5.9. Country Case Study: Tanzania
Omary M.S. Minzi, Unit of Pharmacology and Therapeutics, School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO BOX 65013, Dar Es Salaam Tanzania, Minziobe- email@example.com; Rose Shija, World Health Organization, PO Box 9292, Dar Es Salaam Tanzania; Olipa D. Ngassapa, Department of Pharmacognosy, School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO BOX 65013; Mildred Kinyawa, Pharmacy Council, PO BOX 31818, Dar Es Salaam Tanzania.
Pharmacy education is an important area that contributes to the growth of the pharmaceutical human resources and hence the overall pharmaceutical sector in a country. This case study summarizes recent developments related to pharmacy education in Tanzania. It provides a country situational analysis and current information regarding pharmaceutical training institutions, their numbers, capacities and contribution in making up the profession.
Pharmaceutical workforce challenges in Tanzania include:
1- Critical shortage of all categories of pharmaceutical workforce;
2- Inadequate growth in pharmaceutical human resources;
3- Skills mix imbalance, especially in the area of patient care; and
4- Distribution imbalances.
The case study also discusses various strategies aimed at icreasing the number of pharmaceutical personnel in the country.
The human resources for health crisis affects 57 countries worldwide, including Tanzania [1-5]. In Tanzania, it is estimated that public and private sector dispensaries (ie, lowest level of facilities for health care provision), where primary care to most of the population is provided, were staffed by only 31% and 16%, respectively, of the required health workforce .
Access to quality medicines and competent health care providers are fundamental aspects of the health care system. Pharmaceutical human resources are responsible for the management, supply, and use of medicines and are vital components of the architecture to improve access to medicines. Therefore, their availability is of critical importance in meeting national and global health goals, thus requiring special attention.
There is a pressing need for appropriate pharmaceutical human resources planning to develop local strategies to
address workforce challenges. This case study provides the Tanzanian experience using workforce development approaches that cuts across all levels of the pharmaceutical workforce, from dispensers to pharmacists and specialized pharmaceutical workforce. It is based on the pharmaceutical human resources report of 2009 , which was conducted in Tanzania, and applied a WHO-designed methodology. The main objective of the assessment was to determine the total workforce providing pharmaceutical services in the public, non-governmental organisation (NGO), and private sectors.
5.9.2. Key issues
Human resources shortages
The pharmaceutical human resources report of 2009  identified a total of 640 pharmacists (1 per 50,000 population), 479 pharmacy technicians (1 per 80,000), and 376 pharmacy assistants (1 per 100,000). The study also revealed a total of 5241 pharmaceutical outlets served by 1495 pharmaceutical personnel. If pharmaceutical human resources was evenly distributed across all pharmaceutical outlets, only about 29% of outlets would be staffed. This means that pharmaceutical services are provided by unqualified (non-pharmaceutical) personnel in over 70% of the pharmaceutical outlets. It is, therefore, not surprising that 187 facilities surveyed ex- pressed shortages of over 500 pharmaceutical personnel.
Inadequate growth in pharmaceutical human resources
The 2009 assessment showed limited growth in the numbers of pharmacists and pharmaceutical technicians between 2007 and 2009, with a low level of new pharmaceutical personnel entering the workforce each year (Table 5.9.1).
Table 5.9.1. Total pharmaceutical human resources 2007 to 2009
Before 2009, there was only one pharmacy school offering a Bachelor of Pharmacy (BPharm) degree, which began in 1974 with an enrolment capacity between 25 and 50 and an output rate of 12 to 50 students per year. By 2009, there were two pharmacy schools offering a BPharm Degree, with a combined intake of about 100 students; two pharmacy techni- cian training schools (diploma), with an intake capacity of about 90 students; and one pharmaceutical assistant programme enrolling 20 students. All schools faced expansion challenges as they had significant inadequacies in physical infrastructure, academic human resources, and budgets.
Cadre 2007 2008 2009
Pharmacists 568 593 640
Pharmaceutical technicians 369 402 479
Pharmaceutical assistants 315 327 376
Consequently, despite increasing demand for training, only 21% and 8% of applicants to the pharmacy degree and pharmacy technician diploma programmes were admitted in 2008 .
Skills mix imbalance
The assessment also identified a skills mix imbalance with more pharmacists than pharmaceutical technicians and assistants in the country. Pharmacists mainly work in urban areas and at higher levels of the health system and, with such an upside-down triangle, it means that vacancies at lower levels of the health system will remain. Other cadres that do not have pharmaceutical competencies will continue to fill these gaps unless concerted efforts are made to increase the number of technicians and assistants.
The distribution of pharmaceutical personnel is inequitable and has led to a severe shortage in rural areas and inequitable service provision. Pharmaceutical cadres were found to be concentrated in urban areas, with the ratio of personnel per 10,000 population in a region ranging between 0.01-1.37 for pharmacists and 0.02-0.56 for pharmacy technicians . This imbalance poses a major challenge to the nationwide provision of pharmaceutical services, since the proportion of the population living in rural areas is greater than that in urban areas. To ensure that only quality products are made available to the population, functional and well-resourced pharmaceutical supply and regulatory systems are required, with adequate numbers of qualified pharmaceutical personnel.
The findings of the 2009 Assessment of Pharmaceutical Human Resources led to the development o the Pharmaceutical Human Resources Strategic Framework with key stakeholders, which could be integrated into broader human resources for health strategies. The Ministry of Health and Social Welfare (MOHSW) has begun several initiatives to address the above challenges, which are summarized in this section.
Pharmaceutical human resources strategic framework
A draft Pharmaceutical Human Resources Strategic Framework 2011 2020 was developed by key stakeholders in April 2010 aimed at addressing the significant shortage of pharmaceutical human resources. Policy goals were identified to address human resources planning and development (Table 5.9.2).
Table 5.9.2. Human resources issues and policy goals
HR Development Policy goals
HR Management Policy goals
HR Planning Policy goals
1 Human resources planning
2 Job descriptions
1.3 To strengthen partnerships between the Pharmaceutical Society of Tanzania (PST), Pharmacy Council (PC), Pharmaceutical Services Unit (PSU) and Human Resources for Health Department to coordinate pharmaceutical human resources planning
1.4 To formulate and implement a pharmaceutical human resources plan with stakeholders input
1.5 To review and revise the pharmaceutical human resources establishment in the public sector that reﬂects needs at different levels
1.6 To strengthen the PC register to ensure accurate and up-to-date human resources information of all pharmaceutical cadres
2.1 To develop clear job descriptions for each pharmaceutical cadre in the public sector
3 Recruitment and retention
4 Training institution and academic capacity
4.1 To establish new training programmes, particularly for pharmaceutical technicians and assistants
4.2 To build the teaching and physical capacity of existing training institutions (public and private)
4.3 To review academic staff recruitment criteria to allow recognition of professional performance, expertise, and experience
4.4 To develop training programmes for teachers in teaching methods
4.5 To revise incentive packages for academic members
4.6 To expand post-graduate (master s, PhD) education programmes to build expertise for academia (teaching and research)
4.7 Increase output of graduates to reach a target of 950 pharmacists, 1450 pharmaceutical technicians, and 1500-2600 pharmaceutical assistants by 2015
4.8 Review competency requirements and curriculum of each cadre to optimize length of training without compromising quality
5 Continuing professional development (CPD)
5.1 To develop and certify CPD programmes for all pharmaceutical cadres through a partnership among the PC, PST, and training institutions
3.1 To improve human resources management at district levels
3.2 To develop and establish retention schemes for underserved areas
3.3 To improve the physical working environment in underserved areas
3.4 To implement remote supervisory support systems for pharmaceutical services in the public sector
3.5 To revise and improve retirement beneﬁts
3.6 To review the salary structure of all pharmaceutical cadres