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and external mentoring programme. It is envisaged that this mentoring programme will be utilized and assessed to determine if a mentoring approach aids in the implementation of the country specific work plans to develop local medicines supply competencies.
5.6.5. The future
By the end of 2012, validated pedagogical approaches for the development of medicines supply competencies in two of the three cadre levels will be completed and made available to the wider international community in a creative commons environment.
We are still to determine whether the competency-based education approaches we have developed can be made sustainable in the local environment. In the future, these pedagogical approaches will be made available to a broader range of academic institutions in the region, including universities, tertiary colleges, and ministries of health. To aid in the uptake of these new approaches, it is envisaged that in-country academic workshops will be conducted detailing the pedagogical approaches and aiding their implementation in various health care curricula. Uptake of the new approaches and their implementation will then be monitored over the following twelve months.
References
1. UNFPA. United Nations Population Fund Pacific Sub Regional Office. 2012 [cited 7 February 2012]. Available from: http://countryoffice.unfpa.org/pacific/
2. UNSW-HRH. Mapping Human Resources for Health Profiles from 15 Pacific Island Countries; 2009.
3. Brown A. A systematic review of the literature addressing competencies, training and workforce requirements for any health care worker in Pacific Island Countries involved in essential medicines supply management. Report to the Pharmaceuticals Programme, Western Pacific Regional Office, World Health Organization; 2009.
4. Brown A, Cometto G, Cumbi A, de Pinho H, Kamwendo F, Lehmann U, et al. Mid-level health providers: A promising resource. Rev Peru Med Exp Salud Publica. 2011;28(2):308-15.
5. Fulton BD, Scheffler RM, Sparkes SP, Auh EY, Vujicic M, Soucat A. Health workforce skill mix and task shifting in low income countries: A review of recent evidence. Human Resources For Health. 2011;9(1):1.
6. FIP. 2009 FIP Global Pharmacy Workforce Report. 2009 [cited 10 February 2012]. Available from: http://www.fip.org/programmesandprojects_ pharmacyeducationtaskforce_humanresources?filename=fip 2009%20 GPWR%20cover%20contents%20foreword.pdf
7. WHO-WPRO. Regional Strategy on Human Resources for Health, 2006-2015. 2007 [cited 10 February 2012]. Available from: http://www.wpro.who.int/ publications/PUB_978+92+9061+2445.htm
8. WHO. The World Medicines Situation 2011 Medicines Prices, Availability and Affordability. 2011 [cited 10February 2012]. Available from: http://www.who.int/medicines/areas/policy/world_medicines_situation/ WMS_ch6_wPricing_v6.pdf
9. AusAID. Tracking development and governance in the Pacific. 2008 [cited 10 February 2012]. Available from: http://www.ausaid.gov.au/publications/ pdf/track_devgov.pdf
10. AusAID. Pacific Regional Aid Strategy 2004 2009. 2004 [cited 10 February 2012]. Available from: http://www.ausaid.gov.au/publications/pdf/ pacific_regional_strategy.pdf
11. UNFPA. Reproductive Health Commodity Security (RHCS) Status Assessment Reports for 10 Pacific Islands. 2008 [cited 10 February 2012]. Available from: http://210.7.20.137/Pages/Connect_RHCS.html
12. UNFPA. UNFPA Annual Report 2010. 2010 [cited 10 February 2012]. Available from: unfpa.org/public/home/publications/pid/7797
13. WHO-WPRO. Regional Strategy for Improving Access to Essential Medicines in the Western Pacific Region 2005-2010. 2005 [cited 10 February 2012]. Available from: http://www.wpro.who.int/publications/ PUB_9290611855.htm
14. WHO-WPRO. Special Issue on EC/ACP/WHO Partnership on Pharmaceutical Policies (Year 5). Essential Drugs Medicines Policy. 2010;2010(4):1-12.
15. Brown A. Supply training package for essential reproductive health medicines & devices for 1st level Health Workers, A report for the United Nations Population Fund. Suva: UNFPA Suva; 2009.
16. Bailey MC, Khaiyum E, Prasad VR. Fiji School of Medicine Diploma in Pharmacy graduates, ten year analysis-where are they now? Pac Health Dialog. 2006;13(2):151-4.
17. Anderson C, Bates I, Futter B, Gal D, Rouse M, Whitmarsh S. Global perspectives of pharmacy education and practice. World Medical & Health Policy. 2010;2(2):5-18.
18. Reason P, Bradbury H, editors. The SAGE Handbook of Action Research: Sage Publications; 2008.
19. WHO-GHWA. HRH Action Framework. 2012 [cited 14 February 2012]. Available from: http://www.capacityproject.org/framework/
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5.7. Country Case Study: Singapore
Authors
Lita Chew, Registrar, Singapore Pharmacy Council, phacst@ nus.edu.sg; Wu Tuck Seng, President, Singapore Pharmacy Council; Christine Teng, President, Pharmaceutical Society of Singapore; Lim Hui Leng, Member, Pharmaceutical Society of Singapore
Summary
Ageing population, increasing burden of chronic diseases, and rising health care costs are significant challenges that must be addressed by the pharmacy profession in Singapore
Collaboration of pharmacy profession with other health care members to achieve safe, optimum, seamless care for patients and the public is key
Investing in capacity and capability building of pharmacists is crucial. This includes manpower development, education, training, leadership, specialisation for pharmacists, and role redesign of pharmacy support workforce
Information, communication, and automation technology is being leveraged to provide safe, quality and cost effective pharmacy services
Policies and regulations are being developed or used to drive and achieve safe and quality care
A unified philosophy that galvanises the pharmacy profession and focus on patients through professional practice, ethics, and values is being developed and propagated
5.7.1. Background
Singapore is an island city-state with a population of 5.18 million people [1]. It has a well-established health care system, public and private, with an excellent reputation for quality medicine. In the World Health Report on health systems, Singapore was ranked number one in Asia and sixth globally [2]. Health care provision comprises a mix of seven public hospitals and six specialty centres, which together accounts for 72% of inpatient beds, with 16 private hospitals accounting for the remaining 28%. Primary health care is easily accessible through an extensive and convenient network of some 2000 private general practitioners and 18 public outpatient polyclinics. Private practitioners provide 80% of primary health care services whilst government polyclinics provide the remaining 20% [3]. Health care financing is based on a combination of government subsidies (Medisave, Medishield, Medifund), through taxation and individual responsibility.
The health care system in Singapore faces major challenges - a growing and ageing population, increasing burden of chronic diseases, and rising health care costs. As such, the shift from episodic care to long-term care, community-based disease prevention, and treatment of chronic diseases are necessary.
Pharmacists in Singapore work in diverse settings, including community pharmacies, hospitals, pharmaceutical industry, academia, and research. As of December 2011, there are 2013 pharmacists registered with the Singapore Pharmacy Council. Approximately 50% of the registered pharmacists work in patient care with a majority working in public institutions. The pharmacist-to-population ratio is approximately 1:2800 [4].
Rising to the challenge, pharmacists are embracing new professional roles, aside from their traditional dispensing role, to ensure the provision of optimal and cost-effective pharmaceutical care. Areas where pharmacists are making a significant difference to the care of patients include chronic disease management through pharmacist-run clinics, antibiotic stewardship, speciality practice (oncology, infectious disease, critical care, and psychiatry), medication review, medication reconciliation, and medication therapy management services.
5.7.2. Key challenges facing the pharmacy workforce
Ageing population and increase in burden of chronic diseases
Singapore has one of the lowest fertility rates in the world (the total fertility rate for 2007 is 1.27) and one of the fastest ageing populations. By 2030, one in five Singaporean residents will be aged 65 and above. This situation is similar to other East Asian countries such as Japan and South Korea. With longer life expectancies and an ageing population, chronic diseases will become a growing burden. The prevalence rates for hypertension, diabetes mellitus, and dyslipidemia (high blood cholesterol) are 23.5%, 11.3% and 17.4% respectively [3].
Health care professional workforce production
To meet health care demands, it is estimated that the country needs to grow the health care professional workforce (doctors, nurses, dentists and pharmacists) by 50%, or about 20,000 more, by the year 2020. Greater numbers of pharmacists are needed in direct patient care and in community settings to look after the elderly and those with chronic illnesses. Pharmacists will also be required in health programmes focussing on disease prevention, promotion of healthy lifestyles, and health screening.
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