24 25
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The vision and competency project team has developed an initial construct towards an educational roadmap to guide efforts in and mechanisms for pharmacy education [16]. Countries, particularly those marginalised by the human resources for health crisis, can use the evidence gathered to develop their workforce and to track the results of their efforts. The scaling up, quality assurance, and quality improvement of global pharmacy education are prerequisites for addressing workforce shortages and service development.
Since publication of the 2009 Workforce Report, a revision of the literature, discussion panels, respondent validation, and an online validation survey were conducted that supported the development of the first Global Competency Framework (GbCF) for services provided by members of the pharmacy workforce. The Global Competency Framework (GbCF) Version 1 contains a core set of behavioural competencies (www.fip.org/education_taskforce).
The GbCF Version 1 can be a starting point to provide guidance for foundation level practice, not only at an individual level but also for further development into advanced practice. It can also be an aid in providing an overview of how practice at a foundation level can be translated into what and how students should learn and interact with pharmaceutical care skills during their initial degree, always with country specifications in mind (the GbCF does not imply that there should be a single global curriculum that would fit all countries). Table 4.1 indicates the terminology used by PET regarding the theme of competence.
Table 4.1. Terminology used by PET [17]
Acting as a mapping tool for the creation of country specific needs for the development of practice and practitioner professional development, the GbCF can be attached to an assessment grid and, together with appropriate assessment tools, can aid countries that do not currently have a competency framework but wish to develop one. By creating a portfolio, in synergy with other assessment tools, countries can implement the GbCF into practice, developing education and training infrastructures for their practitioners.
Table 4.2. Prevalence of practitioner development (or competency) framework
Data gathered from the global workforce report survey in 2012 indicate that 27 countries (33%) have a competency framework for pharmacists, 17 countries (21%) are currently developing one and 37 countries (46%) do not have one in place. For pharmacy technicians, 18 countries (24%) reported having a competency framework, 8 countries (11%) reported they are developing one and 48 countries (65%) reported that they do not have a competency framework. As stated in Table 4.2, despite an increase in number of respondents, there has been no significant increase in the number of countries that have reported using or developing a national competency framework since 2009.
The data also support the growing body of evidence that suggests that frameworks that use a competency approach are being implemented by pharmacists and pharmacy technicians as a way of operationalising otherwise vague concepts of CPD and CPD policy. [18-22].
The GbCF is under development; there is further work to be done and more studies to be conducted to effectively define the core competencies for a foundation level framework across all pharmacy sectors that will improve the competence of the practitioners. Nonetheless, the findings provide evidence that at the core, a practitioner is the same globally (i.e. having similar expectations of competence). Practice is likewise similar, as practitioners are experts of medicines. This is a key moment in global education development and should form the basis for further research and development into advanced practice development strategies.
4.5 Pharmacy support workforce
FIP acknowledges that health care facilities cannot operate without medicines [14]. The availability of both medicines and a pharmacy workforce in adequate numbers with appropriate competencies is crucial to ensuring a well-functioning phar- maceutical system [14].
.................................................................................
Single item of knowledge, skill or professional value.
A complete collection of competencies that are thought to be essential to performance.
Full repertoire of competencies.
The knowledge, skills, behaviours and attitudes that an individual accumulates, develops, and acquires through education, training, and work experience.
Effective and persistent behaviour.
A measure of performance against a specified criteria or standard.
The systems, procedures, and information used by the pharmacists in providing professional services that serve as a standard against which performance can be assessed.
Competency
Competency Framework
Competence
Competencies
Performance
Performance Indicators
Practice Standards
Pharmacists
2009 Workforce Report (n=52) 2012 Workforce Report (n=81)
Yes 20 (38%) Yes 27 (33%)
In development 13 (25%) In development 17 (21%)
No 19 (37%) No 37 (46%)
Pharmacy Technicians
2009 Workforce Report (n=41) 2012 Workforce Report (n=74)
Yes 8 (20%) Yes 18 (24%)
In development 9 (22%) In development 8 (11%)
No 24 (59%) No 48 (65%)
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In low-income countries where a shortage of pharmacists and technologies exists, other cadres are required to have extended responsibilities. This reliance on mid-level cadres is consistent with global trends and often reflects the unavailability of more highly qualified health professionals in those countries [23, 24]. In middle to high-income countries, well-trained pharmacy support staff allow pharmacists more time for clinical activities, which can translate into improved patient health outcomes and savings in health expenditure [25-27].
The global distribution of the pharmacy support workforce is varied. Global Pharmacy Workforce Survey data for 2012 show the greatest reliance on pharmacy support workforce cadres to be in South East Asia (67.5%), with the Americas (28.4%) being least reliant on these cadres (Figure 4.6). Significant variation is, however, also evident between countries within regions.
Figure 4.6. Percentage of regional means for pharmacy and technician
workforce (n=62 matched variable pairs)
Many terms are used to describe those working within the pharmacy support workforce (e.g.pharmacy technician, assistant, technologist, dispenser, assistant pharmacist) with a variety ofexpected competency patterns. It should be noted that the International Labour Organisation adopted a definition for pharmacy technicians Pharmacy technicians and assistants perform a variety of tasks associated with dispensing medicinal products under the guidance of a pharmacist, or other health professional [28]. However is not used consistently, with many countries requiring these cadres to work unsupervised (especially in rural environments) [29].
A better understanding of the pharmacy support workforce is required to meet their needs in regard to education, registration and other work related issues. In response to this need, a global pharmacy support workforce review for non-pharmacist roles is being undertaken to present a global picture of the diverse nature of this cadre. Preliminary data indicate the varied nature of workforce distribution, cadre names, competency expectations, supervision, regulation systems and education needs.
With a consistent call from countries for a greater focus on pharmacy support workforce cadres, future involvement in this sector of the pharmacy workforce is to be encouraged. Any global focus should seek to address local country needs with the larger aim of ensuring safe use of quality medicines by patients.
4.6 Developing educational leadership
As pharmacy roles continue to evolve and the number of health providers rises to better meet the health needs of a globalized society, transformative leadership is needed to ensure that educational systems continue to innovate while remaining harmonized with workforce planning. The same globalization that has increased economic, social, technical and political interdependence between nations has also influenced education. International trade, cultural exchange, and the use of webbased communication systems have created opportunities for more robust discussions of collaborative but needs-based educational models for pharmacy services [30]. Taking full advantage of these opportunities will require new insights, skills, and perspectives at every leadership level.
However, for these discussions to be transformative, there must be a better understanding of how culture affects leadership.
Advancing educational leadership will require the profession to purposefully study the evidence from health care, education, and leadership. Some educational systems have prioritized leadership development as a critical part of the training programs required of pharmacists and pharmacy staff. Accreditation bodies (e.g., the US-based Accreditation Council for Pharmacy Education s Standards and Guidelines [31]) increasingly value inclusion of leadership instruction. Some professional organizations have created special interest groups and frameworks (e.g., the Royal Pharmaceutical Society Leadership Competency Framework [32]) to support leadership development across the career of the pharmacy professional. Such models tend to be focused on a single system or population, however, and additional work is needed to determine the potential for cross applicability. Further, as educational systems continue to connect, there is a need for specific training for leaders to become competent in cross-cultural awareness and practices.
Although there are numerous local, regional, and national efforts for leadership communication, development and recognition, some resources with an international focus include, but are not limited, to:
International Leadership Association - http://www.ila-net.org/ This association is a global network for all those who practice, study and teach leadership.
The Leadership Quarterly - http://www.sciencedirect.com/ science/journal/10489843 | This journal brings together a focus on leadership for scholars, managers, and administrators, as well as university academic staff across the world who teach leadership courses.
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% t
ot al
w or
kf or
ce
100.0
75.0
50.0
25.0
0.0
56.8
32.5
64.3
49.5
71.6
51.1
43.2 67.535.7 50.528.4 48.9
SE Asia Eastern Mediterranean
Africa Europe
Western Pacific Americas
Pharmacist workforce
Technician workforce