Community Pharmacists In Conflict Zones: Providing Care For Patients With Non-communicable Diseases In Conflict Affected Areas In Northern Syria.

• By: ALJADEEAH, Saleh (Institute of Tropical Medicine, Belgium)
• Co-author(s): Dr Saleh Aljadeeah (Institute of tropical Medicine, Antwerpen, Belgium)
  MSc María Belén Tarrafeta Sayas (Institute of tropical Medicine, Antwerpen, Belgium)
  Prof. Dr Raffaella Ravinetto (Institute of tropical Medicine, Antwerpen, Belgium / School of Public Health, University of the Western Cape, Cape Town, South Africa)
  
• Abstract:

  Background:
  Access to affordable and quality-assured medicines is critical for strengthening and achieving successful primary health care (PHC), but conflicts affect the functioning of health systems, including the performance of pharmaceutical systems and access to essential medicines. Morbidity and mortality related to the collapse of health systems and lack of access to care, including essential medicines, are often significantly higher than that morbidity and mortality directly caused by the conflict including violence. During humanitarian crises and conflict, healthcare and health research typically focus on acute conditions, such as infectious diseases, with lower priority accorded to non-communicable diseases (NCDs). Under these circumstances, pharmacists can play a critical role in management and prevention of NCDs, but little is known about the changing role of pharmacists at PHC level during conflicts for the supply of - and access to - essential medicines.
  
  Purpose:
  To describe the role of pharmacists at PHC level providing care for patients with non-communicable diseases during the ongoing conflict in Northern Syria.
  
  Methods:
  This was an explanatory qualitative study. Data were collected remotely through semi-structured interviews with patients and pharmacists. Interviews were conducted in Arabic until saturation, recorded, transcribed, and translated into English. Following the thematic content analysis approach of Braun and Clarke, data were coded and categorized, and themes and subthemes were identified.
  
  Results:
  Fourteen NCDs patients and seven pharmacists were interviewed between May and August 2023. Two main themes representing the role of pharmacists in providing access to NCDs medicines were identified; a) maintaining access to medicines, in the absence of national authorities that regulate the pharmaceutical sector. This included sub-themes of supply of essential medicines to prevent shortages; navigating the market for fair prices, and investigating reliable sources to procure quality assured medicines. b) providing healthcare services beyond access to medicines. This included sub-themes of measuring blood pressure, measuring blood glucose levels, follow up of patients of NCDs and reviewing their treatment regimens, and other services beyond the classical scope of community pharmacists in this region.
  
  Conclusion:
  Overall, our study highlights the enhanced role of community pharmacists in regions affected by conflict, where regulatory and supply systems are severely disrupted. It underscores the importance of collaboration between national and international humanitarian organizations operating in conflict zones and local community pharmacists to optimize health service delivery. Furthermore, there is a pressing need for additional training for community pharmacists in conflict settings to equip them with the necessary skills to deliver pharmaceutical care services tailored to the unique challenges of such settings.