Informal over-the-counter supply of antibiotics in Ghana: A qualitative analysis of practices in community pharmacies

Background: Antibiotics are among the most widely prescribed medicines and fall within a well-defined framework for access and supply. Despite existing regulatory systems for antibiotic control, weak regulatory enforcement has led to non-prescription access from community drug retail outlets and widespread self-medication with antibiotics. Objective: To explore the factors associated with the over-the-counter supply of antibiotics within community pharmacies across Ghana. Method: The exploratory qualitative study employed semi-structured interviews. The study population consisted of pharmacy practitioners randomly recruited from the medicine retail outlets situated in rural, peri-urban, and urban communities in Ghana. The interview questions were organised within the framework of the theory of planned behaviour and investigated participants' attitudes, social norms, and perceived control over antibiotic use. The data was transcribed, coded, and thematically analysed using NVivo version 10. Results: Twenty-three pharmacy practitioners (i.e., pharmacists, pharmacy technicians, and medicine counter assistants) participated in the study. Participants described how economic incentives, sales targets, and the perceived social status of customers often pressured them to supply antibiotics without prescriptions, especially in an environment where regulatory oversight was viewed as weak or absent. Many noted that customers felt increasingly entitled to request antibiotics, drawing confidence from online health information and limited public education. Although the participants knew about antibiotics and antimicrobial resistance, their awareness of existing national antimicrobial policies was limited. Conclusion: The over-the-counter supply of antibiotics in Ghana is fuelled by various factors that differ slightly along the lines of community urbanisation and development. Policy makers must take full cognisance of these factors and adopt community-tailored strategies that target medicine retailers.