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Erica Wheeler, Technical Officer, Human Resources for Health, World Health Organization (WHO), wheelere@who.int; Helen Tata, Technical Officer, Medicines Programme Coordination, WHO Department of Essential Medicines and Health Products, tatah@who.int; Gilles Forte, Coordinator, Medicines Programme Coordination, WHO Department of Essential Medicines and Health Products, forteg@who.int


Case studies in countries facing severe health care workforce shortages - Ghana, Ethiopia, Malawi, Nigeria, Sudan and Tanzania identified clear areas and needs for increased workforce production and potential solutions to increase capacity.

When relevant stakeholders are informed and brought together to address workforce issues there are greater possibilities for coordinated workforce planning and implementation.

Adequate investment in education is required, as education provides the foundation for building a competent health care workforce.

The WHO guidelines on transforming and scaling up health professional education and training include 17 recommendations for strengthening the health care workforce focusing on the areas of: governance and implementation; education and training institutions; regulation and accreditation; financing; and monitoring and evaluation.

The WHO guidelines are highly relevant to the transformation and scaling up pharmacy education.

6.1. Background

Strengthening the health care workforce

In response to the grave shortage of health workers, especially in 57 countries, the World Health Organization (WHO) has adopted several recent resolutions for health systems strengthening [1]. These resolutions have been translated into action in the area of health professional education through the development of policy and technical guidelines designed to improve and transform the quantity, quality and relevance of health worker education and training. The production of the right types of health workers is fundamental to face the health challenges of the 21st century.

Pharmaceutical workforce capacity development

The attainment of national medicines policy objectives requires adequate finances and available, trained pharmaceutical

personnel with the necessary skill mix. However, in many sub-Saharan African countries there is a severe shortage of pharmaceutical human resources. This shortage continues in spite of growing workforce demands resulting from substantial donor investment in medicines for the three priority disease areas, HIV/AIDS, tuberculosis and malaria [2]. The shortage can be attributed to the neglect of pharmaceutical workforce capacity development by policymakers, donors, and international organizations [3].

Recognizing the importance of pharmaceutical human resources development, and in line with the World Health Organization (WHO) Medicines Strategy 2008 2013 to enhance human resources capacity to improve access to essential medicines of adequate quality [4], WHO s Essential Medicines Department supported a pilot programme in four countries in 2009. The programme sought to quantify the workforce providing pharmaceutical services in both the public and pri- vate sectors in Ghana, Nigeria, Sudan, and the United Republic of Tanzania. Financial support was received from the European Union. Also, a set of tools was piloted to assess the availability, development, distribution, attrition and shortages of pharmaceutical human resources [5].

The results of the four country studies revealed that:

Pharmaceutical human resources development was identified as a challenge and not based on the specific needs of the countries pharmaceutical services.

The pharmaceutical course enrolment levels were low in all four countries. For example, only one out of 10 applicants were enrolled in Nigeria. The enrolment levels are 20% for BPharm and 33% for MPharm in Tanzania, while in Ghana the enrolment for BPharm is 13% (130 enrollees per 1000 applicants).

Pharmaceutical workforce development in all four countries is also hindered by issues with their pharmacy training facilities. Inadequate infrastructure, lack of funding, insufficient teaching staff, weak accreditation system, and substandard quality of the education are amongst the main issues.

Based on the study results, each country developed a pharmaceutical human resources strategic framework to address these issues. All the stakeholders recognized that there are opportunities in each educational system that should be used to help overcome barriers and achieve policy goals for human resources development. For example, improving training facilities can be achieved by making optimal use of private sector contributions and funding from other sectors, including from governmental and nongovernmental organizations. In Nigeria, funding opportunities for research and infrastructure were identified from the federal government, and the National Universities Commission and the Raw Materials Development Council [6]. Funded, collaborative partnerships between local universities and universities overseas, such as that between the United Republic of Tanzania and United States of America, can be expanded and used as an opportunity to build teaching and infrastructure capacity to train pharmacists, pharmacy technicians, and assistants [7].


PART 6 STRENGTHENING THE PHARMACY WORKFORCE THROUGH TRANSFORMING AND SCALING UP EDUCATION .................................................................................

Another weakness of the pharmacy education systems in the four countries is the under development of regular curriculum review in training institutions. The use of a competency-based approach to education and curriculum development has been identified by the countries as a policy goal. The involvement of all stakeholders in recognizing the importance of needs- based education is the necessary starting point for instigating improvements in the pharmacy curriculum. Educational outcomes should be clear. This can be achieved by having a detailed indicative curriculum for accreditation of pharmacy courses that provides curriculum developers and evaluators with a checklist of the items that should appear in a curriculum [8]. To overcome the financial difficulties involved in adapting international models to national requirements [5], the tools already developed and used in some of the countries such as Sudan can be borrowed [9]. All the countries provide academic training programmes to train teaching staff. The issue of academic staff shortages can be resolved by improving remuneration and defining a clear career structure for teacher practitioners [5].

An investment in the development of e-learning facilities and systems may bring a long-term solution to the problem of academic capacity. Internationally developed e-learning packages can provide access to international academic research databases. In some of the countries, like Nigeria, the National University Commission provides online access to e-books and journals [5]. Moreover, donor agencies are willing to invest in this area [5]. The willingness of donor agencies to fund the development of information and communication technology-compliant facilities should also be explored.

Pharmacists roles are evolving worldwide and pharmacy education systems should be flexible enough to respond to educational needs [7]. The pharmacy profession is moving from a purely dispensing role to a medication management role [10]. The education system must therefore have the flexibility necessary to respond to the evolving nature of the profession. In order to meet current and future needs, existing continuing professional development and post-graduate programmes should be developed to optimize pharmacists competencies [11]. The further specialization of the pharmacy profession requires the strengthening of pharmaceutical support staff, such as pharmacy technicians and assistants [12]. In Tanzania, the opportunities for correcting skill mix imbalances and for scaling up the annual output of pharmaceutical assistants include: large labour market demand for pharmaceutical cadres; the availability of university laboratories that are underused and that could offer evening programmes; the availability of facilities outside training institutions (halls, centres, etc.); and collaboration with nongovernmental organizations and the Ministry of Health and Social Welfare, to advertise to prospective students [6].

The results of the assessment of the pharmaceutical workforce in the four countries form the basis on which to transform and scale up pharmacy education in order to strengthen the workforce.

6.2. Increasing capacity for workforce production

It is important to keep in mind that the purpose of addressing workforce production is to improve population health. This requires fundamental reforms in multiple spheres, namely: modification and use of teaching methods that have proven most effective in adult education to be applied within education and training institutions; modification of curricula to focus on national/community needs; improving the competency of and increasing the number of faculty or using health service providers as adjunct faculty; and of course increasing the numbers of adequately-trained health professionals, while ensuring that they are equitably distributed among all geographical areas and health services, from primary to tertiary levels, to provide high quality care.

Our global challenge together is to educate and manage the largest expansion of health workers in history. This should be done on the basis of the best available evidence in capacity building to ensure models of best practice are replicated and adapted within country and regional contexts.

Expanding the number of health professionals must be part of a national health plan. This requires political commitment and leadership at the highest levels, as well as strong governance at the institutional level that views communities as partners in improving health outcomes. The guidelines on transforming and scaling up health professional education and training tackle these complex and interconnected issues in five different areas:

1- Governance and implementation; 2- Education and training institutions; 3- Regulation and accreditation; 4- Financing; and 5- Monitoring and evaluation.

There are some countries, which have made significant steps to scale up health professional education and/or address the quality of health worker training.


In Malawi, an evaluation of the UK Department for International Development (DFID) funded programme has shown that the programme was successful in achieving its primary objective of increasing the number of professional health workers in Ministry of Health and the Christian Health Association of Malawi (CHAM) institutions. The evaluation reported that across the 11 priority cadres, the total number of professional health workers increased by 53%, from 5,453 in 2004 to 8,369 in 2009. However, only 4 of the 11 cadres met or exceeded their targets, as set out in the original EHRP design document. The conclusion of the evaluation report further stated that the investments made by the Government have resulted in tangible increases in access to health services and lives saved for the people of Malawi. [13]