Africa’s missing link in pandemic preparedness is the community pharmacy. So why is it disconnected?

Across much of Africa, the community pharmacy is where healthcare actually begins. Long before patients reach a hospital or clinic, they seek advice, rapid tests, referrals, and medications from pharmacists and community medicine providers. Yet despite occupying this critical position at the front of the health system, pharmacies remain disconnected from the national diagnostic networks, surveillance systems, financing structures, and public health intelligence architecture that determine how care is coordinated and crises are managed.

The consequences of this fragmentation extend far beyond retail healthcare. Recent Ebola outbreaks across parts of Africa, much like COVID-19 before them, reinforced a critical lesson: health systems become dangerously vulnerable when frontline care, diagnostics, data systems, and public health response mechanisms do not operate as connected ecosystems.

This is where the convergence of pharmacy-first, connected diagnostics, and technology-enabled health intelligence becomes the missing coordination layer African health systems need.

For many African health systems, the challenge is no longer simply expanding access to care but strengthening coordination across the systems that deliver, finance, monitor, and govern care. Pharmacies, laboratories, insurers, hospitals, and public health authorities often continue to operate within parallel structures, limiting continuity of care, weakening surveillance, and reducing the system’s ability to respond quickly to emerging threats.

Yet pharmacies occupy a uniquely strategic position within the healthcare ecosystem. They are accessible, community-based, trusted, and deeply embedded within everyday health-seeking behaviour. In both urban centres and underserved communities, pharmacies frequently serve as the earliest point of patient interaction with the formal health system. This makes them not only important service delivery actors, but also potentially critical nodes within broader health intelligence and preparedness systems.

From a Healthcare Federation of Nigeria (HFN) perspective, Pharmacy-First should therefore not be understood merely as a retail healthcare expansion model. It should be viewed as part of a broader effort to build interoperable frontline healthcare systems capable of improving routine care, strengthening financial protection, and enhancing epidemic preparedness.

Digital infrastructure is what makes this integration operational at scale.

When pharmacies are digitally linked to diagnostic networks, referral systems, insurers, laboratories, and surveillance platforms, they evolve from isolated medicine outlets into integrated frontline health actors. Diagnostic information no longer remains trapped within individual facilities but contributes to broader system visibility, continuity of care, and population-level intelligence.

The difference this makes is most visible at the point of first contact. Consider a patient arriving at a community pharmacy with fever, respiratory complaints, or an unusual pattern of illness. In a fragmented system, that patient typically receives symptomatic treatment, limited follow-up, minimal data capture, and weak referral coordination. This gap leads to the patient re-entering the community and infecting individuals they come in contact with, leading to a domino effect that ends up as a full-blown outbreak.

In an interoperable ecosystem, however, the same encounter activates a connected chain: digital triage tools flag risk, rapid diagnostic tests are administered, results feed into linked laboratory systems, and real-time reporting mechanisms alert public health authorities to emerging patterns before they escalate. The pharmacy becomes an early detection node, supported with the right decision-making tools, not simply a medicine outlet.

This is how Pharmacy-First evolves from a retail access model into part of a broader health system intelligence architecture.

Evidence from Nigeria already demonstrates the potential of pharmacies to function as more integrated frontline health actors when supported by the right systems and coordination frameworks. In Abuja and Lokoja, a pharmacist-led hypertension management programme showed that patients receiving structured counselling and adherence support through community pharmacies demonstrated significantly improved treatment adherence and stronger engagement with long-term care. The intervention reinforced an important principle: pharmacies are not simply dispensing points; they are capable of supporting continuity of care, patient education, and chronic disease management at scale.

Importantly, the same systems that strengthen everyday healthcare delivery can also strengthen epidemic preparedness. Integrated pharmacy and diagnostic ecosystems can support earlier disease surveillance, improve continuity of care, enhance antimicrobial stewardship, strengthen chronic disease management, and enable more coordinated emergency response mechanisms.

They also create opportunities for more efficient health financing systems. Reliable diagnostic data improves clinical decision-making, reduces unnecessary treatments, supports claims verification, curbs fraud, and enables smarter risk pooling across insurance systems. As African countries continue expanding universal health coverage efforts, stronger integration between pharmacies, diagnostics, and financing systems will become increasingly important to both sustainability and quality assurance.

Furthermore, when pharmacies, labs, and financing systems share interoperable data, the result is a closed-loop, outcomes-trackable ecosystem where claims are verified against confirmed diagnoses, fraud is flagged algorithmically, and providers can be reimbursed for outcomes rather than activities alone. Aggregated diagnostic data also enables more precise actuarial modelling, allowing risk pools to be priced on actual disease burden rather than conservative assumptions, making premiums more affordable and schemes more solvent. For governments deepening universal health coverage commitments, this integration is not a technical nicety but a fiscal imperative: every percentage point reduction in leakage and unnecessary utilisation creates headway to extend coverage to underserved populations. The entities that build this connective tissue will occupy a structurally advantaged position, not merely as service providers, but as the data infrastructure layer that makes African healthcare systems more efficient, trustworthy, and scalable.

This is particularly relevant given the growing role of the private sector across African healthcare systems. In many countries, private pharmacies, laboratories, clinics, and community medicine providers already deliver a substantial proportion of frontline healthcare services. Yet national health architectures often continue to treat these actors as peripheral rather than foundational components of healthcare delivery and preparedness systems. Sustainable health system transformation demands moving beyond parallel public and private structures toward more coordinated ecosystem design.

The data these connected pharmacies and diagnostic systems generate also makes the broader case for Africa’s digital health ambitions. The continent’s governments and innovators are increasingly exploring how AI, predictive analytics, and digital health platforms can improve healthcare delivery, disease surveillance, and resource allocation. But those technologies are only as effective as the underlying data they run on, and community pharmacies generate some of the richest, most granular real-world health information available within African health systems.

From disease trends and medication adherence patterns to rapid diagnostic results and referral behaviour, pharmacies capture signals that can strengthen both routine healthcare planning and emergency preparedness. Excluding them from national digital ecosystems means excluding one of the most important sources of community-level health intelligence.

At the same time, the governance questions surrounding digital health integration must be confronted directly. Technology alone does not create resilient health systems. The larger barriers often remain institutional fragmentation, weak interoperability standards, inconsistent regulation, misaligned incentives, limited financing structures, and low trust across sectors.

Too many digital health initiatives across Africa continue to operate as isolated pilot programmes without sustainable integration into national systems. Innovation frequently advances faster than governance frameworks, leaving promising technologies disconnected from financing systems, surveillance structures, and long-term institutional adoption pathways.

Addressing this challenge will require deliberate policy action.

Governments must move beyond fragmented experimentation toward enabling national frameworks that integrate pharmacies into primary healthcare delivery, disease surveillance, emergency preparedness, and financing systems. This includes establishing interoperable digital health architectures, strengthening regulatory frameworks for digital diagnostics and pharmacy-based services, integrating pharmacies into national surveillance systems, expanding reimbursement pathways, investing in broadband and digital infrastructure, and developing data governance frameworks that balance innovation with privacy, trust, and national sovereignty.

The macroeconomic returns on this investment are substantial. A well-integrated pharmacy and diagnostics infrastructure reduces the disease burden that suppresses workforce productivity, increases absenteeism, and constrains human capital development, all of which compound into slower GDP growth over time. It also catalyses a domestic digital health economy: interoperable systems create demand for local software developers, data engineers, regulatory professionals, and health technology entrepreneurs, generating skilled employment and reducing dependence on imported health solutions. For foreign investors and development finance institutions, standardised frameworks and clear data governance signal market maturity, lowering the risk premium on healthcare investment and unlocking private capital at scale. Ultimately, countries that build this infrastructure are not just improving health outcomes; they are constructing a foundational layer of economic resilience, where a healthier, more productive population becomes a competitive asset in the broader trajectory of national development.

The private sector also has a central role to play. Pharmacies, laboratories, insurers, healthcare providers, technology companies, and telecommunications operators must collaborate around interoperable, patient-centred systems rather than isolated commercial platforms. This includes investing in shared digital infrastructure, strengthening referral coordination, embedding diagnostics into frontline workflows, training providers in surveillance and digital triage protocols, and responsibly using anonymised data to strengthen public health intelligence.

Most importantly, public-private collaboration must become central to health security planning itself.

Ebola and COVID-19 demonstrated that outbreaks do not distinguish between public and private healthcare systems. Pandemic preparedness therefore must be embedded within routine healthcare delivery, not operate separately from it. The same frontline systems used every day for diagnosis, referral, treatment, and patient engagement must also become the backbone of emergency response capacity.

Africa now has a significant opportunity to design health systems differently, not as fragmented layers of pharmacies, laboratories, hospitals, insurers, and surveillance systems operating independently, but as interoperable ecosystems capable of delivering both everyday care and emergency resilience. Achieving this will require more than digital tools alone. It will depend on governance, interoperability standards, sustainable financing, regulatory coordination, institutional trust, and long-term alignment between public and private actors. Most importantly, it will require recognising that frontline healthcare providers are not peripheral to health security; they are central to it. Thus, Pharmacy-First, connected diagnostics, and pandemic preparedness should therefore not be treated as separate reform agendas. Together, they represent the foundation of a more intelligent, responsive, and resilient healthcare system for Africa.

This article is a partnership between the Healthcare Federation of Nigeria (HFN) and BusinessDay to highlight policies and programmes to promote the rebuilding of Nigeria’s health sector. As a private sector-led coalition, HFN advocates for policies and partnerships to strengthen healthcare delivery. This partnership aims to spark meaningful discussions and drive transformative change in Nigeria’s health sector.

This article was developed with input from members of the HFN Editorial Committee, including Njide Ndili (President, Healthcare Federation of Nigeria, and Country Director, PharmAccess Nigeria), Dr Folajimi Adebowale (CEO, Recon Health Media), and Chisom Amadi (Director, Digital Innovations, PharmAccess Nigeria).