In terms of the pharmacy workforce, the country previously relied on foreign training until establishing the first pharmacy course and graduating the first cohort of local pharmacists in 2009. There is also currently one technician training institution, which aims to train over 50 technicians a year.
In Ethiopia there was a decision made by the government to adopt a flooding policy of producing a significant number of health workers, including not only health professionals but also health extension workers.
There is a big shortage of health workers at every level throughout the country, but this is particularly the case in rural areas. Information from the Human Resources for Health (HRH) observatory shows that 84% of the population resides in rural areas while the remaining 12 million (16 %) live in urban areas, making Ethiopia one of the least urbanized countries in the world . Rural areas, therefore, are where the toll of a host of communicable and non-communicable diseases is most acutely felt. The government, therefore, decided to focus its efforts on areas where they can save the most lives. In fulfillment of this effort, the government has trained and placed teams of specialized health officers, midwives, and anesthesia professionals aimed at reducing maternal mortality at each of the nation s 800 primary hospitals. A other programme will add several thousand new doctors to address the country s shortage of physicians.
The country s HRH Plan  has taken into account the skill mix of health workers based on needs and determinants. This model is considered appropriate as it takes into consideration the health service location, the staffing level, population growth and economic growth as the bases for estimating health workforce requirements (and projecting them for the future). The projections for the health workforce requirements of Ethiopia by the year 2020 are based on the assumption of universal primary health service coverage, and hence a three-fold increase in the production of HRH by 2020. It is expected that this plan will increase the health workforce density level from 0.8 to 1.8 per 1000 population. However, this is not to say that Ethiopia will not face a lack of adequate workforce since the level reported in the HRH Observatory data is 0.84 health workers per 1000 population which is below the standard set by WHO of 2.3 health workers per 1000 population (based on the numbers of doctors, nurses, and midwives).
In terms of pharmacy workforce production, the number of providers, especially in the private sector, has expanded greatly in the past 10 years with currently over 18 pharmacy schools graduating almost 1900 students in 2011 and 26 technician training programs graduating 6000 technicians in 2011. The government strategic plan outlines a projected need of 2200 pharmacists and 10,000 pharmacy technicians by 2020.
6.3. Recommendations for scaling up workforce production
A total of 17 recommendations are being made in the WHO guidelines on transforming and scaling up health professional education and training that can be subsumed under the 5 domains listed above. Among the 17 recommendations, all governments are recommended to adopt five. Under the areas of governance and implementation, they cover:
1- Political commitment and leadership for health professional education and training into the human resources for health plan of the country/state/province in keeping with administrative/legislative responsibilities.
2- Alignment of the education plan with HRH and health systems national plans.
3- Formal collaboration and shared accountability between the Ministry of Health and the Ministry of Education as well as other relevant ministries and/or the civil service commission in the country.
4- Alignment of information on HRH training and education with HRH information systems.
5- Ensuring platforms/mechanisms to support the implementation of the reform and scale-up plan, for instance the creation or strengthening of national or sub-national institutions, capacities or mechanisms (e.g. legislation, policies, procedures).
Other recommendations that are included under the remaining four domains include:
- Either instituting and/or strengthening the regulation of health professional education to ensure quality and relevance and ensuring accreditation of institutions and programmes.
- Strengthening and updating faculty as well as recruiting health professionals as adjunct faculty where feasible and acceptable.
- Ensuring continuing professional development for both health professionals and faculty, in the case of the latter, through policy that makes it mandatory.
- Curriculum development for relevance to community needs.
- Streamlining educational pathways, or ladder programmes, for the advancement of practicing health professionals, in both undergraduate and postgraduate programmes.
- Improving interprofessional education for collaboration and better patient care.
- Introducing technologies (simulation, technology, eLearning) that enhance and support patient care, diversify health care capability, link facilities, and increase the accessibility of trained health workers to information and material to keep practice relevant.
- Human resources for health information systems that allow for better planning of skill mix and deployment, but are also indicators of the adequacy of health professionals.
- Retention of health workers in rural and remote areas where there are usually hard-to-reach and underserved populations.
- Adequate investment in health professional education both at the international and domestic level (addressing funding and addressing economic constraints) and instituting mechanisms that make education and training more accessible to those wishing to pursue a career as a health professional.
1. World Health Organization [Website]. Resolutions on health workforce development. Geneva: WHO. Available from: http://www.who.int/hrh/ resolutions/en/index.html
2. Hirschhorn L, Ogunda L, Fullem A, Dreesch N, Wilson P. Estimating health workforce needs for antiretroviral therapy in resource-limited settings. Hum Resour Health. 26 January 2006; 4:1.
3. Frost LJ, Reich MR. Access: How do good health technologies get to poor people in poor countries? Cambridge: Harvard Center for Population and Development Studies; 2008. Available from: http://www.hsph.harvard.edu/ faculty/michael-reich/files/accessbook.pdf
4. World Health Organization. WHO Medicines Strategy 2008 2013. Geneva: WHO; 2008.
5. Tata H, Wuliji T, Cinnella E. Pharmaceutical human resources assessment tools. Geneva: WHO; 2011.
6. Framework for the development of human resources in the pharmaceutical sector. Nigeria: Federal Ministry of Health; 2010
7. Assessment of the pharmaceutical human resources in Tanzania and the strategic framework. Tanzania: Ministry of Health and Social Welfare; 2009
8. Marriott JL, Nation RL, Roller R, Costelloe M, Galbraith K, Stewart P, and Charman W. Pharmacy education in the context of Australian practice. Am J Pharm Educ. 2008: 72(6):131.
9. Framework for the development of human resources in the pharmaceutical sector. Sudan: National Ministry of Health; 2010.
10. Sosabowski MH, Gard PR. Pharmacy education in the United Kingdom. Am J Pharm Educ. 2008: 72(6):130.
11. Assessment of human resources of pharmaceutical services in Ghana. Ghana: Ministry of Health; 2009.
12. International Pharmaceutical Federation (FIP). 2009 Global pharmacy workforce report. The Hague, The Netherlands: FIP; 2009.
13. Department for International Development (DFID), Management Sciences for Health (MSH), Management Solutions Consulting Limited (MSC). Evaluation of Malawi s emergency human resources programme. Cambridge, Massachusetts, USA: MSH; 2011. Available from: http://www. msh.org/newsbureau/upload/Evaluation-of-Malawi-s-Emergency- Human-Resources-Programme.pdf
14. Africa Health Workforce Observatory. Human Resources for Health Country Profile: Ethiopia. AHWO; June 2010. Available from: http://www. hrh-observatory.afro.who.int/en/hrh-country-profiles/profileby-country.html