Figure 5.8.1. Pharmacies and pharmacists per 100,000 for all provinces
Source: Stats SA, 2009; SAPC Register, April 2010
SAPC records from 2010 show that 63% of pharmacists worked in the private sector, 29% in the public sector, and 8% were unknown. Considering that over 80% of the population rely on public health services and only 29% of pharmacists work in the sector, the inequity in access to the pharmacy workforce is glaring. Previous records indicate even lower proportions of pharmacists working in the public sector, especially in rural and underserved areas.
Slow production of pharmacy graduates
South Africa produces on average 476 pharmacy graduates per year. About 86 of these are foreign students, mostly from southern African countries, who will not be permitted to practise in South Africa. Recent estimates indicate that the number of graduates needs to double to meet projected demands. This means that the eight existing Schools of Pharmacy need to increase their outputs or new schools need to open. Both options require additional academic staff, physical infrastructure, and increased throughput. This is challenging in the current environment in which attracting and retaining academic staff is difficult due to low salary levels (junior lecturer salaries are sometimes lower than starting salaries in the private and public health sectors) and schools having to compete for resources in higher education.
Few pharmacy support workers
South Africa has fewer registered pharmacy support workers than pharmacists, 9,071 to 12,813, implying that many tasks performed by pharmacists could be done by assistants. However, a recent report indicated that, in some settings, pharmacy support personnel were underutilised, which seems to indicate poor role allocation and skill mix in the provision of pharmaceutical services.
on improving health outcomes . Two interrelated initiatives currently underway are the PHC re-engineering strategy, with a population-oriented service model of PHC, and the National Health Insurance (NHI), which will introduce universal health insurance over a 14-year period [6,7]. These reforms promise to have farreaching effects on the public and private health sectors, but as yet the implications are unknown.
South Africa s high disease burden, particularly HIV and TB, high inequality, and a reforming health system provide challenges and opportunities for the pharmacy workforce.
5.8.2. Key issues
Pharmacy workforce planning
The pharmacy workforce is a critical part of any health system, and planning the South African pharmacy workforce is important if high quality pharmaceutical services are to be delivered to the whole population. This includes the production of pharmacists and pharmacy support workers, and the optimal use of existing pharmacy personnel. One of the first steps in planning for the future is having a clear picture of the current production and practice of the pharmacy workforce, but until recently, the data available was limited. The SAPC recognised the need for accurate data and analysis of human resource needs. In February 2012, the Council published its report, Pharmacy Human Resources in South Africa 2011 . The document will assist the Minister of Health in refining and implementing pharmacy workforce requirements in the HRH Strategy for the Health Sector 2012/13-2016/17 published towards the end of 2011 .
Pharmacy workforce shortages
All areas of pharmacy practice in the country report shortages: community, hospital, industry, and academia, with vacancy rates for pharmacists of up to 76% reported in the public sector in one province. However, the situation has changed recently in that private hospitals and community pharmacies also report difficulties in attracting and retaining pharmacists. Workforce shortages are a factor of the production of pharmacy graduates, as well as recruitment and retention.
Inequitable distribution of the pharmacy workforce
A feature, by no means unique to South Africa, is the inequitable distribution of the pharmacy workforce both geographically and by sector. The contrast between the nine provinces is marked, with the two most urbanised provinces, Gauteng (GP) and Western Cape (WC), having the highest numbers of pharmacists and pharmacies (Figure 5.8.1).
be r p
EC FS GP KZN L MP NC NW WC TOTAL 4.87 7.24 10.36 5.96 3.62 5.77 8.10 6.46 13.29 8.73
15.94 18.16 44.93 18.58 10.23 14.53 13.77 20.08 41.05 25.08
Pharmacy Human Resources in South Africa 2011 Report
The Pharmacy Human Resources in South Africa 2011 published by the SAPC is the culmination of extensive work by a joint task team comprising stakeholders from pharmacy practice and education . The publication provides comprehensive information on the current pharmacy workforce situation in the country, including production and practice. The document aims to assist the Ministry of Health in developing an integrated plan for the country s health system by providing accurate statistics and an informed analysis of the production and utilisation of pharmacy human resources. Further, it provides a comparison with international trends and highlights challenges and future strategies for the pharmacy profession in South Africa. The report was launched on 24 February 2012. The information is accessible online from the SAPC website (http://www.sapc.za.org/G_Publications.asp).
Recruiting and retaining pharmacists in the public health sector
Over the past few years the government has introduced a range of initiatives to recruit and retain health professionals, including pharmacists, into the public health sector, and in particular to rural and underserved areas. One initiative to increase the number of pharmacists in the public sector commenced in 2001 when mandatory one-year community service in the public sector was introduced for all pharmacists following registration with the SAPC. This service is carried out immediately after the internship year and is organised through the national department of health in collaboration with the provincial health departments, which are responsible for placing pharmacists in public sector facilities. Over the past 10 years, this has brought an average of 479 additional pharmacists into the public sector each year, not all of whom remain in the public sector after completion of the mandatory year of service. A study is currently underway to determine the number of pharmacists who remain in the public sector as well as the reasons why others leave it. Despite the relative inexperience of young pharmacists, there are many reports of the positive contribution they make, particularly in rural settings. In urban settings, it appears that community service pharmacists are used primarily to supplement poorly staffed pharmacies.
Other schemes to attract and retain pharmacists in the public sector have focused on improving conditions of service, such as the introduction of rural and scarce skills allowances (pharmacy was named as a scarce skill by the Ministry of Labour in 2007). The most recent initiative implemented in 2009-10 was the Occupation-specific Dispensation (OSD), which consolidated the previous two allowances and included a re- grading component. The data from the past few years show a
gradual increase in the proportion of pharmacists working in the public sector from 12% in 2004 to 29% in 2010 (Figure 5.8.2). Many attribute this shift to improved salaries, formal establishment of posts and opportunities for career advancement, and conditions of service in the public sector, although significant policy and legislative changes in regulations relating to the ownership and licensing of pharmacies, which previously was restricted to pharmacists, and the introduction of the dispensing fee in 2006, have affected other sectors of the pharmacy profession during this period.
Figure 5.8.2. Pharmacist distribution per sector 2004-2010
Source: SAPC Register, June 2010
A recent initiative commenced by the National Department of Health, applicable to the health workforce in both the private and public sectors, is the Excellence in Health care Awards, which recognise outstanding achievements in the health care sector. In collaboration with the SAPC, the National Pharmacist and Pharmacist s Assistant of the Year Awards are presented annually at a ceremony hosted by the Minister of Health. These awards serve as an affirmation of excellence in pharmacy prac- tice and appreciation of service from the government.
Scaling up pharmacy support workers Pharmacist assistants
A few years ago, the development of pharmacy support workers was identified as a gap in the South African pharmacy workforce, and a number of strategies have been put in place to grow this part of the pharmacy workforce. In 2000 the SAPC successfully re-launched the pharmacist assistant programme with two levels: pharmacist assistant (basic) and pharmacist assistant (post-basic). The pharmacist assistant qualification is categorised into manufacturing, wholesale, community, and institutional (hospital) pharmacy . Most local and provincial health departments, as well as private hospitals and community pharmacies, accessed government skills funding to support these training opportunities. Subsequent to this, some health providers have accessed further funding to train pharmacist assistants, for example in 2011 the Western Cape Provincial Department of Health received funding from the Expanded Public Works Programme to train 120 unemployed young people aged 18-25 years as pharmacist assistants. Overall, these initiatives have resulted in a steady increase in the numbers of pharmacist assistants in the country (Figure 5.8.3).
Note: 2007 data was unavailable
0% 2004 2005 2006 2008 2009 2010
Public Private Unknown
73% 75% 74%
67% 64% 63%
9% 7% 7% 8% 8%