The role of faith-based organizations in the pharmaceutical systems of low-and-middle-income countries – A scoping review

In many low- and middle-income countries (LMICs), faith-based organizations (FBOs) play a critical role in ensuring access to essential pharmaceutical services. Despite their longstanding presence in this role, there are few existing reviews describing the contributions of FBOs to pharmaceutical systems in LMICs. This study aims to provide a structured overview of the existing literature on FBO engagement in pharmaceutical systems across LMICs. This study utilizes the Pharmaceutical Systems Strengthening (PSS) Framework to categorize FBO contributions across key components of the pharmaceutical system. A scoping review, guided by the Arksey & O'Malley approach, was undertaken. Searches focused on English-language literature from 2000 onward across multiple databases. Two reviewers independently screened titles and abstracts, and relevant full texts were analyzed to extract the contributions of FBOs. We identified 524 papers, with 30 meeting inclusion criteria after eligibility assessment. These studies spanned 21 LMICs, 19 of which were in Africa, and documented FBO contributions across five religions: Christianity (N = 30), Islam (N = 4), Hinduism (N = 1), Sikhism (N = 1), and Buddhism (N = 1). While FBO engagement is noted in all pharmaceutical system components, the most documented FBO contributions were in: financing (donations, pooled procurement and drug revolving funds), regulatory systems (quality and safety surveillance), human resources (capacity building) and pharmaceutical products and services (operating outlets that supply pharmaceutical products, promoting increased uptake and adherence). Findings also highlighted that FBOs collaborate within and across sectors. However, there remains a paucity of data on evaluating FBO contributions. This scoping review highlights the diverse roles of FBOs in pharmaceutical systems across all components of the PSS framework to address critical system gaps. The overrepresentation of Christian FBOs in the literature underscores the need to further explore engagement across other religious traditions. A critical gap identified is the lack of rigorous measurement of FBO outcomes and impact.