Community Pharmacies and Malaria Surveillance in an Elimination Setting in Ghana: A Cross-Sectional Study of Infrastructure, Documentation Systems, and Provider Willingness

In the fight against malaria, knowing where the disease is hiding is just as critical as having the medicine to cure it. For decades, health officials have relied on hospitals and clinics to report every case they see, creating a map of the disease's spread. But in many places, people do not go to hospitals first when they feel a fever coming on. Instead, they walk into small, private shops that sell medicine, often called community pharmacies. These shops are everywhere, open late, and easy to reach. If the people working in these shops could tell health authorities about the malaria cases they treat, the map would become much clearer, allowing officials to stop the disease before it spreads again. This is the goal of malaria elimination: to find every single case and treat it so the parasite has nowhere to hide. However, getting these private shops to report their data has been difficult, largely because the systems they use to keep records are not set up for public health tracking, and no one is sure if the shop owners are even willing to take on the extra work.

A team of researchers in Ghana decided to investigate this exact problem in the Tema West Municipality, an area chosen for its high number of pharmacies and its role in the country's plan to eliminate malaria. They wanted to see if these shops were ready to join the national surveillance network. The researchers visited sixty-five different pharmacies and spoke with one hundred and thirty-five staff members, including pharmacists and assistants who handle the daily sales. They checked the shops for the basic tools needed to report data, such as working phones, computers, internet access, and backup generators for power outages. They also looked at how these shops currently kept records of their patients, asking what information they wrote down and how they stored it. Finally, they presented the staff with a realistic scenario where they would be asked to report malaria cases to the government and asked if they would be willing to do it, and what kind of help they would need to make it happen.

The findings revealed a story of two very different realities living side by side. On one hand, the physical and digital tools were almost everywhere. Nearly all the pharmacies had working phones and computers, and most had generators and internet access. In fact, ninety-three percent of the shops had the basic infrastructure needed to participate in a modern reporting system. This suggests that the hardware is not the problem; the shops are equipped to connect. On the other hand, the way they used these tools to track patients was deeply inconsistent. Only about fourteen percent of the pharmacies had a fully working system for documenting cases. When the researchers looked at what information was actually being written down, they found that while most shops recorded a patient's name and phone number, they rarely captured the details needed to understand the disease. Less than half of the shops recorded the patient's age or sex, and even fewer wrote down the specific diagnosis, the result of a malaria test, or whether the patient was sent to a hospital for further care. Without these specific details, the data collected is like a puzzle with most of the pieces missing; it tells you a transaction happened, but not enough about the illness to help stop the spread.

Despite these gaps in record-keeping, the people working in the shops were surprisingly eager to help. When asked if they would be willing to contribute to a malaria reporting system, nearly seventy percent said they were ready to give their time to do the work. Another seventeen percent said they would be willing to give both their time and some of their own resources, such as money or supplies. Only a small fraction said they were unwilling to participate at all. The staff indicated that if they were to start reporting, they would prefer to do it through a digital platform, such as a website or a mobile app, rather than using paper forms. They also made it clear that while they were willing to give their time, they needed support to make it sustainable. The most requested help was financial support to cover the costs of reporting, followed closely by training on how to do it correctly. The biggest obstacles they feared were simply not having enough time during their busy workdays and feeling unsure about how to handle the new tasks.

The researchers concluded that while the shops are physically ready and the workers are willing, the system itself is not yet ready to accept their data. The current way these pharmacies keep records is too varied and incomplete to be useful for national health planning. To fix this, health officials cannot just ask the shops to report more; they need to provide standardized tools that fit into the shops' existing daily routines. This means creating simple, digital reporting systems that can talk to the national database, training the staff on exactly what information to collect, and ensuring they have the financial and logistical support to keep doing it. The study suggests that if these barriers are removed, community pharmacies could become a powerful new layer of protection, filling in the blind spots of the malaria surveillance map and helping Ghana move closer to a future where the disease is no longer a constant threat.