BACKGROUND: Frequent stock-out of drugs in the public hospitals causes National Health Insurance Scheme (NHIS) enrollees to purchase most of their medicines out-of-pocket in community pharmacies, thereby imposing financial constraints on them against the main objective of the scheme. The objectives of this study were to determine and compare the level of participation of private retail community pharmacies (PRCPs) in the NHIS of Nigeria and Ghana, to describe their spatial distribution, and to highlight from literature major factors that would influence the participation of these pharmacies in the scheme.METHODS: PRCPs data were collected from the Nigerian NHIS active secondary healthcare providers list of 1stJuly 2017 and the Ghanaian NHIS active providers online list of 2018. PRCPs densities at the national levels were calculated from last published national coverage data for each country.RESULTS: The total number of PRCP accredited by NHIS of both Nigeria and Ghana is 964(639[66.3% versus 325[33.7%]). NHIS accredited PRCPs densities for Nigeria and Ghana were 1 PRCP per 9, 390 enrollees and 1 PRCP per 33, 108 enrollees respectively. Across the Nigerian States, it was noted that Lagos State has the highest proportion (21.4%, n = 137) of community pharmacy participation in the scheme whereas, in Ghan, Greater Accra Region has the highest participation (34.2%, n = 111).                                                                                                                             CONCLUSION: This study revealed low participation of PRCPs and skewed spatial distribution between urban and rural areas of both countries, although there was higher participation of these pharmacies in Nigeria due to Nigerian lower NHIS coverage data compared to Ghana.KEYWORDS: National Health Insurance Scheme (NHIS), Reimbursement, Essential Medicines, Private Retail Community Pharmacy (PRCP), Nigeria, Ghana