Pharmacists as System-Level Leaders: Driving Action Against Substandard and Falsified Medicines
Exploring the SFMeds Champions scheme
by Dr Helena Rosado, Research and Evaluation Lead
Substandard and falsified medicines (SFMeds) are not only a pharmaceutical problem – they are a systemic threat to global health, patient safety, public trust, and the fight against antimicrobial resistance (AMR).
The World Health Organisation estimates that one in ten medicines in low- and middle-income countries are substandard or falsified, with the burden falling heaviest across Africa. Beyond treatment failure, these medicines contribute to avoidable deaths, economic loss, erosion of trust in health systems, and worsening AMR – quietly but consistently undermining progress toward universal health coverage.
Yet prevention and response to SFMeds are often seen as technical issues – something for laboratories, regulators, inspectors, and policy units alone to tackle. The Commonwealth Pharmacists Association (CPA), through the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) programme, is challenging this narrative and empowering pharmacists as leaders in tackling the SFMeds crisis.
“The challenge is sometimes defined as a wicked problem – complex, cross-cutting, and resistant to simple solutions because it involves multiple stakeholders with conflicting interests, unclear boundaries, and no single point of accountability. It is the kind of problem where every actor owns a piece of it, but no one owns the whole.”
Oksana Pyzik
Associate Professor, UCL School of Pharmacy
CPA Trustee
Why pharmacists must lead
Pharmacists are uniquely positioned to detect, report, and prevent SFMeds for several reasons:
- They see the whole medicines supply chain: From procurement to storage, distribution, dispensing, and patient counselling, pharmacists are often the final safeguard before medicines reach the public.
- They are trusted, accessible healthcare professionals: The fight against SFMeds depends not only on quality control but on restoring confidence. High-profile tragedies – such as global deaths linked to contaminated syrups – have shown how SFMeds incidents damage patient trust in medicines and the health system itself.
- They are capable of mobilising institutions: Regulation alone will never catch every breach. Without local champions working inside health facilities, supply chains and professional cultures will not change fast enough.
Leadership from the pharmacy profession – across clinical, operational, educational, and community settings – is, therefore, indispensable.
A strategic shift: From awareness to empowered action
In 2023, CPA launched a dedicated SFMeds workstream in eight African CwPAMS countries. As part of the workstream, in 2025, 25 pharmacists from hospitals, community settings, academia and beyond became SFMeds Champions to take part in an intensive programme designed to move beyond awareness into practical, applied leadership and action.
Using a blended model of self-directed learning, peer support and structured live sessions, our SFMeds Champions joined a leadership and advocacy journey, progressively building capability in areas including:
- Understanding the global and local scale of SFMeds
- Practical vigilance integrated into everyday practice
- Leadership confidence and advocacy skills
- Driving institutional action through system-focused action plans
- Peer-to-peer influence through stakeholder engagement and communication
- Sustaining change and scaling impact over time
Alongside this learning, our SFMeds Champions were encouraged to research their local context, map risks within their organisations, develop interventions and improvement plans, and design real-world campaigns.
A broader understanding of the problem
Our programme helps Champions examine SFMeds as a complex systemic challenge – not merely technical but also encompassing political, logistical, economic and behavioural factors. Weak regulation, fragmented supply chains, limited enforcement, and inconsistent accountability all contribute to the persistence of SFMeds. When these challenges are poorly understood, they risk being deprioritised or viewed as issues for someone else to solve.
The SFMeds Champions programme equips pharmacists to help shift this narrative. By gathering evidence, presenting findings, leading conversations within their institutions and communicating the real cost of poor-quality medicines, they are helping to show that medicine quality is a critical component of patient safety, AMR mitigation and health system credibility.
Turning knowledge into institutional change
What distinguishes our programme is its focus on translating learning into meaningful action. SFMeds Champions have been encouraged to work directly with institutional leadership, procurement teams, clinical colleagues and, in many cases, external partners to strengthen medicine quality systems.
As a result, some health facilities have since introduced or expanded internal quality monitoring, identifying issues linked not only to manufacturing but also to distribution and storage. Others have created new reporting pathways, conducted internal trainings, engaged regulators, mapped supply chain vulnerabilities, or improved local procurement standards. Expanding the workstream’s influence, some facilities have even become sources of expertise for neighbouring facilities, training additional pharmacists and contributing to wider national capacity.
These efforts demonstrate what can happen when pharmacists are supported not only to understand the issues but to lead change from within their systems.
Campaigns and community momentum
This month saw the SFMeds Champions put their leadership skills into action. Across multiple countries, they delivered training, awareness campaigns and outreach during World AMR Awareness Week, which will continue into Fight the Fakes Week in early December. Activities have ranged from staff education events and procurement reviews to community engagement, radio discussions, leadership briefings and local policy development.
Champions have supported one another, shared learning, celebrated successes and demonstrated what can be achieved when professionals are empowered and connected.
Looking ahead
CPA’s network of SFMeds Champions is still in its early stages, yet the impact already visible shows the value of investing in professional leadership at the frontline. We are proud to be supporting this growing movement of pharmacists who are not waiting for change to arrive from elsewhere – they are driving it themselves, within their institutions and wider health systems.
“Pharmacists sit at the point where medicine quality, patient safety and system accountability meet. Strengthening vigilance for SFMeds is not only about detecting poor-quality products; it is about protecting trust in our health systems and ensuring that antimicrobial stewardship efforts deliver real impact.”
Dr Scott Matafwali
SFMeds Technical Advisor, CwPAMS
We look forward to seeing even more from this community in the months ahead, as our Champions continue to learn, expand their influence, shape policy, and raise the standards of medicine quality across the Commonwealth. The work is far from over, but the leadership emerging gives great confidence: meaningful, lasting change in SFMeds is not only possible – it is already underway.
Dr Helena Rosado
Research and Evaluation Lead
About the author
Helena is a registered pharmacist in the UK and Portugal with over 20 years of experience in the health sector, working for not-for-profit, academic and private organisations as both a generalist and a specialist. She holds a degree in Pharmaceutical Sciences and a PhD in Medical Microbiology with postdoctoral fellowships in pharmaceutical and medical microbiology, policy, and practice.
Her key interests include global public health, the use of healthcare data for strategic decision-making, education and equity.
About CwPAMS and the Fleming Fund
The Department of Health and Social Care’s Fleming Fund is a UK aid programme supporting up to 25 countries across Africa and Asia to tackle antimicrobial resistance (AMR), a leading public health threat across the world. The Fleming Fund invests in strengthening data surveillance systems through a portfolio of country grants, regional grants and fellowships managed by Mott MacDonald, and global projects managed by partners.