One of the main agenda set by the World Health Organization (WHO) for the future of public health is to form accessible, multidisciplinary networks of public health professionals who actively engage within communities and provide key public health services in order to ultimately improve the life expectancy of the population [1]. Community pharmacy professionals, being one of the most easily accessible and widely distributed health professionals among the community, could be an indispensable component of this agenda. Community pharmacies have great potential as a setting in public health owing to their location in the heart of the community. This characteristic feature provides a platform for more proactive contribution in solving gaps in public health services and programs including health-promotion and a variety of preventive services [2]. Some of the health-promotion and preventive services which could be delivered via community pharmacy settings are promoting health and wellbeing (e.g. physical activity, weight management, curbing antibiotic resistance through promoting different community-based antimicrobial stewardship programs), preventing the occurrence of diseases (e.g. smoking cessation, infectious diseases), identifying and referring ill individuals via screening and maintaining health of those with chronic diseases such as diabetes, hypertension. The benefits of pharmacy services in these important public-health issues have been documented in many reviews and clinical trials [3–6].

However, there are a number of barriers that have hindered the provision of public health services in community pharmacy settings. Lack of knowledge and skills, lack of confidence and adequate training, lack of policies, poor recognition within the healthcare system, patients’ reluctance to use pharmacy services and presence of inadequate number of pharmacy staff are some of the factors which can contribute to the low level of pharmacy services uptake and public health initiatives [7–11]. In developed countries, such as the United Kingdom, pharmacists are well integrated into public-health programs [12]. In contrast, community pharmacies in Ethiopia are not yet legally included as a health care professionals within the public health workforce and their role in providing public health services is yet to be appropriately recognized and endorsed by public health and governmental agencies, academicians and other healthcare professionals. With much smaller numbers, compared to developed countries, community pharmacy professionals in developing countries including Ethiopia tend to focus on the traditional medication dispensing roles and seldom provides health prevention and promotion services. Taking the global evidence into consideration and due to lack of data in Ethiopia, the present study was conducted with the aim of documenting the level of involvement of pharmacists and pharmacy technicians in the provision of public health services and the perceived barriers that limit their involvement in the delivery of such services. Such data are essential to the improvement of public-health programs in community pharmacy in Ethiopia. Although there is a general understanding of the way CDROs are providing population-based services to the public as well as barriers that hinders to the provision of such services, there is limited quantitative data in Ethiopia on the specific public health priorities in which pharmacy professionals are involved. The finding of our study will, therefore, fill the existing literature gap in Ethiopia and inform policy makers, public health agencies and other healthcare professionals regarding community pharmacy based public health services and potential barriers so as to better integrate community pharmacy professionals in the public health taskforce.

The changing role of community pharmacy professionals from their traditional dispensing responsibilities to a greater contribution to population health is being accepted all over the globe [17]. To the best of our knowledge, this is the first survey to explore the extent and type of involvement of community pharmacy professionals in public health priorities in Ethiopia.

According to the finding of this survey, community pharmacy professionals are less intensely engaged in the provision of public health services. Although the beneficial effect of involving community pharmacy professionals in public-health activities such as smoking cessation, hypertension, diabetes, and sexual health has been confirmed in different clinical trials [17, 18], it’s apparent from our study that community pharmacy professionals’ involvement in Ethiopia is severely limited. The findings of this survey were supported by similar studies done elsewhere which showed that community pharmacy professionals are mostly involved in activities pertaining to the dispensing of medications and have less intense involvement in public health activities [19, 20]. Community pharmacy professionals in this study were less intensely engaged in the area of smoking cessation, weight management and screening for hypertension, diabetes, dyslipidemia and risk of suicide. In a study done in Northern Ireland to evaluate the role of a community pharmacies in smoking cessation, the involvement of community pharmacy professionals was especially low (19%) [21]. This is consistent with the findings of our result, where only 8.5% of respondents reported provision of counselling on smoking cessation. However, the involvement of community pharmacy professionals in chronic disease screening and lifestyle counselling were found to be very low compared to studies done in developed countries such as Canada and USA, where community pharmacy professionals provide a variety of diagnostic screening services for blood pressure, dyslipidemia, and capillary glucose as well as pharmaceutical and preventive care services for asthma, diabetes, and hypertension [16–19]. This is due to the narrow scope of Ethiopian community pharmacy professionals as they are largely limited to the dispensing of medications and seldom provides screening and counseling services on chronic non-communicable diseases. While some community pharmacies are offering pharmaceutical care to chronically ill patients, the role is still in its infant stage. Their responsibilities in chronic disease state management and health promotion should be further developed to successfully tap their invaluable contribution to patient care. On the other hand, community pharmacy professionals in this survey reported a higher level of involvement in sexual health and management and screening of infectious diseases. Similar studies conducted elsewhere also reported a higher involvement of community pharmacy professionals in sexual health including emergency contraception, treatment for vaginal candida infection, information on hepatitis B and HIV and sexual health promotion [22–24]. The results of this study corroborate with a national survey conducted in Ethiopia which reported a higher involvement of community pharmacies in promoting antimicrobial stewardship and infection prevention [25]. Given the high prevalence of infectious diseases and availability of continuous trainings on tropical and communicable diseases, it is not surprising that pharmacy professionals in Ethiopia are well engaged in the provision of public health services pertaining to infectious and communicable diseases.

Furthermore, it has been found that community pharmacy professionals with a qualification of degree or above and with more than 5 years of experience had a significantly higher level of public health service delivery than those having diploma and with less than 5 years of experience. With the recent adoption of ward-based clinical pharmacy training in undergraduate pharmacy schools of Ethiopia, along with a higher number of years working in community pharmacy settings, it’s not surprising that pharmacy professionals having a bachelor and/or postgraduate degree and more than 5 years of experience in practice settings had a relatively higher level of involvement in public health services.

Integrating CDROs into regional and national population health programs is a valuable and crucial way for improving public health in the country. In line with this, understanding the various barriers for the provision of such services is the first key step in this community pharmacy-public health integration process. In the present survey, lack of knowledge or clinical skills was the most commonly reported barrier to the provision of public health service in community pharmacy followed by lack of access to additional training programs and lack of personnel or resources. Similar barriers have also been documented in different parts of the globe including lack of time and personnel, lack of clinical skills and tools [7–10]. Public’s lack of awareness of community pharmacy professional’s role in public health and uncooperative patients were other important barriers identified in the literature but had not been prominent in our study [26, 27]. Studies conducted in both developed and developing countries also reported that training programs are needed so as to boost community pharmacy professional’s confidence in providing public health services, making educational intervention a necessity [17, 28]. Providing specific trainings that will fill the knowledge and skill gap required for the provision of such services is recommended both in academia and practice settings as it will result in the delivery of public health services in a better and more skillful way than ever before. Overcoming the aforementioned perceived barriers also needs restructuring the health care system of the country so as to integrate these indispensable health care professionals into the public health task force. This restructuring entails beyond merely financial investments in the sector; full commitment and engagement also needs to be achieved by all pharmacy stakeholders, academic institutions, health policy makers and non-governmental organizations involved in the provision of public health. Moreover, considering compensation for service delivery, interdisciplinary communication, and re-statement of the role and responsibility of community pharmacy professionals may result in a better provision of community pharmacy based public health services.

This survey highlights an area of community pharmacy practice where there is lack of literature in Ethiopia. Yet, the survey has some limitations that should be taken into account while interpreting the results. As the study was a descriptive cross-sectional survey conducted in only six selected cities of Amhara regional state, caution should be exercised when generalizing to other cities and regions in Ethiopia. Moreover, our use of a self-administered questionnaire, which depends on honesty and faith of the respondents, could affect the responses as it may be subjected to respondent or recall bias. Even with the above limitations, this survey has significant implications for improving the involvement of community pharmacies in health promotion and prevention by serving as a general comparison of frequency and characteristics of delivery of public health services in different sites of the country.

The present survey demonstrated that community pharmacy professionals’ involvement in public health services is low particularly in lifestyle-related counselling activities (smoking cessation, promoting physical-activity and healthy eating, weight management and alcohol consumption) and screening services (for hypertension, diabetes, dyslipidemia and risk of suicide). Lack of knowledge or clinical skills was the most commonly reported barrier for expanding public health service in community pharmacy settings. In order to better integrate community pharmacies into future public health programs and optimize the contribution of pharmacists, interventions should focus on overcoming the identified barriers. Follow-up studies seeking community pharmacy professionals’ involvement in public health services on a national scale may also be needed to identify more barriers and to better inform regulatory bodies.