Challenges and Opportunities in Community Pharmacies in Bangladesh: A Qualitative Study
Md. Bony Amin, Wahid bin Ahsan
Department of Human-Centered Design, Userhub, Dhaka, Bangladesh
Abstract
This qualitative study explores operational challenges and improvement opportunities within Bangladesh’s community pharmacy sector—a vital yet under-researched component of healthcare delivery in low- and middle-income countries (LMICs). Using semi-structured interviews with 10 purposively selected participants (five pharmacists and five customers), data were thematically analyzed. Five key themes emerged: manual and error-prone inventory management; inconsistent medicine availability; unreliable supply chains with counterfeit risks; low digital adoption; and weak regulatory enforcement. Participants suggested solutions including affordable digital tools, diversified supplier networks, transparent pricing, and stronger oversight. The findings underscore the urgent need for integrated policy and operational reforms rooted in stakeholder experiences to enhance pharmacy services, healthcare access, medicine safety, and public trust in Bangladesh’s health system.
Keywords: community pharmacy, pharmacy operations, Bangladesh, qualitative study, inventory management, customer trust, medicine supply chain, digital health adoption, pharmaceutical regulation, healthcare access, low- and middle-income countries (LMICs)
Introduction
Community pharmacies are a cornerstone of healthcare delivery in low- and middle-income countries (LMICs), serving as the primary access point for essential medicines and advice. In Bangladesh, they often represent the first line of care but face persistent challenges in inventory management, medicine authenticity, service quality, and adapting to technological change. These issues affect operational efficiency, public health outcomes, patient trust, and regulatory oversight.
Inventory management weaknesses are well documented in LMICs. Stockouts are common, with Olaniran et al. (2022) reporting essential medicines unavailable in roughly one-third of cases, often due to supply chain delays and inadequate stock monitoring. Even where national supply is adequate, poor inventory control can create shortages (Leung et al., 2016). Improper disposal of expired medicines can cause environmental hazards and facilitate counterfeit circulation (Kamba et al., 2017).
Service quality directly influences patient trust and satisfaction. In Dhaka, Sultana (2018) identified pharmacist counselling, patient record-keeping, fair pricing, and medicine quality as key drivers. Adhikary et al. (2018) further found that cleanliness, privacy, and respectful communication shape patient satisfaction. Internationally, pharmacist attentiveness, reliable availability, affordability, and safety advice are linked to higher trust (Druică et al., 2021).
Weak supply chains and limited regulatory capacity undermine medicine quality in Bangladesh. Fragmented distribution systems, low public awareness, and inadequate oversight create conditions that enable the circulation of counterfeit medicines (Orubu et al., 2020). The complexity of multi-tiered supply chains further complicates authenticity verification, particularly for imported or high-demand products (Tremblay, 2013). Addressing these challenges requires integrated interventions that combine regulatory reform, supply chain optimization, and community education to strengthen both medicine quality assurance and public trust (Steele et al., 2019).
Digital health tools could help address these challenges, but adoption is uneven. Leadership, regulatory readiness, and workforce capacity enable uptake, while infrastructural gaps and cultural resistance act as barriers (Nakkas & Scott, 2025). In pharmaceutical supply chains, operational disruptions and change resistance impede digital implementation (Ozbiltekin-Pala & Aracıoglu, 2024), and adoption depends heavily on training, perceived usefulness, and system reliability (Borges do Nascimento et al., 2023).
Regulation is essential for ensuring medicine quality and safe service delivery. Effective systems require investments in inspection capacity and post-marketing surveillance (Roth et al., 2018), yet weak enforcement in many LMICs allows poor-quality medicines and unqualified providers to persist (Lowe & Montagu, 2009). The rapid growth of e-pharmacy, if unmatched by regulatory readiness, can create new safety risks such as unverified medicine sales (Miller et al., 2021).
While these studies provide valuable insights, few qualitative investigations capture the perspectives of both pharmacists and customers in Bangladesh. Little is known about how operational challenges, supply chain vulnerabilities, customer perceptions, digital adoption, and regulation intersect in day-to-day practice. This study addresses this gap by exploring these issues through interviews with pharmacists and customers, identifying challenges and opportunities for improving inventory management, service efficiency, medicine authenticity, and public trust.
Research Question and Sub-Questions
Central Research Question
How do pharmacists and customers in Bangladesh experience and perceive the challenges and opportunities in pharmacy operations, and what improvements can be made to enhance inventory management, service quality, and trust?
Sub-Questions
- How do pharmacists manage stock, record-keeping, and expired or unsold medicines, and what challenges do they face?
- How do customers choose pharmacies, and what factors influence their trust and satisfaction with services?
- How do supply chain weaknesses affect medicine availability and authenticity?
- What are the barriers and enablers to adopting digital systems in pharmacy operations?
- How do existing regulatory frameworks impact service quality and medicine safety, and what changes are needed?
Methodology
Research Design
A qualitative, exploratory design was used to capture the lived experiences of pharmacists and customers in Bangladesh’s community pharmacy sector—insights not easily measurable through quantitative methods. Semi-structured interviews allowed flexibility in exploring individual perspectives while maintaining alignment with the study objectives.
Participants and Sampling
Two participant groups were included: pharmacists (owners, sellers, employees) and general customers. Purposive sampling was used to identify individuals with relevant experience. Ten participants—five from each group—were recruited through personal networks and referrals to ensure diversity of viewpoints.
Data Collection
Interviews lasting 25–40 minutes were conducted in Bengali and audio-recorded with consent. Separate semi-structured interview protocols were used for pharmacists and customers. The pharmacist protocol comprised 13 questions covering inventory management, stock challenges, digital adoption, and regulatory experiences. The customer protocol included 10 questions focusing on pharmacy selection, medicine availability, service quality, and perceptions of online medicine purchasing. Observational notes were also taken to contextualize responses.
Data Analysis
Recordings were transcribed, translated, and thematically analysed using Braun and Clarke’s (2006) framework. Manual coding generated five inductive themes: inventory management, customer trust, supply chain, digital adoption, and regulation.
Ethical Considerations
Participants gave informed consent and were assured of anonymity. Identifying details were removed, and data were stored securely. Audio files were deleted after transcription. The study adhered to established ethical principles for research with human participants as outlined by the American Psychological Association (2017).
Findings
The analysis of interviews with pharmacists and customers in Bangladesh revealed five interconnected themes: inventory management challenges, customer trust drivers, supply chain weaknesses, digital adoption barriers, and regulatory gaps. While each theme addresses a specific research sub-question, they are deeply intertwined in shaping pharmacy operations and customer experiences.
Inventory Management Practices and Challenges
Pharmacists reported relying primarily on manual record-keeping and personal judgment to manage stock levels. Most pharmacies maintained handwritten ledgers or simple notebooks, with purchasing decisions guided by previous sales patterns and customer requests rather than systematic demand forecasting. The absence of formal inventory management tools often led to inefficiencies, particularly in identifying slow-moving or expired medicines. Disposal of expired stock was irregular, with some pharmacists returning items to suppliers, while others stored them indefinitely due to lack of disposal guidelines.
One pharmacist noted, “We keep track in a register, but sometimes mistakes happen. If I am busy, I can forget to record.” This reliance on memory and manual systems increased the risk of stock discrepancies and overstocking, especially for low-demand products.
Customer Decision-Making and Trust in Services
Customers generally selected pharmacies based on proximity to home, perceived reliability of stock, and familiarity with the pharmacist. Trust was strongly linked to consistent medicine availability, transparent pricing, and respectful interaction. Negative experiences — such as being sold expired products or charged more than the printed price — undermined confidence.
A customer explained, “I go to the pharmacy I know. If they don’t have my medicine once, I will still return, but if it happens often, I change.” Such comments highlight the balance between loyalty and availability that shapes pharmacy choice.
Supply Chain Weaknesses and Medicine Authenticity
Both pharmacists and customers expressed concern over unpredictable supply chains. Pharmacists frequently encountered delayed deliveries from distributors, particularly for less common or imported medicines. This sometimes, forced customers to visit multiple pharmacies for a single prescription. Participants also described encountering counterfeit or low-quality medicines, which eroded trust in the broader system.
One pharmacist shared, “Sometimes we get medicines that don’t look right… the packaging is off. We have to send them back, but not everyone does.” These experiences underscored the need for stricter quality control and verification mechanisms across the supply chain.
Digital Adoption: Barriers and Opportunities
While awareness of digital tools for inventory management and e-pharmacy services existed, actual adoption was minimal. Many pharmacists cited cost concerns, lack of training, and uncertainty over system reliability as reasons for avoiding digital solutions. Customers were divided: some expressed interest in online ordering for convenience, while others distrusted digital transactions for medicines.
A pharmacist observed, “A computer system would help, but it is expensive and needs someone who knows how to use it.” The findings suggest that digital adoption is contingent on both affordability and trust-building measures.
Regulatory Gaps and Suggested Improvements
Participants perceived current regulatory enforcement as inconsistent. Pharmacists called for clearer guidelines on expired medicine disposal, stricter controls on counterfeit drugs, and formal recognition of qualified practitioners. Customers emphasized the need for transparent pricing enforcement and stronger action against unlicensed pharmacies.
As one customer stated, “The government should check if pharmacies are giving real medicines and fair prices — not just collect fees.” These views align in calling for more visible and proactive regulatory oversight to protect both business integrity and public health.
Table 1. Key Themes, Challenges, and Opportunities in Community Pharmacy Operations in Bangladesh
| Theme | Key Challenges | Opportunities for Improvement |
| Inventory Management | Manual record-keeping; absence of demand forecasting; irregular or unsafe disposal of expired medicines. | Implement affordable digital inventory systems; provide training in stock forecasting; establish and enforce disposal guidelines. |
| Customer Trust | Inconsistent availability of essential medicines; price variation; occasional sale of expired or substandard products. | Maintain reliable essential stock; enforce transparent pricing; adopt quality assurance measures. |
| Supply Chain Reliability | Delayed deliveries; reliance on few distributors; exposure to counterfeit medicines. | Diversify supplier networks; strengthen supplier vetting; introduce verification tools (e.g., barcoding, mobile authentication). |
| Digital Adoption | High implementation cost; limited digital literacy among staff; customer skepticism toward online medicine purchases. | Subsidize user-friendly digital tools; offer staff training; run public campaigns on safe digital medicine services. |
| Regulatory Enforcement | Inconsistent inspections; unclear disposal regulations; persistence of unlicensed providers. | Expand inspection scope to quality, pricing, and qualifications; standardize disposal protocols; strengthen oversight of both physical and online pharmacies. |
The five themes — inventory management, customer trust, supply chain reliability, digital adoption, and regulatory enforcement — represent interconnected dimensions of pharmacy operations in Bangladesh. Each theme reflects both persistent operational barriers and actionable improvement opportunities grounded in participant experiences. Table 1 summarizes these themes, highlighting the specific challenges identified by pharmacists and customers alongside corresponding opportunities for improvement.
Discussion
This study explored the perspectives of pharmacists and customers in Bangladesh, identifying five interconnected dimensions of community pharmacy operations: inventory management, customer trust, supply chain reliability, digital adoption, and regulatory enforcement. These themes confirm patterns reported in the LMIC pharmacy literature while adding context-specific insights from both providers and consumers.
Inventory Management
The reliance on manual, memory-based stock control reflects a persistent challenge in LMICs (Leung et al., 2016; Olaniran et al., 2022). Such practices increase the risk of discrepancies, stockouts, and waste due to expired medicines. Participants’ accounts of irregular disposal align with Kamba et al.’s (2017) concerns regarding environmental hazards and counterfeit redistribution. Practical solutions include affordable digital inventory systems with forecasting functions, paired with targeted training. Regulatory bodies could strengthen these efforts by enforcing clear disposal guidelines.
Customer Trust
Consistent medicine availability, transparent pricing, and respectful service emerged as central to pharmacy choice and loyalty, echoing findings from Sultana (2018) and Druică et al. (2021). Negative experiences—particularly repeated stockouts or price discrepancies—undermined trust and sometimes prompted customers to switch providers. Building and maintaining trust requires operational reliability, quality assurance measures, and stricter price regulation.
Supply Chain Reliability
Pharmacists and customers described delivery delays, limited supplier options, and counterfeit risks—issues also reported by Orubu et al. (2020) and Tremblay (2013). Strengthening supplier vetting, diversifying distribution channels, and implementing verification systems such as barcoding could improve both medicine availability and authenticity.
Digital Adoption
Limited uptake of digital tools stemmed from cost, inadequate training, and mistrust in system reliability, consistent with Nakkas & Scott (2025) findings on digital health transformation barriers. Customers’ divided opinions on e-pharmacy services highlight the need for both infrastructure development and public education. Subsidized, user-friendly systems combined with awareness campaigns on safe online purchasing could accelerate adoption.
Regulatory Enforcement
Perceptions of inconsistent oversight mirror observations by Lowe & Montagu (2009) and Roth et al. (2018) that weak enforcement in LMICs enables poor-quality medicines and unlicensed providers. Inspections should extend beyond document checks to assess medicine quality, pricing compliance, and practitioner credentials. Clear frameworks for expired medicine disposal and e-pharmacy operations are essential to safeguard both physical and digital pharmacy services.
Implications and Recommendations
The findings point to an urgent need for targeted reforms aligning operational practices, technological adoption, and regulatory oversight in Bangladesh’s community pharmacies.
From an operational perspective, affordable, context-appropriate digital inventory systems—paired with training in demand forecasting—could address stock discrepancies, reduce wastage, and improve the availability of essential medicines. Strengthening supply chain resilience through diversified sourcing, verified distribution channels, and contractual performance requirements would further protect service reliability and medicine authenticity.
On the regulatory front, national standardization of expired medicine disposal protocols, combined with proactive inspections covering quality testing, price compliance, and staff credential verification, would close critical oversight gaps. Clear frameworks for e-pharmacy operations—including authentication systems and consumer protection standards—are essential to safely integrate digital sales into the sector.
Capacity building should complement these reforms. Training pharmacy staff in customer communication, quality assurance, and digital tool use can enhance both service quality and public trust. Public awareness campaigns on safe medicine sourcing, recognizing counterfeit products, and understanding rights in medicine pricing would reinforce community engagement and accountability.
Together, these measures can improve operational efficiency, ensure medicine safety, and strengthen the role of community pharmacies as trusted gateways to healthcare access in Bangladesh.
Conclusion
This study provides qualitative evidence on the operational realities of community pharmacy services in Bangladesh, integrating perspectives from both pharmacists and customers. Five interconnected themes emerged: manual and error-prone inventory management, fluctuating medicine availability affecting customer trust, fragmented and vulnerable supply chains, slow digital adoption, and inconsistent regulatory enforcement.
Linking these themes to existing literature on pharmacy operations in low- and middle-income countries (LMICs), the study demonstrates how weaknesses in one area—such as supply chain reliability—can cascade to affect service quality and public confidence. Addressing these challenges requires coordinated reforms encompassing policy, operational improvements, technological adoption, and capacity building.
The findings contribute valuable, context-specific insights to the growing evidence base on LMIC pharmacy systems. They also offer practical recommendations for regulators, pharmacy operators, and public health stakeholders aiming to improve medicine availability, authenticity, and affordability. Strengthening community pharmacy services is critical not only for operational efficiency but also for equitable healthcare access and enhanced trust in the health system.
Limitations and Future Research
This study is based on a small, purposively selected sample of pharmacists and customers from urban and peri-urban areas in Bangladesh. Consequently, the findings may not fully capture the diverse experiences of those in rural or remote settings, where infrastructure, supply chains, and service models may differ significantly. Additionally, reliance on self-reported data introduces potential recall and social desirability biases, though observational notes helped mitigate these concerns.
Future research should expand the sample size and geographic coverage to include rural and hard-to-reach communities. Combining qualitative interviews with quantitative methods—such as inventory audits and standardized customer satisfaction surveys—would enhance the robustness of findings. Longitudinal studies could further examine the effects of digital adoption, regulatory reforms, and supply chain improvements over time, providing valuable evidence to guide sustained enhancements in pharmacy operations.
Acknowledgements
The authors thank all participating pharmacists and customers for generously sharing their time, experiences, and insights. Appreciation is also extended to colleagues and advisors who provided constructive feedback during the design, data collection, and analysis stages. The authors acknowledge the use of AI-assisted language tools to improve clarity and presentation, with all content critically reviewed by the research team to ensure accuracy and fidelity to the study’s findings.
Declaration of Interest
The authors declare no conflicts of interest related to this study.
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