A double-edged sword?: Digitalization, health disparities, and the paradoxical case of e-pharmacy in Ghana.

Objective: With the ongoing push for greater digitalization of healthcare in low- and middle- income countries (LMICs), the larger questions around who will benefit most from such efforts and what elements of disparities and inequities may further be created or reinforced are often overlooked. This study was undertaken to assess a pioneering e-pharmacy initiative in Ghana that aimed to explore issues of access and disparities in relation to pharmaceutical services. Method: The study used a qualitative research design where semi-structured interviews were conducted virtually with 21 licensed community pharmacists recruited through purposive and snowball sampling techniques. The data were analyzed using inductive thematic analysis approach. Results: Pharmacists recognized the transformative potential of e-pharmacies, particularly in resource constrained regions that face issues of pharmacy and healthcare deserts. However, drawing on their experiential knowledge, they highlighted the paradoxes and challenges of promoting digitalization of healthcare in a country characterized by poor infrastructure, poverty, and multiple intersecting layers of inequities, as well as digital divides and low digital/health literacy. In the absence of adequate infrastructure, funding support and regulation, the possibility of local pharmacies, often the first point of care, being replaced by big corporations was feared. Participants also cautioned to steer the discourse of e-pharmacy away from access, pricing, and convenience to safety and quality. Conclusion: Digitalization of healthcare and e-pharmacies holds tremendous potential in the LMICs. However, such technological initiatives, if implemented without proper groundwork and adequate support, would run the risk of creating and exacerbating health disparities, especially in sub-Saharan Africa. A bottom-up approach, through grassroot engagement and implementation science, tethered to building safe, affordable, and equitable infrastructure and access to care will be essential for the success of e-pharmacy and other digitalization initiatives in the region and beyond. This research has direct implications for public health, policy, and pharmaceutical care.