With one doctor for every 3,198 South Africans, and a healthcare system in which most people rely on the public sector while private care remains concentrated among a minority, the pharmacy has become the frontline of healthcare for millionsof South Africans. Not by design, but by necessity.1,2
Every day, pharmacy professionals assess symptoms, identify red flags, dispense prescription medication and, importantly, recommend over-the-counter treatment to patients. For many South Africans, the pharmacist is the first, and sometimesthe only, healthcare professional they can easily access. This makes the recommendation moment at the dispensary counter far more than a retail interaction. It is often a crucial healthcare decision that can influence symptom relief, treatment success, patientsafety, recovery and overall wellbeing. Six forces are redefining how recommendations are made at the pharmacy counter, with consequences for patients, pharmaceutical brands and the future of community healthcare in South Africa.
1. Some patients are dependent on the pharmacist’s recommendation
For many patients, the pharmacy professional may be the only healthcare professional they speak to about a symptom, concern or treatment choice. Community pharmacies are accessible, local and often easier to reach than a doctor’s consultingroom, especially when patients are managing cost, transport, time away from work, or long queues in the public system. In this context, a recommendation is not simply a product suggestion. It may be the patient’s first clinical conversation, their first safetycheck and, when needed, the point at which they are referred for more urgent care. South African research has already highlighted the community pharmacy sector as an underused access point for health services, particularly where healthcare systems are stretched.3
2. Some patients are informed, but not always accurately
Many patients arrive at the pharmacy counter with a treatment idea shaped by Google searches, social media, health forums, influencers or AI tools. This is not necessarily a problem. Informed patients can ask better questions and participatemore actively in their care. The challenge is that online health information varies widely in quality, and misinformation can make patients more confident about the wrong treatment. Recent research in JMIR highlights the ongoing challenge of health misinformationon social media, while pharmacy literature reinforces the role pharmacists can play in correcting misinformation and guiding evidence-based decisions.4,5 In practice, this means a patient may leave with a different product from the one they intendedto buy — not because their preference was ignored, but because a pharmacy professional assessed the symptoms, risks and evidence and made a safer recommendation.
3. Recommendation confidence is the real driver of product selection
With hundreds of treatment options across almost every therapeutic category, pharmacy professionals recommend what they clearly understand and clinically trust. Research into pharmacists’ OTC recommendations shows that pharmacists considerclinical evidence, product suitability and professional judgement when making recommendations.6 Confidence does not come from memorising product claims. It comes from understanding the patient, understanding the evidence and knowing when a treatmentis appropriate. For pharmaceutical brands, this has important implications. A product that is recognised but not understood clinically will not be recommended consistently, regardless of how much is spent on awareness. Brand recognition may get a product ontothe shelf. Clinical confidence is recommended.
4. The pharmacy consultation has become a clinical event
A request for a cough remedy may involve a patient already taking codeine. A query about weight-loss supplements may reveal symptoms that require medical assessment. A parent asking about fever management may have a child whose symptomswarrant an urgent referral. Today’s pharmacy professional navigates chronic disease, polypharmacy, pregnancy, peadiatric dosing, age-related contraindications and the appropriate boundaries of self-care. These decisions are often made within minutes, withlittle access to the patient’s medical history beyond what the patient reveals at the counter. That makes the quality of the conversation and the pharmacist’s ability to ask the right questions central to safe care.
5. Patients are more complex than ever
South Africa carries a high and overlapping burden of disease. HIV, tuberculosis, hypertension, diabetes, arthritis and other chronic conditions increasingly intersect in patients who are managing more than one health need at the same time.A 2024 BMJ Global Health study notes that, by international standards, South Africa has very high levels of HIV, hypertension, diabetes and arthritis, with common disease combinations including hypertension and diabetes, and hypertension and HIV.7This is not a patient population requesting simple remedies in isolation. It is a population that requires counselling, safety checks, monitoring, judgement on referrals, and trust that their overall well-being is being taken seriously. The pharmacy professionalwho fields these interactions is not simply a retail function. They are a frontline healthcare provider, and the quality of that care depends directly on the currentness and depth of their clinical education.
6. Ongoing education is not a benefit. It is a requirement
South Africa’s community pharmacies now shoulder a share of primary healthcare that, in a better-resourced system, would often be handled by a doctor. Globally, the Global Self-Care Federation estimates that current self-care practicessave 10.9 billion individual hours and 1.8 billion physician hours each year.8 In South Africa, where access to healthcare professionals is uneven and health needs are complex, the pharmacy’s role as first-line care is not a trend. It is structural.Treatment guidelines change. New evidence emerges. Patients arrive with more complicated histories and varying-quality information. A pharmacist who qualified a decade ago needs to continually update their clinical knowledge in meaningful ways, including throughongoing clinical education offered by Pharmacy Institute and used by more than 13,200 members. Every recommendation is ultimately a reflection of what a healthcare professional knows at that moment. For this reason, pharmaceutical manufacturers should investin ongoing clinical education not only to support stronger recommendation behaviour, but as a responsible way to improve patient care. Continuing professional development is also recognised in pharmacy education literature as central to maintaining competenceand improving practice.9 For pharmaceutical brands, ongoing clinical education is among the highest-return investments available. Not in awareness, but in advocacy. The difference between a brand a pharmacist has heard of, and a brand a pharmacisttrusts enough to recommend by name, is clinical confidence.
Clinical education is an crucial healthcare investment
More than 13,000 pharmacy professionals across South Africa interact with patients every day. Their recommendations collectively shape millions of treatment decisions each year. Those decisions are increasingly clinical, increasingly evidence-basedand increasingly influenced by the depth of education behind them, not the volume of advertising in front of them. Supporting the clinical education of pharmacy professionals is not simply a marketing initiative. It is a healthcare investment. For patients,it means safer, more personalised recommendations. For pharmacy professionals, it means greater confidence in complex decision-making. For pharmaceutical brands, it means moving from awareness to genuine advocacy. And in a country where the pharmacy counteris, for millions of people, the most accessible point of clinical care they will encounter, it may be one of the most important healthcare investments available.
Sources
1. MedicalBrief (2022). “SA’s doctor shortage has worsened substantially in past 3 years.” medicalbrief.co.za
2. The Presidency of the Republic of South Africa (2024). “From the desk of the President – Monday, 20 May 2024.” thepresidency.gov.za
3. Frontiers in Reproductive Health (2023). “The South African community pharmacy sector — an untapped reservoir for delivering HIV services.” frontiersin.org
4. Kbaier D. et al. (2024). “Prevalence of Health Misinformation on Social Media — Challenges and Mitigation Before, During, and Beyond the COVID-19 Pandemic: Scoping Literature Review.” Journal of Medical Internet Research. jmir.org
5. Harris IM. et al. (2024). “Pharmacists’ role in combating medical misinformation.” Journal of the American College of Clinical Pharmacy. accpjournals.onlinelibrary.wiley.com
6. Rutter P. et al. (2014). “Does evidence drive pharmacist over-the-counter product recommendations?” Journal of Evaluation in Clinical Practice / PubMed. pubmed.ncbi.nlm.nih.gov/24854503
7. Johnson LF. et al. (2024). “A model-based approach to estimating the prevalence of multiple chronic conditions in South Africa.” BMJ Global Health. gh.bmj.com
8. Global Self-Care Federation (2022). “The Global Social and Economic Value of Self-Care.” selfcarefederation.org
9. American Journal of Pharmaceutical Education (2023). “The Benefit of Continuing Professional Development for Continuing Pharmacy Education.” ajpe.org
About Pharmacy Institute
Pharmacy Institute is an independent online academy for pharmacy professionals, trusted by more than 13,000 HCPs across South Africa. Pharmacy Institute is built on a single conviction: that deep clinical education shapes recommendation behaviour atthe dispensary counter. Through evidence-based courses, product-integrated learning pathways, and a trusted environment and community of pharmacists, Pharmacy Institute helps pharmaceutical brands move from awareness to advocacy and from campaigns to clinicalcapability.
About Michael Gullan
Michael Gullan is the founder and CEO of G&G Advocacy. Michael provides strategic consulting to G&G Advocacy’s clients at a senior level. Michael is passionate about thescience of adult learning in the corporate workplace and has made it his mission to provide innovative and effective e-learning solutions designed to nurture an educated and high-performance workforce in South Africa so we can build a stronger, sustainableeconomy that creates more jobs and opportunities across all levels of our society. Michael is deeply committed to uplifting South Africa via education, learning, and creating a knowledge
