Abstract
This study aimed to assess the roles, readiness, barriers, and opportunities of community
pharmacies in providing self-testing services and health promotion and prevention (PP)
services under the oversight of the National Health Security Office (NHSO). Since 2023, the
NHSO has expanded benefit packages, allowing all insured populations to access these
services at community pharmacies. A mixed-methods approach was employed, including
analysis of quantitative data from fiscal years 2024–2025, surveys of 1,021 members of the
public, 400 community pharmacists, and 452 individuals from key populations, as well as indepth interviews with multiple stakeholders.
The results showed that overall service utilization changed only slightly, except for OV-ATK,
which demonstrated rapid growth. In contrast, HPV testing uptake remained low and varied
markedly across health regions. Public interest in pharmacy-based self-testing increased when
cost subsidies were provided; however, awareness of pharmacy-based entitlements remained
low (<35%), and most respondents were unable to identify participating pharmacies. For PP
services, hospitals were the preferred service providers. Major barriers reported by pharmacies,
health service providers, and professional organizations included complex service procedures,
concerns related to identity verification, unstable digital systems, and reimbursement
structures that did not adequately reflect actual workload.
Pharmacists demonstrated adequate knowledge for certain test kits, such as OV-ATK, but
required further capacity building for other tests and time-sensitive services, including PrEP
and PEP. While community pharmacies have the potential to improve access to such services,
implementation should begin through pilot models in collaboration with NGOs, laboratories,
and hospitals, supported by clear data systems and referral pathways. Professional
organizations play a critical role in supporting pharmacy participation through standard setting,
capacity development, evidence generation, and technology integration; however, structural,
system-level, and incentive-related barriers remain.
The social return on investment (SROI) analysis indicated high social value (SROI = 5.71).
Overall, community pharmacies have significant potential as a complementary channel for
self-testing and PP services, particularly for working-age and reproductive-age populations.
Nevertheless, system-level scale-up requires coordinated demand- and supply-side measures,
including effective rights communication, appropriate benefit design, reimbursement reform,
streamlined data systems, practical service standards, referral networks, and robust monitoring
and evaluation. If the policy is maintained, structural reforms should be accelerated and
continuously evaluated using the RE-AIM framework and SROI. If discontinued, a gradual exit
strategy should be implemented, accompanied by systematic assessment of impacts on
access, equity, and the workload of core health service providers to inform future policy
reassessment.
