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oncology and pharmacotherapy geriatrics, cardiology, psychiatry, and infectious disease. This will allow pharmacists to practise at a specialist level dealing with complex disease states and pharmacotherapy problems. It is also congruent with advancing pharmacists careers and fulfilling aspirations in clinical areas.

The Electronic Transaction Act in Singapore allows electronic prescriptions to be recognised and this has further strengthened our push towards making computerised physician order entry a reality nationally. Even prescriptions for controlled drugs can be performed electronically if there are sufficient security measures.

The national electronic health record launched recently has meant that pharmacists can now access patients medical and medication records. Medication reconciliation by pharmacists is now more thorough and efficient. Together with the Health Sciences Authority computerised medical information system (CMIS), the database for adverse drug reaction reporting will enable safer medication therapies for Singaporeans.

The Ministry of Health National Medication Safety Taskforce set up in 2010 articulated a national medication safety strategy focussing on standardisation of medication practices, promoting medication safety culture amongst health care providers, building awareness of medication safety in patients, and enhancing medication delivery systems.

5.7.5. Conclusion

Past leaders in pharmacy practice and education envisaged that pharmacy would be a health profession that ensures the integrity of drug therapy. Embracing this legacy, the profession needs to continue to set its sights on the quality use of medicines. This vision is built on the fact that the less-than- optimal use of medicines is a major public health problem and that pharmacy is the right profession to address this concern. The profession s movement in the 1990s toward patient-centred practice continues to develop with emerging practice trends and patient care needs.

We are also cognizant of our diverse backgrounds in community, hospital, marketing, sales and distribution, manufacturing, regulatory, and academia. A unified philosophy that clearly identifies the patient as the primary beneficiary of the profession and its services is an important lever to move the profession as a body to meet the rising demands on the health care system and changes in the delivery of health care. In our strategies, we seek to focus on the commonality that binds us all through professional practice, ethics, and values and continue to work together for the common good of the public and the profession.


1. Department of Statistics Singapore. 2012 [cited 15 May 2012]. Available from: http://www.singstat.gov.sg/stats/latestdata.html#12

2. WHO. World Health Report 2000 - Health systems: Improving performance. Geneva: WHO; 2000 [cited 15 May 2012]. Available from: http://www.who. int/whr/2000/en/

3. Ministry of Health, Singapore. Cited 15 May 2012. Available from: http:// www.moh.gov.sg/content/moh_web/home/our_healthcare_system.html

4. Singapore Pharmacy Council. Annual Report 2011.

5. Singapore Pharmacy Council [website]. 2012 [cited 15 June 2012].

Available from: http://www.spc.gov.sg

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5.8. Country case study: South Africa


Hazel Bradley, Senior Lecturer, School of Public Health, University of the Western Cape, South Africa, hbradley@uwc. ac.za; Lorraine Osman, Head, Public Affairs, Pharmaceutical Society of South Africa, lorraine@pharmail.co.za


South Africa has 12,813 pharmacists; the majority work in community (43%) and hospital (35%) settings, but they are inequitably distributed geographically and between public and private health care sectors. The proportion of pharmacists working in the public health care sector has increased over the past few years, probably due to the introduction of community service for pharmacists, increased salaries, opportunities for career advancement, and improved conditions of service.

The country has grown its pharmacy support workforce in the public and private sectors to 9, 071 pharmacist assistants aided by government funding for employers to support training. Training for two new cadres, pharmacy technicians and pharmacy technical assistants, with increased scopes of practice is planned to commence in 2015.

Eight Schools of Pharmacy produce on average 476 graduates annually, with the curriculum and teaching and learning methodologies developing to meet health services requirements. The current challenge to double the number of graduates to meet the projected health service requirements is overwhelming, given the constraints of academia, but is an area of active engagement of the South African Pharmacy Council (SAPC) and Schools of Pharmacy.

New roles proposed for pharmacists promise to utilise pharmacists professional skills to the benefit of the health services, although precisely how they will be integrated into South Africa s reforming health system is yet to be determined.

The Pharmacy Human Resources in South Africa 2011, published by the SAPC, provides comprehensive information on the current pharmacy workforce in the country, together with strategies for future development of the profession. It will assist the Minister of Health in developing integrated plans for the country s health system. Unless otherwise referenced, the data in this case study is derived from this publication.

5.8.1. Background

South African pharmacy workforce

South Africa s pharmacy workforce is made up of pharmacists

and two levels of pharmacy support personnel, basic pharmacist assistants and post-basic pharmacist assistants, registered with the South African Pharmacy Council (SAPC). In 2010, South Africa had just over 12,813 pharmacists and 9,071 pharmacist assistants, which includes those in training, with considerable differences in distribution across the nine provinces, particularly between urban and rural areas.

The greatest numbers of pharmacists work in community (43%) and hospital (35%) settings, with smaller numbers in industry (6%), wholesale (3%), professional administration (3%) and academia (1%). The majority of pharmacists in South Africa are younger than 55 years, and in two provinces more than 60% are below 35 years. Over the past four decades, in line with international trends, the pharmacy workforce in South Africa has feminised from an 83:17 ratio of male to female in 1970s to 40:60 ratio in 2010.

The educational requirements to register as a pharmacist are a four-year Bachelor of Pharmacy degree followed by a one-year internship. South Africa has eight schools of pharmacy at universities around the country producing on average 476 graduates per year. On completing their internships, all pharmacists are required to work in a public sector (government) pharmacy for one year prior to working in the sector of their choice. Pharmacist assistants complete a course of training with an accredited provider and undergo in-service training under the supervision of an approved pharmacist tutor.

Context of the South African health system

South Africa is situated at the southern tip of Africa and has a population of 50 million, of whom 57% reside in urban areas. Whilst it is ranked as an upper middle-income country, a distinguishing feature is its very high inequality (Gini coefficient), which has not improved since the establishment of the first democratic government in 1994.

South Africa has poor health outcomes for the proportion it spends on health, and will be one of the countries likely to miss its health Millennium Development Goal targets [1]. The reasons for poor health outcomes put forward recently in the Negotiated Service Delivery Agreement (NDSA) are South Africa s quadruple burden of disease characterised by the coexistence of diseases associated with underdevelopment, non-communicable diseases, a high injury burden, and HIV and TB epidemics; poverty and unemployment; and an inequitable and underperforming health service [2].

Approximately eight million (17%) South Africans are covered by private medical schemes, but a larger proportion use parts of private delivery systems such as general practitioners (24.3%) and pharmacies. The remainder rely on public health services.

South Africa began reforming its fragmented hospital-centric health departments in 1994 to a unified health system with a primary health care (PHC) approach based on the district health system and published a national drug policy in 1996