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THE FUTURE OF PHARMACY
INTERNATIONAL PHARMACY JOURNAL
ca p a b i l i t i e s sh o u l d b e t h e ult i m a t e c r i t e r i a fo r a s s e s s i n g t h e d e v e l o p m e nt of a co unt r y, n ot e c o n o m i c gr o w t h a l o n e . S o u t h Afr i c a ’ s HDI is 0 . 619 , whi c h p l a c e s it 1 23 r d o ut of 1 8 7 co u nt r i e s . 9 Howe v e r, S o u t h Afr i c a ’ s Gr o s s D o m e s t i c Pro du c t (%1 QFSDBQJUBJT64 BOEUIFQFSDFOUBHF (%1 e x p e n d i t u r e o n p ub l i c h e a l t h is e s t i m a t e d at 8 .5 in 2 0 0 9 . 2 9 Tabl e 1 sh o w s t h e h e a l t h p r ofi l e of S o u t h Afr i c a . 2 1
In t h e p a s t t h e p r o v i s i o n of ma t e r n a l h e a l t h s e r v i c e s in S o u t h Afr i c a r e m a i n e d f r a g m e nt e d , i n a d e q u a t e l y r e s o u r c e d a n d p o o r l y co o r d i n a t e d , whi c h r e s u l t e d in un e q u a l a c c e s s t o ma t e r n a l h e a l t h s e r v i c e s in a r e a s whi c h we r e hig h - d e n s i t y, s e m i - u r b a n , inf o r m a l s e t t l e m e nt s a n d p a r t i c u l a r l y in r ur a l a r e a s . 3 0 Count d o w n t o 2 0 15 r a i s e s co n c e r n s in t e r m s of t h e e x t e nt t o whi c h p r o g r e s s h a s b e e n a c h i e v e d a n d wh e t h e r t h e t r a c k of p r o g r e s s is a d e q u a t e t o m e e t t h e t w o o b j e c t i v e s fo r m a t e r n a l h e a l t h a n d r e d u c t i o n in inf a nt m o r t a l i t y. Regr e t- t a b l y, a c c o r d i n g t o t h e Count d o w n t o 2 0 15 r e p o r t r e l e a s e d in March 2 0 1 2 , S o u t h Afr i c a is on t h e up d a t e d li s t of p r i o r - i t y co u nt r i e s (w h i c h h a s e x p a n d e d f r o m 6 8 t o 7 3 co u nt r i e s) wit h a hig h b ur d e n of ma t e r n a l m o r t a l i t y b e t w e e n 2 0 1 0 a n d 2 0 1 2 . 3 1 The WHO hea lt h p r ofi l e s t a t i s t i c s o n S o u t h Afr i c a r e p o r t a s t a g g e r i n g r e g i o n a l a v e r a g e of 62 0 m a t e r n a l d e a t h s p e r 1 0 0 , 0 0 0 li v e bir t h s , a n d a co unt r y a v e r a g e of 4 1 0 m a t e r n a l d e a t h s p e r 1 0 0 , 0 0 0 li v e bir t h s . 2 9 Addit i o n a l l y it is a l s o li s t e d in t h e up d a t e d 74 co u nt r i e s wit h t h e hig h e s t inf a nt m o r t a l - i t y r a t e s , a s s t a t i s t i c s sh o w t h a t t h e co u nt r y h a s a n inf a nt m o r t a l i t y r a t e gr e a t e r t h a n 4 0 de a t h s p e r 1 , 0 0 0 li v e bir t h s . 3 2 - 3 4 Lack of p r o g r e s s in r e d u c i n g m a t e r n a l a n d inf a nt m o r t a l i t y sh o w s a re fl e c t i o n of t h e n e e d t o imp r o v e co v e r a g e of f a m i l y p l a n n i n g , a nt e n a t a l c a r e , a n d sk i l l e d b ir t h at t e n d a nt s dur i n g c hi l d b i r t h a n d p o s t n a t a l c a r e . 3 1 Ava il a b i l i t y of sk i l l e d b ir t h at - t e n d a nt s a n d e m e r g e n c y ob s t e t r i c c a r e m a y b e r e d u c e d du e t o un d e r s t a f fi n g , p a r t i c u l a r l y in r ur a l a r e a s .3 2
Health workforce S o u t h Afr i c a f a c e s sh o r t a g e s du e t o m o v e m e nt of he a l t h c a r e p r of e s s i o n a l s f r o m t h e PHCs to pr i v a t e h e a l t h f a c i l i t i e s a n d t h e n t o int e r n a t i o n a l h e a l t h a n d d e v e l o p m e nt o r g a n i s a - t i o n s . 3 5 The 2 0 1 1 Wo r l d Healt h St a t i s t i c s sh o w t h a t t h e d e n s i - t y p e r e v e r y 1 0 , 0 0 0 p o p u l a t i o n in S o u t h Afr i c a is 4 0 . 8 fo r nur s - i n g a n d mi d w i f e r y p e r s o n n e l , 7.7 fo r p hy s i c i a n s a n d a ve r y lo w 2 . 8 fo r p h a r m a c e u t i c a l p e r s o n n e l . 3 6 The dir e sh o r t a g e of p r of e s s i o n a l s in t h e p h a r m a c e u t i c a l wo r k f o r c e dir e c t l y af - f e c t s t h e d e v e l o p m e nt , m a n u f a c t u r e , di s t r i b u t i o n a n d p r o p e r us e of e s s e nt i a l m e d i c i n e s , in c l u d i n g t h e sup p o r t i v e f un c- t i o n s of r e g u l a t i o n a n d o p e r a t i o n a l r e s e a r c h . The su c c e s s - f u l im p l e m e nt a t i o n of t h e s e r e s p o n s i b i l i t i e s by co m p e t e nt p h a r m a c e u t i c a l p e r s o n n e l is r e q u i r e d fo r t h e e x i s t e n c e of a s t r o n g h e a l t h s y s t e m in or d e r t o a v o i d n e g a t i v e im p l i c a t i o n s o n t h e co u nt r y ’ s m a t e r n a l a n d inf a nt p o p u l a t i o n . 3 7 One of t h e in d i c a t o r s fo r t h e s e c o n d t a r g e t , im p r o v i n g m a t e r n a l a n d inf a nt h e a l t h , is t h e num b e r of chi l d b i r t h s fo r whi c h t r a i n e d mi d w i v e s a r e p r e s e nt . 13 Thus , t h e r e i nf o r c e m e nt of r e p r o d u c- t i v e h e a l t h s y s t e m s t hr o u g h jo i nt ef f o r t a n d co o p e r a t i o n wit h h e a l t h c a r e p r of e s s i o n a l s su c h a s mi d w i v e s a n d nur s e s is of p r i m e im p o r t a n c e in or d e r t o a c c e l e r a t e t h e p r o g r e s s of r e a c h i n g t h e m a t e r n a l h e a l t h t a r g e t s by 2 0 15 . 6 Fur t h e r m o r e ,
a s r e i t e r a t e d by Mr. B a n K i -Moon , cur r e nt S e c r e t a r y G e n e r a l of t h e Unit e d Natio n s , “Only f un c t i o n i n g h e a l t h s y s t e m s c a n d e li v e r a n int e g r a t e d p a c k a g e of e s s e nt i a l int e r v e nt i o n s a n d s e r v i c e s n e e d e d by wo m e n a n d gir l chi l d r e n a n d t o b e a b l e t o ma k e a dif f e r e n c e , t h e y mu s t r e a c h t h e m at t h e r ig ht p l a c e a n d t im e ”. 3 8
Health coverage The Unit e d Natio n s Popul a t i o n Fund (UNFPA) re c o m m e n d s a min i m u m of fo u r a nt e n a t a l c a r e v i s i t s t o p r o v i d e e s s e n - t i a l s e r v i c e s fo r p r e v e nt i n g m a t e r n a l h e a l t h co m p l i c a t i o n s su c h a s e c l a m p s i a . 3 9 A del a y in t h e d e c i s i o n t o s e e k c a r e fo r mat e r n a l a n d inf a nt h e a l t h is of t e n du e t o la c k of e du c a t i o n t o id e nt i f y co m p l i c a t i o n s , s o c i a l b a r r i e r s su c h a s la c k of a b i l i t y t o ma k e d e c i s i o n s , la c k of r e s o u r c e s , a n d t h e cul t u r a l b e li e f s a n d p r a c t i c e s sur r o u n d i n g c hi l d b i r t h a n d d e li v e r y. 4 0 Addit i o n a l l y, t h e d e l a y in a c c e s s i n g h e a l t h c a r e c a n b e infl u - e n c e d by f a c t o r s su c h a s p o o r ro a d s a n d t r a n s p o r t s y s t e m s , whi l e a de l a y in r e c e i v i n g qu a l i t y h e a l t h c a r e is of t e n du e t o in s u f fi c i e nt f a c i l i t i e s , sup p l i e s , fin a n c e s a n d t r a i n i n g of h e a l t h p e r s o n n e l . 4 1
Documentation and record keeping S o u t h Afr i c a ha s m a d e ef f o r t s t o in c r e a s e a c c o u nt a b i l i t y a n d d e d i c a t i o n t o imp r o v e m a t e r n a l h e a l t h by t h e fo r m a - t i o n of t h e Natio n a l Commi t t e e o n Confi d e nt i a l Enquir y int o Mater n a l D e a t h s (NCCEMD) an d ma k i n g m a t e r n a l d e a t h s a not i fi a b l e co n d i t i o n . 4 2 The NCCEMD st ip u l a t e s t h e t o p fi v e co n d i t i o n s c a u s i n g m a t e r n a l d e a t h s in S o u t h Afr i c a a s n o n - QSFHOBODZSFMBUFEJOGFDUJPOT DPNQMJDBUJPOTPGIZQFS- UFOTJPO PCTUFUSJDIBFNPSSIBHF QSFHOBODZ SFMBUFETFQTJT BOEQSFFYJTUJOHNBUFSOBMEJTFBTFT 4 3 Addit i o n a l a s s e s s m e nt by t h e NCCEMD es t im a t e d UIBUPGNBUFSOBMEFBUITXFSFDMFBSMZBWPJEBCMFXJUIJO t h e h e a l t h c a r e s y s t e m . 4 2 , 4 3 The mat e r n a l d e a t h r e p o r t t o t h e NCCEMD gi v e s a c c u r a t e inf o r m a t i o n o n t h e c a u s e s of de a t h s a n d qu a l i t y of c a r e wit h i n t h e h e a l t h in s t i t u t i o n s . Howe v e r, it is imp o r t a nt t o b e aw a r e t h a t m o s t m a t e r n a l d e a t h s t h a t t a k e p l a c e o ut s i d e of h e a l t h in s t i t u t i o n s a r e n ot r e p o r t e d UPUIF/$$&.%"OFTUJNBUJPOPGCFUXFFOBOEPG mat e r n a l d e a t h s o c c u r in h e a l t h in s t i t u t i o n s in r ur a l a r e a s . Lack of t h o r o u g h r e p o r t i n g o n ma t e r n a l d e a t h s o ut s i d e of h e a l t h in s t i t u t i o n s c a n t h e r e f o r e r e s u l t in p r e j u d i c e d co ll e c - t i o n of inf o r m a t i o n . 4 4
In 19 9 8 , S o u t h Afr i c a im p l e m e nt e d t h e Int e g r a t e d Mana ge - m e nt of Chil dh o o d Illn e s s e s , d e v e l o p e d by t h e WHO, to pr o m o t e im p r o v e d gr o w t h a n d d e v e l o p m e nt of chi l d r e n un d e r t h e a ge of fi v e . This pr o g r a m in c l u d e s t h e e a r l y d e t e c - t i o n a n d m a n a g e m e nt of t h e co m m o n c hi l d h o o d illn e s s e s int e g r a t e d wit h p r e v e nt a t i v e a n d cur a t i v e m e a s u r e s . 4 5 Howe v e r, a p p l i c a t i o n of t hi s p r o g r a m r e m a i n s a ch a l l e n g e up t o da t e , a s inf a nt m o r t a l i t y r a t e s h a v e o nl y s e e m e d t o in c r e a s e . The ma in c a u s e s of inf a nt d e a t h s in S o u t h Afr i c a a r e du e t o HIV/AIDS , di a r r h o e a , p n e u m o n i a in or d e r of t h e i r p r o m i n e n c e . Thir t y p e r ce nt of de a t h s we r e r e p o r t e d t o o c c u r JOUIFJSmSTUNPOUIPGMJGF*O PGDIJMESFOVOEFSUIF