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5.3. Country case study: Ghana
Authors
Amaning Danquah D, Head Education and Training, Pharmacy Council, Ghana, dandanquah45@gmail.com; Edith Andrews, Medicines Adviser, WHO Country Office, Ghana, andrese@ who.gh.who.int; Mahama Duwiejua, Professor and Executive Secretary, National Council for Tertiary Education, Ghana, mahama_duwiejua@yahoo.com; Joseph Nyoagbe, Registrar, Pharmacy Council, Ghana, kodjo1959@yahoo.co.uk; Martha Gyansa-Luterodt, Director of Pharmaceutical Services, Ministry of Health, Ghana, maglutt@hotmail.com
Summary
Access to good quality medicines and competent health care providers are fundamental aspects of the health care system. Pharmaceutical human resources are responsible for ensuring the uninterrupted supply of quality medicines to the population, their management, and rational use, all these being vital components of the architecture to improve access to medicines. The human resources for health crisis affects 57 countries worldwide, including Ghana.
In 2009, an assessment of pharmaceutical human resources was undertaken in Ghana (funded by the WHO and the European Commission), and the findings provided the evidence, which informed a human resources strategic framework and strategic pharmaceutical workforce plan. The plan was developed by key stakeholders with the intention of being integrated into the broader national human resources plan for health. Some of the key findings of the assessment were significant pharmaceutical human resources shortages, inequitable distribution, skill mix imbalances, and limited training capacity.
Even though Ghana training institutions had produced over 2,500 pharmacists since 2009, only a little over 1,500 were actively practicing in Ghana. Anecdotal evidence from the Pharmacy Council of Ghana identified workforce retention as the greatest challenge contributing to the key findings observed. The following strategies were adopted to address the workforce challenges, namely: expansion of training institutions, improved remuneration packages in the public sector, and the development and implementation of the Doctor of Pharmacy (Pharm D) degree and other continuous professional development (CPD) programmes.
5.3.1. Background
The introduction of pharmacy practice in the Gold Coast (now Ghana) in the 1930s was associated with the development of Western-type medical services in the country. Pharmacy has generally undergone tremendous changes both in concept and practice since then-major changes resulting in an emphasis on patients rather than medicines.
Pharmaceutical human resources in Ghana are required to provide services as diverse as medicines selection, procurement, compounding, dispensing, medicines information and advice, therapeutic drug monitoring, pharmacovigilance, manufacturing, training, and research.
Although Ghana has a register of 2969 pharmacists, 2139 technicians and 4250 medicine counter assistants, only a total of 1,966 are actively practicing pharmacists (0.81 per 10,000 population), 1,075 actively practicing pharmacy technicians (0.44 per 10,000), and 3,000 medicine counter assistants (1.24 per 10,000). In 2011, public and private sectors employed 35% and 65% of pharmacists, respectively, compared to 26% and 74% in 2009. The pharmaceutical manufacturing industry only employs 4% of the pharmacy workforce; however, this sector is expanding with the establishment of new manufacturing sites and growth of existing companies.
Table 5.3.1. Number of pharmacists per employment sector
Data source: Assessment of Pharmaceutical Human Resources 2011(1).
*Pharmacists are allowed to work in more than one sector of employment.
Table 5.3.2. Total number of premises providing pharmaceutical services
Data source: Pharmacy Council Register of Pharmaceutical Facilities 2011
5.3.2. Key issues
Challenges affecting pharmacy workforce planning, management, and/or development.
1. Distribution imbalance of pharmaceutical personnel between rural and urban areas 2. Needs-based pre-service pharmacy education 3. Poorly-defined roles of pharmaceutical personnel 4. CPD and career development: Lack of needs-based CPD programmes
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No. of pharmacists (N=1,966)
% Sector
Private Hospitals & Clinics 16 0.8
Private retail/wholesale pharmacies* 1,931 98.2
Pharmaceutical manufacturers 80 4.0
Academia/teaching 60 3.0
Multilateral/bilateral/NGOs 6 0.3
Not currently working N/A N/A
Public Health Institucions
Public Hospitals & Christian Health Association of Ghana (CHAG)
505
Quasi Gov t Hospitals 65
Regulatory 75 33.0
Types of premise Number Percentage Number of pharmacists
Public hospital pharmacies 172 1.3 570
Private hospitals/clinics dispensaries 925 6.7 16
Private retail/wholesale pharmacies 2,007 14.6 1,931
Licensed Chemical Sellers 10,602 77.4 N/A
Total 13,706 100.0
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5. Recruitment: Significant delays in the recruitment of personnel to the public sector (takes up to one year), which serves as a barrier to increasing public sector workforce levels 6. Incentives for attracting personnel to work in rural areas are not enforced
Projection and supply
Rural areas are the most affected when it comes to pharmaceutical personnel. There is a concentration of pharmacy personnel in urban areas due to lack of amenities and infrastructure such as quality public and private schools that act as a disincentive to working in the rural areas. Pharmaceutical cadres are concentrated in urban regions with the ratio of pharmacy personnel in each region ranging between 0.14-3.17 per 10,000 population for pharmacists (Table 5.3.3) and 0.12-0.52 for pharmacy technicians. This disparity has led to inequitable service provision. To ensure that only quality products are made available to the population, functional and well-resourced pharmaceutical supply and regulatory systems are required, with adequate numbers of trained personnel.
Table 5.3.3. Regional Distribution of Health facilities and Pharmacy Work-
force 2011
Figure 5.3.1. Comparative frequencies for density of pharmacists per 10,000 and density of pharmacies per 10,000 in the different regions of Ghana (logarithmic scale to enable region comparison)
Sources: Ghana Statistical Service, 2010 Population and Housing Census; Private Hospitals and Maternity Homes Board Report, 2011; Pharmacy Unit MoH/Ghana Health Service (GHS) November 2011; Pharmacy Council, 2011
Education capacity, skill mix
There are currently three universities undertaking the training of pharmacists (Bachelor of Pharmacy degree) with a combined annual intake of 240 students in 2009; one pharmacy technician training school (Higher National Diploma) enrolling 90; and 21 Medicines Counter Assistants (MCA) programmes enrolling 600 students every six months. To date, there are no formalised training requirements for Licensed Chemical Sellers (LCS). However the Pharmacy Council (PC) organises annual training programmes for LCS and CPD programmes for pharmacists.
The curriculum for pharmacy education has also been revised to a Doctor of Pharmacy (Pharm. D) programme to improve patient-pharmacist interaction, address job satisfaction and career development challenges, and also bridge the wide gap between academia and practice to reflect emerging trends in health care delivery in other countries.
The Specialist Health Training and Plant Research Act [3] which establishes the College of Pharmacists is also being implmented to provide further opportunities for post-graduate and specialist training locally.
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Number pharmacists
Number pharmacies
No. of public health facilities
No. of private hospitals, clinics & maternity homes (PHCM)
Pharmacists % change 2009-11
Technicians % change 2009-11
Density pharmacists /10,000 population
Density pharmacies /10,000 population
Region
Greater 1238 1328 34 51 18.9 28.6 3.17 3.40
Accra
Volta 30 25 175 55 7.1 2.4 0.14 0.12
Region
Eastern 60 62 357 26 34.8 0.0 0.23 0.24
Central 46 44 106 84 2.2 8.1 0.22 0.21
Region
Western 58 50 110 242 3.6 0.0 0.25 0.21
Ashanti 400 420 159 269 21.2 9.6 0.85 0.89
Region
Brong 58 48 82 130 38.1 0.0 0.25 0.21
Ahafo
Northern 47 18 196 15 67.9 42.1 0.19 0.07
Region
Upper 47 18 196 15 67.9 42.1 0.19 0.07
East
Upper 12 6 57 2 50.0 0.0 0.18 0.09
West
TOTALs 1966 2007 1310 925 20.1 15.6 0.81 0.83
Upper EastNorthern Region
Upper West
Volta Region
EasternCentral Region
WesternBrong Ahafo
Ashanti Region
Greater Accra
0.21
0.06 0.09
0.21
0.12
0.89
0.24
0.07
3.40
0.21 0.25
0.150.18
0.25
0.14
0.85
0.23 0.19
3.17
0.22
D en
si ty
p er
1 0,
00 0
(lo g1
0 fo
r s ca
lin g)
3.00
2.00
1.00
0.00
Density pharmacies per 10,000 Density pharmacists per 10,000