Walk through Kampala Metropolitan Area or any of the 11 cities across the different regions in Uganda, and you will likely spot a pharmacy in whichever direction you turn – some sitting right on the doorstep of a public health facility. Uganda now has more than 14,000 licensed drug outlets, with the highest concentration in the capital, according to data from the National Drug Authority (NDA). This expansion reflects three intersecting pressures: persistent medicine supply gaps in public facilities, a rising disease burden, and an increasingly profitable private medicines market. While improved access is welcome, together with the regulatory and clinical risks accompanying this growth, the acceleration of antimicrobial resistance (AMR) demands urgent policy attention. WHY ARE PHARMACIES MULTIPLYING? Three factors are driving the boom. First, Uganda’s public health system, while significantly expanded over the past decade, continues to face medicine supply pressures that have not yet caught up with rising demand. At Mulago National Referral Hospital, for instance, doctors sometimes direct patients to nearby private pharmacies for specific drugs that are not available at that time. Private pharmacies have stepped in to complement public facilities, effectively extending access to medicines beyond what the government system can currently provide. Second, a growing burden of illness is increasing pressure on health services across the country. Third, out-of-pocket consultation costs remain prohibitive for a significant share of the population. Unable to afford clinical assessment, many Ugandans bypass formal care entirely, presenting directly at a pharmacy to describe symptoms and purchase what they can afford. Self-medication is, therefore, not a behavioural failing; it is a rational response to a system that prices out the poor. A GENUINE CONTRIBUTION TO ACCESS Private pharmacies have filled a genuine gap in Uganda’s health system. Extended operating hours, geographic reach beyond public facility catchment areas, and consistent medicine availability have expanded access for urban and peri-urban populations. For patients managing chronic conditions, including hypertension and diabetes, private pharmacies provide a critical continuity layer that the public system alone cannot sustain. The sector also contributes directly to the health economy: generating employment across dispensing, logistics, and digital health, and attracting private investment into cold-chain and last-mile delivery infrastructure. These benefits are acknowledged. What demands immediate policy attention, however, are the risks growing alongside them – risks if left unaddressed will quietly undermine the very access gains the sector has delivered. WHEN ACCESS COMES AT A COST The same commercial energy driving the boom also creates serious regulatory and clinical risks. The NDA has established prescription requirements for antimicrobials and other restricted medicines and has pursued enforcement action against non-compliant outlets. However, compliance remains inconsistently observed across the sector. Where patients self- select antimicrobials based on affordability rather than clinical diagnosis, the consequences are predictable: incorrect drug selection, inadequate dosing, and incomplete treatment courses — each a driver of antimicrobial resistance. AMR is not a future risk; it is an accelerating one, with implications that extend beyond Uganda’s borders. A second risk is the proliferation of substandard and falsified medicines. The NDA conducts market surveillance and has acted against non-compliant outlets. But at 14,000-plus drug outlets, the surveillance-to-outlet ratio makes comprehensive oversight structurally difficult. Patients receiving medicines with sub-therapeutic active ingredient levels, compromised by poor storage or past expiry, face both treatment failure, and in the case of antimicrobials, an additional contribution to resistance. The regulatory capacity needed to police this market has not kept pace with its growth. A third, structural risk is the erosion of professional pharmaceutical practice by retail commercialisation. As pharmacies diversify into cosmetics, household goods, and general retail, the distinction between a licensed healthcare outlet and a general shop becomes difficult to maintain in practice and in patient perception. The clinical functions of a pharmacist — reviewing contraindications, checking for drug interactions, and counselling on adherence risk become secondary to revenue generation. This is not merely a professional standards concern; it represents a quiet but significant degradation of the safety net that qualified pharmacy practice is meant to provide. LEVERAGING THE BENEFITS The NDA should enforce prescription requirements as a non-negotiable condition of license retention, not as an aspirational standard. Non-compliant outlets should face graduated sanctions, including licence suspension. Uganda is not unusual in the challenge it faces; what distinguishes high-performing systems such as the United Kingdom’s is consistent, credible enforcement backed by institutional capacity. The NDA’s inspection and sanction capacity should be resourced accordingly. Stricter prescription enforcement will only work if affordable pathways to obtain a prescription exist. The ministry of Health should empower and authorize Village Health Teams (VHTs) to issue referral notes for common conditions and certify qualified pharmacists to prescribe from a defined essential medicines list. Without supply- side reform to match demand-side regulation, enforcement will disproportionately restrict access for those who can least afford clinical consultation. A mandatory digital link between public facility prescriptions and private pharmacy dispensing records would create a verifiable, auditable trail — closing the gap between diagnosis and dispensing, and enabling real- time surveillance of prescribing and dispensing patterns. Rwanda’s electronic prescription system, integrated with health facility records, offers a directly applicable regional model. The writer is an Expert Associate at the Blueprint Consortium Africa, Kampala.The post Is Uganda’s pharmacy boom expanding access or fueling a public health crisis? appeared first on The Observer.