As current essential medicines supply provision continues to fall short of WHO and UN targets, a new systematic, needs-based approach for essential medicines supply management (EMSM) education is zrequired as a first step in developing a competent workforce in PICs.
5.6.3. Strategies used and lessons learnt
A new approach has been developed involving a partnership between UNFPA Suva sub-regional office, the University of Canberra (UC), Ministry of Health officials and the health personnel within identified PICs (Federated States of Micronesia, Republic of Kiribati, PNG, Solomon Islands, Kingdom of Tonga, Tuvalu, and Republic of Vanuatu).
The FIP-PET needs-based approach to pharmacy education  and a participatory action research (PAR) methodology have been used to form a systematic framework to provide a regional solution to these educational deficiencies (See Figure in Part 4. Pharmacy education). Such a framework is consistent with local cultural norms and has the effect of meeting the expectations of donor organisations and local Ministries of Health by providing immediate, tangible benefits that can be presented to the global research community.
In the health sector, PAR is based on reflection, data collection, and action that aims to improve health and reduce health inequities through involving heath personnel who, in turn, take actions to improve their own circumstances . Any resultant action is then further researched, and an interactive reflective cycle perpetuates data collection, reflection, and action.
This systematic strategy has as its starting point the need to understand local culture and its impact on learning and teaching, the mapping of competency requirements, and an understanding of currently available information and materials. Subsequently, this information has been applied to develop and trial new pedagogical approaches to the training of health personnel involved in EMSM. This strategy seeks to support the existing systems of the country.
It is important to note that education is only part of a sustainable approach to HRH development. The HRH Action Framework demonstrates the interrelationship between human resource management systems, leadership, partnership, finance, education, and policy (Figure 5.6.2) . The framework identifies that education should not be considered in isolation, but is one of six interrelated components that need to be addressed for sustained development in HRH to be achieved . Any new approach to EMSM education must integrate into the overarching HRH plan for individual PICs.
Figure 5.6.2. WHO Global Health Workforce Alliance (GHWA) Health Action
Framework (HAF)  (The HRH Action Framework is an initiative of the GHWA and represents a collaborative effort between the U.S. Agency for International Development (USAID) and WHO. Republished with permission)
Through engaging in this regional strategy, we have learnt that considering culture and countryspecific requirements is important to the countries. The focus on practical, work-based competency has shown quick competency development with immediate application to the workplace. Overall, engaging practitioners, locally active international organizations, and academia is a constructive way to promote the needs and best practice of pharmacy education.
A literature search and several focus groups were conducted involving various levels of health care personnel in PICs to determine cultural learning needs and expectations of training approaches. Using this data, we have established 20 principles that should be considered when preparing training for PICs (publication in process). These principles take into account cultural considerations and the priorities of health care workers in the region and are used to guide the development of training materials.
FINANCE HUMAN RESOURCES MANAGEMENT SYSTEMS
IMPROVED HEALTH WORKFORCE
HEALTH SERVICES EQUITY
EFFECTIVENESS EFFICIENCY QUALITY
BETTER HEALTH OUTCOMES S
OTHER HEALTH SYSTEMS
COUNTRY SPECIFIC CONTEXTS INCLUDING LABOR MARKETS
I N G
There is a scarcity of information available in the published and grey literature concerning the competencies required for medical supply management of various cadres of health care workers in PICs. In-country competency mapping exercises were conducted in PNG, Vanuatu, and the Solomon Islands with online validation activities and focus groups conducted to verify a pharmacy competency framework for Pacific Island Countries (available from main author on request). The validated competency framework is service-based rather than cadre specific, containing 113 competencies organised into four clusters: 1) Organisation and Management Competencies - a systems focus, 2) Professional/Personal Competencies - a practice focus, 3) Pharmaceutical Public Health Competencies - a population focus, and 4) Pharmaceutical Care Competencies - a patient focus. A service-based approach allows wider application to the diverse pharmacy practice environments of PICs. Health personnel responsible for the delivery of pharmacy services are encouraged to use this tool when considering appropriate training in EMSM and when monitoring staff effectiveness in their local environments.
Existing training materials for health personnel involved in EMSM at the facility level were reviewed by locally practising health personnel. The personnel concluded that currently-used materials do not cover the expected competency requirements for these health personnel, while the structure and content of the materials assessed do not consistently meet the local criteria for best practice in training.
In considering cultural aspects of learning and the competency requirements for various cadres of staff, three different competency development approaches have been developed and are being trialled in a creative commons environment:
1- A country specific five-day skills based workshop with workplace follow up for primary health care workers, including nurses, midwives and nurse aids (Level 1);
2- A ten month on-the-job certificate using a combination of distance and short intensive sessions with workplace follow up for health care workers in medicines supply at the provincial level (Level 2); and
3- A short intensive workshop with workplace mentoring and follow up for pharmacists and stores managers at a national level (Level 3).
Level 1 competency-based education model
The Level 1 teaching methodology uses an individual, needs-based approach to develop a practical training manual and a country specific interactive workshop with a focus on medicines supply management competencies. To do this, a pre-Level 1 training screening tool is used in conjunction with stakeholder engagement by phone and e-mail
to determine the current standard opperating procedures and policies that affect medicines supply management in that country. This data is then used to develop a competency based, problem oriented, practical training manual and an interactive five-day workshop with the involvement of local health care personnel.
Skills games, role play, group discussion, story telling, and site visits provide the basis of the experiential workshop with limited use of computer projection and maximum involvment by local health care personnel. Selected competencies and participant self-assessment are measured before and after the workshop. Three months after the workshop, heath care personnel are visited by a local supervisor to note the translation of developed compitencies into the local environment anddiscuss any workplace-related issues. Level 1 workshops have been conducted in nine countries with a total of 224 particpants. Participant feedback indicates that the practical nature of the workshop with specific reference to workplace activities has enabled compenency improvment. This has been confirmed though our assessment of the students. The use of group work enabling communication in local languages and group discussions where participants can hear and share ideas have been documented as highlights consistent with their cultural approach.
Level 2 competency-based education model
In the absence of training programmes in the region for Level 2 health care workers, we are currently trialling a ten-month on-the-job certificate (certified under the Australian Qualifications Framework), using a combination of distance and short in-country intensive sessions in Vanuatu and Fiji with a total of 33 participants. The course is coordinated by the University of Canberra. The development process engaged Ministry of Health staff and local academic institutions, where they exist, to help develop the overall course structure and required training material. Mechanisms are being explored using mobile phone to provide out of country support. Local supervision is provided through the use of senior staff within the pharmacy and medical stores environment, supported by the University of Canberra.
This course aims to develop competent staff who are able to deliver services in the areas of EMSM, enabling those who have completed the course to better support pharmacy and medical supply management systems within their respective country environments. This course is designed for junior staff or entry-level workers.
Level 3 competency-based education model
In September 2010, a regional, two-week competency development workshop was hosted by UNFPA for pharmacists and medical stores personnel who hold national responsibilities for medicines supply management in 16 PICs. The focus of the workshop was on the development and local application of medicines supply competencies. To facilitate this approach, participants established work plans and a framework for a peer group