Trends and Dynamics of Telepharmacy in Sub-Saharan Africa
The distribution of the study revealed a high incidence of non-experimental studies as the study design was predominantly editorial letters or commentaries. One can thus infer that the practical application of this model of pharmacy has not been fully integrated into the healthcare system in most Sub-Saharan African countries which is similar to most developing countries. As seen, however, from the date of publication of these articles, it can be inferred that the COVID-19 pandemic brought unprecedented transformation to the healthcare system, as this model of pharmacy began to receive much focus, as it is also a means of bridging the gap between Pharmacists and patients, even while ensuring ‘social-distancing’, thus reducing infection rate whilst receiving proper pharmaceutical care. The recent date of these published work is quite understandable because the concept of Telepharmacy, although conceptualized as far back as 1942 in Australia, did not receive appropriate recognition until 2001 when the first attempt to regulate it was made by the Board of Pharmacy, North Dakota in the United States of America. Ethical considerations, high startup cost, as well as a host of other factors, have delayed its applications in developing countries [6, 13].

Currently, there is no regulatory framework for the implementation of Telepharmacy, leading to reliance on regular licenses. 92% of countries in Africa indicated the absence of laws governing online Pharmacy practice even those offering a form of Telepharmacy services [14]. In Nigeria, the National Information Technology Development Agency (NITDA), the Ministry of Health and the Ministry of Communications have begun working with Entrepreneurs interested in health technology to develop a policy document [15]. In addition, the registrar of the Pharmacists Council of Nigeria, Elijah Mohammed, charged the council to do a thorough work regarding regulations of online pharmacies, also stating that every certified online pharmacy should have a Telepharmacy component [16]. This will go a long way in ensuring its integration more into the healthcare system.

Extent and Nature of Work Done in Sub-Saharan Africa
Findings obtained indicate that majority of the studies were a call to action and not actual applications of this model of Pharmacy in healthcare, hence, the need for practical approaches, to be able to compare outcomes between Telepharmacy model and Traditional Pharmacy model. Focus of study bordered on Telemedicine, as a general term to address other forms of telehealth with minor specificity to Telepharmacy. This may not necessarily be because Telepharmacy is not practiced but could be as a result of lack of documentation, hence, dearth of published works. From Table 1, it is seen that majority of the study were commentaries or review/editorial letters. The surveys recorded however addressed different study populations. According to findings by Anosike et al [9] less than half of the population (patients) were willing to pay for a pharmacist-provided home telemonitoring services as majority cited the inability to pay for this service as the reason for their unwillingness as poor income level is a major factor plaguing most developing countries. To manage this issue, it was suggested that the government include charges for this service as tax or in health insurance schemes to ensure patients benefit from this service [9]. The study carried out in Nandi County, Kenya by Amdany et al. revealed that 54.5% of the healthcare workers perceived Telepharmacy as a critical emergency healthcare need, as such, necessary in the health facilities. This also goes to show that Telepharmacy is not just a retail pharmacy concept but is also applicable in a hospital setting [12].

There has been a disruption in care since the COVID pandemic begun as Clinics focused on COVID cases and paid lesser attention to patients coming in with other complaints. This has led to an increase in the prevalence of Non-Communicable Diseases in Sub-Saharan Africa, as such, Telepharmacy was one of the solutions proffered to support e-prescribing thus ensuring continuity of care [8]. In Uganda, medicine delivery services to preferred locations were also incorporated with positive feedback from patients [10]. Hedima & Okoro saw the pandemic era as an opportunity for telehealth improvement in Sub-Saharan African countries, although not without its challenges. Some challenges to Telepharmacy highlighted includes, but not limited to confidentiality and security threat to patients’ data which can be curtailed with appropriate rules and regulations put in place by the government [6].

Currently, the focus is majorly on Online Pharmacy which concentrates on sales and delivery of drugs. However, some online platforms are gradually delving into an aspect of Telepharmacy by providing patients with the option of speaking directly with a Pharmacist (Consultation) from the comfort of their homes. David and Adebisi proposed complementing Telepharmacy with home delivery of medication as well as collaboration with other healthcare professionals [11]. This is a welcome development, although, regulations need to be set in place to ensure only licensed pharmacists with the ability of providing proper drug information are allowed to practice, as the danger of misinformation may be more critical than the current health challenge the patient is facing. One such example of such development is One- Health, amongst many others which are currently increasing on a daily basis. These services are offered on a subscription basis and with the aid of a health analytic dashboard, users can also monitor their health status and progress. Though this platform is not without its challenges, it is seeking for ways to partner with existing Health Maintenance Organizations (HMOs), where its services could be offered to patients with chronic ailments [17].