conduct, interpretation, or reporting of this study. All authors confirm that the research was carried out objectively and independently, with no competing interests to disclose. World Journal of Biology Pharmacy and Health Sciences, 2025, 24(02), 088-094 93 References [1] Gouda HN, Charlson F, Sorsdahl K, Ahmadzada S, Ferrari AJ, Erskine H, Leung J, Santamauro D, Lund C, Aminde LN, Mayosi BM. 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