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This part presents nine case studies on pharmacy workforce planning, management, and development from Afghanistan, Costa Rica, Ghana, Great Britain, Japan, the Pacific Island Countries, Singapore, South Africa, and Tanzania. Sourced from different regions, each case study describes a unique set of pharmacy workforce challenges and issues. The particular focus on Africa, with three case studies from Ghana, South Africa, and Tanzania, reflect the broad changes taking place in this region that is still most affected by the severe shortage of health care professionals. The case studies provide an overview of strategies employed to address key workforce challenges, associated outcomes and lessons learnt.
5.1 Country Case Study: Afghanistan
Authors
Heidarzad N, nheidarzad@yahoo.com; Amarkhail S, shakilla. ammarkhil560@gmail.com, General Directorate of Pharmaceutical Affairs, Ministry of Public Health, Afghanistan; Hakimyar S, samira_hakimyar@yahoo.com, General Directorate of Human Resources, Ministry of Public Health, Afghanistan; Naimi HM, hm_naimi@yahoo.com, Faculty of Pharmacy, University of Kabul, Afghanistan; Amini K, kamini@msh.org; Ehsan J, jehsan@msh.org; Taban Q, qudrattaban@yahoo.com; Wang S, swang@msh.org; Omari Z, momari@msh.org; Morris M, mmorris@msh.org, Strengthening Pharmaceutical Systems Project, Afghanistan; and Wuliji T, twuliji@urc-chs.com, Pharmaceutical Human Resources Consultant.
Summary
There are seven times more pharmaceutical establishments than the total number of pharmacists and pharmacy assistants in Afghanistan.
Evidence and multi-stakeholder collaboration are required to inform needs-based pharmaceutical human resources planning.
In 2011, the Ministry of Public Health conducted a comprehensive assessment of pharmaceutical human resources at the national, provincial, facility, and individual levels to identify key issues and to provide data to inform planning.
Through multi-stakeholder processes, the Ministry of Public Health has developed a draft Pharmaceutical Human Resources Strategic Framework describing strategic objectives and strategies to address priority issues.
5.1.1. Background
The Islamic Republic of Afghanistan is a landlocked country with an estimated population of more than 30 million, of which almost 80% reside in rural areas and 36% live below the
poverty line. Life expectancy is 48 years and while mortality rates have declined significantly over the last 10 years, they remain high with an under-five child mortality rate of 149 per 1,000 live births and a maternal mortality ratio of 449 per 100,000 live births [1].
With approximately 1,163 pharmacists and 822 pharmacy assistants in the country, this workforce is outnumbered seven-fold by the 10,131 private pharmacies, 2,082 public sector pharmacies, 677 pharmaceutical wholesalers, and 17 pharmaceutical manufacturers [2]. These figures are especially concerning given the vital role the pharmacy workforce plays in the health system, providing services ranging from manufacturing and regulating medicines to distributing and dispensing medicines. The number of new pharmacists is limited, as there is only one training institution in Afghanistan (the Faculty of Pharmacy at Kabul University). However the number of schools training pharmacy assistants has increased recently to 21; all but one of these schools are public.
Stakeholders identified eight major areas of services across the public and private pharmaceutical sector in 2010 (described in the Competency Framework for Pharmaceutical Services in Afghanistan):
1- Policy and planning 2- Laws and regulation 3- Quality assurance systems 4- Production/manufacturing 5- Procurement 6- Supply chain management 7- Dispensing: Outpatient hospital and private pharmacy 8- Hospital inpatient dispensing (hospital)
The Ministry of Public Health (MoPH), together with various partners, is actively rebuilding the pharmaceutical system after more than 30 years of conflict to provide safe, affordable, and equitable access to medicines. These efforts include strengthening regulatory and quality assurance mechanisms, implementing strategies and policies to improve rational use of medicines, and supporting the development and reform of pre-service education-all of which require stronger pharmaceutical human resources to ensure the sustainabilityof these efforts.
The General Directorate of Pharmaceutical Affairs (GDPA) and the General Directorate of Human Resources (GDHR) within the MoPH, together with other institutions, are responsible for all activities related to creating and maintaining a sustainable workforce in the pharmaceutical sector. In 2010, the GDPA and GDHR formed a core team with the support of the U.S. Agency for International Development s (USAID s) Strengthening Pharmaceutical Systems (SPS) Project. This core team steered the development and implementation of a comprehensive pharmaceutical human resources assessment in 2011, analyzed and presented findings from the assessment, and facilitated the development of a pharmaceutical human resources strategic framework in 2012 (Figure 5.1.1).
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PART 5 PHARMACY WORKFORCE PLANNING, MANAGEMENT AND DEVELOPMENT CASE STUDIES