Recent focus on the pharmacy workforce in Australia, Canada, Great Britain, and the USA [11-18]; the 2006 and 2009 FIP Global Pharmacy Workforce reports [19,20]; and a systematic review of the literature  add to our understanding of the complex issues that countries face. It is not just a simple case of supply and demand. There is also a need for countries to model their workforce needs based on predicted future provision of services and care, roles and responsibilities of the pharmacy support workforce, increased use of technology, the advancement of biotechnology and personalised medicine, demographic changes, and future patterns of working all while ensuring there is a sustainable academic workforce to maintain the supply of suitably trained pharmacists.
2.2 Systematic review of the literature on the pharmacy workforce
A systematic review of the literature from January 2006 to March 2012 was undertaken that focuses upon the issues facing the expansion of the global pharmacy workforce. Contemporary issues surrounding the global pharmacy workforce and, more specifically, the published methods used to expand the workforce were systematically identified and reviewed. One hundred and nine studies were included in the review, to be published separately. Findings from the review (in press) are summarised below.
Working conditions and job satisfaction
The level of job satisfaction among pharmacy personnel is an important indicator of staff turnover and retention. The primary determinants of job satisfaction were intrinsic aspects of the job; that is, factors that make people satisfied are the work that they do or the way in which they are used. A number of studies found female pharmacists hold high levels of job satisfaction compared with their male counterparts. Job position was consistently found to be a significant predictor of job satisfaction. Other factors identified as increasing pharmacist retention were good remuneration, good relationships with co-workers, and flexible schedules. Factors increasing staff turnover included high stress, insufficient or unqualified staff, and poor salary. Further, job stress and excessive workload negatively affect job satisfaction. Evidence also suggests that pharmacists engaged in shift work might present unique characteristics, which has implications for labour supply and pharmacy services delivery.
Workforce development: education, training, and leadership
Continuing professional development (CPD) has the potential to be useful in pharmacy workforce revalidation. Time, finan- cial costs, resource issues, understanding of CPD, facilitation
and support for CPD, motivation and interest in CPD, attitudes towards compulsory CPD, system constraints, and technical problems were identified as key barriers to CPD. Pharmacy professionals on the whole agreed with the principle of engaging with CPD, but there was little evidence to suggest widespreadand wholehearted acceptance and uptake of CPD, essential for revalidation. Direct experience of effective CPD in the absence of perceived barriers could impact personal and professional development and patient benefit, thus strengthening personal beliefs in the value of CPD.
Supply and demand issues: Current status and future directions
Increased demand and limited supply of pharmacists constrains the ability of the workforce to expand. Many different supply and demand factors that influence the pharmacy profession were identified, the majority of which were common to most countries. The most common factors increasing demand for pharmacists were increased feminisation, increased clinical governance measures through continually reviewing and improving the quality of patient care, increased numbers of prescriptions, and increased complexity of medication therapy. The most common factors mitigating demand for pharmacists included increased use of technology, expansion in the numbers and roles of pharmacy technicians, and increased numbers of pharmacy graduates.
Pharmacy workforce migration
There is greater migration from less-developed countries to more-developed countries. The pharmacist workforce from African and Asian countries was disproportionately affected by migration. A significant number of pharmacists from developing countries migrate to the developed world; however, the extent of such migration was not properly captured. Postulated reasons for migration include better remuneration, joining or supporting family, political and social instability, poor living conditions, poor working conditions and management, unsafe environment, further training and qualifications, and job opportunities and satisfaction.
This systematic review updates and builds a better understanding of the current challenges affecting the global pharmacy workforce in ensuring equitable access and responsible use of safe, effective and quality medicines. This review complements findings from the 2012 Global Pharmacy Workforce Survey on workforce composition and expands on findings from the 2006 and 2009 workforce reports.
1. The World Health Report 2006: Working together for health. Geneva: World Health Organization; 2006. Available from: http://www.who.int/ whr/2006/en/index.html
2. WHO Assembly, 64th year. Resolution WHA 64.6 [Health workforce strengthening] . 16-24 May 2011, p. 9. In Resolutions and Decisions Annexes (WHA64/2011/REC/1). Official Record. Geneva: World Health Organization; 2011. Available from: http://apps.who.int/gb/ebwha/ pdf_files/WHA64-REC1/A64_REC1en.pdf
3. The World Health Report 2008: Primary health care (now more than ever). Geneva: World Health Organization; 2008. Available from: http://www.who. int/whr/2008/en/index.html
4. The World Health Report 2010: Health systems financing - The path to universal coverage. Geneva: World Health Organization; 2010. Available from: http://www.who.int/whr/2010/en/index.html
5. WHO, Global Health Workforce Alliance 2008. The Kampala Declaration and Agenda for Global Action [cited 12 July 12]. Available from: http://www.who.int/workforcealliance/knowledge/resources/ kampala_declaration/en/index.html
6. G8 Communiqué on Africa and Development 8 July 2008.
7. Closing the gap in a generation: Health equity through action on the social determinants of health [cited 12 July 2012]. Geneva: World Health Organization; 2008. Available from: http://www.who.int/social_ determinants/thecommission/finalreport/en/
8. The Taskforce on Innovative International Financing for Health Systems. Civil Society Forum on the High Level Taskforce on Innovative International Financing for Health Systems. London: The Taskforce on Innovative International Financing for Health Systems; 2009.
9. Horton R. Venice statement: global health initiatives and health systems. Lancet 2009; 374: 10-12.
10. Giberson S, Yoder S, Lee MP. Improving Patient and Health System Out comes through Advanced Pharmacy Practice. A Report to the U.S. Surgeon General [cited 12 July 2012]. Rockville, Maryland, USA: Office of the Chief Pharmacist, U.S. Public Health Service; Dec 2011. Available from: http://www.accp.com/docs/positions/misc/Improving_Patient_and_ Health_System_Outcomes.pdf
11. Human Capital Alliance. Pharmacy workforce planning study literature review [cited 01 July 2012]. Human Capital Alliance; 2008. Available from: http://www.humancapitalalliance.com.au/documents/Literature%20 Review%2023102008.pdf
12. Pharmaceutical Society of Australia. Issues paper on the future of pharmacy in Australia [cited 12 July 2012]. Canberra, Australia: PSA; 2010. Available from: http://careers.curtin.edu.au/data/shared/documents/faculty_specific_ resources/health_sciences/psa_futur e_of_pharmacy2010.pdf
13. Human Capital Alliance. Analysis of secondary data to understand pharmacy workforce: Initial supply report [cited 12 July 2012]. Human Capital Alliance; 2008. Available from: http://www.humancapitalalliance.com.au/documents/ Initial%20Supply%20Report%20final%20%2022102008.pdf
14. Canadian Pharmacists Association. Blueprint for pharmacy: The vision for pharmacy [cited 12 July 2012]. Ottawa, Canada: Canadian Pharmacists Association; June 2008. Available from: http://blueprintforpharmacy.ca/ docs/pdfs/the-vision-for-pharmacy_apr-1-09.pdf
15. Guest D, Battersby S, Oakley P. Future Pharmacy Workforce Requirements; Workforce Modelling and Policy Recommendations Executive Report (Pharmacy Workforce Planning & Advisory Group). London: Royal Pharmaceutical Society of Great Britain; 2005.
16. Seston, EM, Hassell K. Workforce update-joiners, leavers, and practising and non-practising pharmacists on the 2010 register. The Pharmaceutical Journal. 2011; 286:473-476.
17. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions. The Adequacy of Pharmacist Supply: 2004 to 2030 [cited 01 July 2012]. Rockville Maryland, USA: DHHS; December 2008. Available from: http://bhpr.hrsa. gov/healthworkforce/reports/pharmsupply20042030.pdf
18. Pharmacy Manpower Project (PMP), Inc. 2009 National Pharmacist Workforce Survey [cited 12 July 2012]. Alexandria, Virginia, USA: PMP; 1 March 2010. Available from: http://www.pharmacy.wsu.edu/ information/2009.Pharmacist.Workforce.Survey.pdf
19. International Pharmaceutical Federation (FIP). 2006 International Pharmaceutical Federation (FIP) global pharmacy workforce and migration report: A call for action. The Hague, The Netherlands: FIP; 2006. Available from: http://www.fip.org/menu_sitemap?page=hrfh_introduction
20. International Pharmaceutical Federation (FIP). 2009 global pharmacy workforce report [cited 01 July 2012]. The Hague, The Netherlands: FIP; 2009. Available from: http://www.fip.org/hr
21. Hawthorne N and Anderson C. The global pharmacy workforce: A systematic review of the literature [cited 01 July 2012]. Human Resources for Health. 19 June 2009; 7:48. Available from: http://www.humanresources-health.com/content/7/1/48