The focus on experiential education methods to develop work-based competency has shown quick competency development with immediate application to the workplace.
Engaging practitioners, locally active international organizations, and academia is a constructive way to promote local needs and best practice in pharmacy workforce development.
A picture of the Pacific
Twenty-two independent island countries scattered over 30 million square kilometres of the Pacific Ocean, comprising of more than 7500 islands, form the Pacific Islands. The Pacific Islands encompass a wide variety of ethnic, cultural, and linguistic groupings that can be broadly divided into Melanesia, Micronesia and Polynesia.
The region has a population of approximately 9.6 million people distributed among a number of small island states with populations varying from 1170 in Tokelau to more than 6,000,000 in Papua New Guinea (PNG) .
Pharmacy in the Pacific
Approximately 300 pharmacy personnel are distributed throughout the public sector of PICs (excluding the PNG estimate of 75), with more than 80% of these filled by pharmacy assistants or similar mid-level cadres [2, 3]. This reliance on mid-level cadres is consistent with global trends and reflects the unavailability of more highly qualified pharmacists [4, 5]. There is less than one pharmacist per 10,000 population on average across PICs , a ratio similar to that found in sub-Saharan African countries .
Essential medicine supply management (EMSM) is the main function carried out by government pharmacy departments across PICs, with clinical hospital pharmacy developing in selected tertiary hospitals of larger countries where sufficient pharmacists are available (eg Tonga and Fiji). Community pharmacy is active in most of the region s countries, with non-pharmacist cadres playing a significant role in many countries.
Health care in PICs is delivered in rural environments where approximately 80% of the population reside . The workforce responsible for maintaining the medicines supply system in PICs is made up of nurses, midwives, nurse aids, and other health personnel at the primary health care level (Level 1); pharmacy supply and health personnel at the provincial/ regional level (Level 2); and pharmacists where available and stores managers at the national level (Level 3) . (Figure 5.6.1)
5.6 Country case study: Pacific Island Countries (PICs)
Andrew Brown, BPharm, Assistant Professor, FIPEd PET, Domain Lead Pharmacy support workforce, Faculty of Health, University of Canberra, Australia, andrew.brown@canberra. edu.au; Peter Zinck, BPharm, Health Systems Specialist, the United Nations Population Fund (UNFPA) Suva Sub-Regional Office, Fiji, firstname.lastname@example.org
In country partners
Biribo Tekanene, Chief Pharmacist, Ministry of Health, Cook Islands
Apolosi Vosanibola, Chief Pharmacist, Ministry of Health, Fiji
Ioana Taakau, Chief Pharmacist, Ministry of Health, Kiribati
Timmy Hanei, Chief Pharmacist Ministry of Health, Solomon Islands
Melenaite Mahe, Chief Pharmacist, Ministry of Health, Kingdom of Tonga
Natano Elisala, Pharmacist/Storeman, Ministry of Health, Government of Tuvalu
Lucy Norman, Central Medical Stores, Ministry of Health, Republic of Vanuatu.
Twenty-two independent island countries scattered over 30 million square kilometres of the Pacific Ocean, comprising of more than 7500 islands, form the Pacific Islands.
Approximately 300 pharmacy personnel are distributed throughout the public sector of PICs, with more than 80% of these filled by pharmacy assistants or similar mid-level cadres.
A lack of education capacity to support competency development of the cadres involved in pharmacy-related services is one of the main issues affecting pharmacy workforce development in PICs.
A new approach has been developed involving a partnership between UNFPA Suva Sub-Regional office, the University of Canberra, Ministry of Health officials, and health personnel within identified PICs.
Cultural principles of learning and a pharmacy competency framework for PICs have been developed and used to create novel, experiential competency-based training approaches for specific cadres.
LEVEL 3: NATIONAL TERTIARY
Example Cadres: Pharmacists and stores personnel
Place of work: National level in Medical Stores or Pharmacy departments
Medicines ﬂow from National Level to Provincial Hospital/Store
LEVEL 1: SECONDARY
Example Cadre: Nurses, primary health care workers and nurse aids
Place of work: Clinics, area health centres and aid posts
Training/knowledge products: 5 day RHCS in-service workshop
Medicines ﬂow from the Primary Care Centre to the Patient
LEVEL 2: SECONDARY
Example Cadres: Pharmacy assistants, stores personnel, nurses and other mid-level cadres
Place of work: Hospitals, provincial stores level, area health centres
Training/knowledge products: Certiﬁcate III in Hospital/Health Services Pharmacy Support (junior staff), Certiﬁcate IV in Hospital/Health Services Pharmacy Support (Supervising staff)
Medicines ﬂow from Provincial Hospital/Store to Primary Care Centre
Figure 5.6.1. An overview of government pharmacy support workforce
cadres in PICs 5.6.2. Key issues
A lack of education capacity to support competency development of the cadres involved in pharmacy related services is one of the main issues affecting pharmacy workforce develo ment in PICs. Evidence of the shortfall is provided by the Australian Agency for International Development (AusAID), UNFPA, and the World Health Organization (WHO), which report continued problems in maintaining the supply of essential medicines through to the clinics and aid posts of PICs [8-13]. WHO asserts that many maternal and child health related deaths in the region may be prevented with readily available essential medicines provided by suitably trained health personnel .
Pacific pharmacy education
Training in EMSM has been conducted in the Pacific over the last several years by UNFPA, United Nations Children s Fund (UNICEF) and WHO . To a large extent, EMSM training in PICs has been fragmented, superficial, and without a long-term plan to sustain the competencies needed for continued availability of essential medicines. Each agency has promoted their EMSM framework and principles, but with limited reference to local competencies or cultural requirements for effective training .
Generalised EMSM training has been used in the past and assumes all target audiences are the same. Within PICs, expected competencies are different for various health personnel depending on their level of activity within the medicines supply system [3, 15]. Any new training strategy should acknowledge this variation and should ensure that the core competencies of medication selection, procurement, distribution, use, and management are addressed.
The Fiji National University (FNU) and the University of Papua New Guinea (UPNG) are the only universities in the region providing diploma and degree level pharmacy education, with most graduates going into the private sector. No formal certificate training is available for mid-level cadres involved in EMSM, apart from semi-structured localised training in the Solomon Islands and Tonga. FNU and UPNG initially ran pharmacy assistant courses before upgrading to their current programme based on traditional Australian curricula . With more than 80% of pharmacy staff posts filled by non-pharmacists with limited formal training, the need for a focus in this area is clear .
Health personnel need to be competent in relevant aspects of EMSM in order to direct their country supply systems effec- tively. This material is often missing from pre-service curricula, while skills in appropriate EMSM are often assumed. As a result, many heath personnel lack the skills required for this essential part of their day-to-day work .