Roles of community pharmacists in health promotion and chronic disease management in low- and middle-income countries: A narrative review of barriers, opportunities, and future directions.

Abstract

The growing burden of chronic diseases continues to place significant pressure on healthcare systems globally, particularly in low- and middle-income countries (LMICs), where shortages of healthcare professionals and limited access to primary health care (PHC) services remain major challenges. Community pharmacists are increasingly recognised as accessible healthcare providers who can contribute substantially to health promotion and chronic disease management. This narrative review aimed to examine the roles of community pharmacists in health promotion and chronic disease management in LMICs, with particular emphasis on existing barriers, emerging opportunities, and future directions for practice. Literature published between January 2015 and December 2025 was identified through PubMed and Google Scholar using search terms related to community pharmacists, health promotion, chronic diseases, non-communicable diseases, primary healthcare, and LMICs. Relevant peer-reviewed articles, policy documents, and grey literature were reviewed and synthesised thematically. Findings indicate that community pharmacists contribute to chronic disease prevention and management through medication therapy management, patient counselling, lifestyle modification education, disease screening, adherence support, vaccination services, and other public health interventions. Pharmacist-led services have been associated with improved medication adherence and better clinical outcomes in chronic conditions such as hypertension and diabetes. However, the full potential of community pharmacists in LMICs is often constrained by inadequate training, regulatory limitations, insufficient reimbursement mechanisms, weak policy support, and poor integration within primary healthcare systems. Emerging innovations, including telepharmacy and digital health technologies, offer opportunities to strengthen pharmacist-led services and expand access to care. Community pharmacists have considerable potential to enhance chronic disease management and health promotion in LMICs. Future research should focus on evaluating the long-term effectiveness, cost-effectiveness, and scalability of pharmacist-led interventions in LMICs. At the same time, policymakers should develop supportive regulatory and financing frameworks to facilitate the integration of community pharmacists into primary healthcare systems.