WHO Technical Briefing seminar Geneva, 16 – 20 November 2009.

1. WHO Technical Briefing seminar Geneva, 16 – 20 November 2009. Pharmaceutical Workforce situation analysisCountry cases studies MrsHelen Tata (WHO/EMP) Mr Daniel Amaning (MOH/Ghana Mrs Bridget Okala (MOH/Nigeria)

2. Overview • Context • Objective • Methodology • Next steps • Case study findings • Nigeria • Ghana

3. Context (1) • A well functioning pharmaceutical system needs personnel with adequate skills and skill mix • The public sector in most developing countries is often the hardest hit from the pharmaceutical personnel crisis. • Information on total workforce in the pharmaceutical sector in most developing countries is scanty and in some cases unavailable. Research concentrates on other categories of health personnel • The lack of comprehensive data on pharmaceutical personnel forms a gap in national capacity for planning for the human resources in the pharmaceutical sector. • Thus the generation of evidence to support pharmaceutical human resources planning strategies is vital.

4. Context (2) • An important area of work for the EC-WHO joint programme of action on Pharmaceutical Policies and Programmes in ACP countries is the strengthening of HR capacity for the pharmaceutical sector in order to improve access to medicines • Development of a framework for HR planning for the pharmaceutical sector forms the basis for strengthening this sector. • Against this background, some countries in Africa planned in 2008 to strengthen the pharmaceutical human resources capacity in their countries. • As a first step, an assessment to determine the capacity mix in the pharmaceutical sectors of their countries was planned • WHO has provided support in the development of tools that have been used for these assessments.

5. Objectives • General Objective of the assessment • To determine human resources availability in the pharmaceutical sector in selected African countries. • Specific Objectives to determine: • the number of health workers currently providing pharmaceutical services in both private and public formal sectors. • the distribution of pharmaceutical personnel in both public and private sectors. • types of pharmaceutical training programs offered in countries • current production capacity of pharmaceutical personnel in schools in each country • what categories of health workers other than pharmaceutical personnel provide pharmaceutical services. • the job satisfaction of pharmaceutical personnel both in the public and private sectors. were also determined

6. Levels of Health Care involved Some specific indicators were collected from the following levels of health care: Ministry of Health, professional and regulatory bodies Pharmacy education providers Health facilities Pharmaceutical manufacturers, wholesalers and medical stores

7. Sampling Not possible to visit all the facilities, thus sampling for: Geographical areas - 6 Facility types - 180

8. Tool: Level III Indicators • Number of facilities offering pharmaceutical services by type and sector • Density of pharmaceutical human resources per 10,000 population by cadre • Proportion of females for each pharmaceutical cadre • Proportion of each pharmaceutical cadre by facility type and sector • Density of each pharmaceutical cadre per 10,000 population by region/district • Description of salary ranges by setting and level

9. Tool: Level III Indicators • List of education programs offered by education level • Total enrolment capacity of education providers by cadre trained • Total academic faculty workforce by type of cadre trained • Number of students enrolled in post-graduate programs by education level • Correlation between types of pharmaceutical services provided and cadres employed • Proportion of facilities with non-pharmaceutical cadres providing pharmaceutical services

10. Countries involved • The following ACP countries were involved in the assessment: • Ghana • Nigeria • Sudan • Tanzania

11. Preliminary results • A workshop was held in Abuja, Nigeria in July 2009 with the following objectives: • Review country data for the pharmaceutical human resource assessments and address data managerial issues • Explore synergies between FIP survey and this survey • Strategies for pharmaceutical workforce development- challenges & outcomes • Share experiences on the use of questionnaires, methodology and workbook and make recommendations for their improvement. • Make recommendations for policy advocacy on human resource planning for the pharmaceutical sector

12. SUDAN: 1.4- Availability of Pharmacies per 1000 of the population at state level: Availability of Pharmacies per 1000 of the population at state level.

13. TANZNIA: Availability of Pharmacies and Pharmacists in different sectors • Total number of Pharmaceutical personnel is 1506 out of which Pharmacists are 639. Majority (44%) of pharmacists work in the public sector, 23% in retail and only 2% in FBO. 67% of Pharmacists are Males • In total there are 5241 Pharmacies, most of which are in the public sector ie 62%. • The total number of pharmaceutical personnel is just 29% in relation to the total number of pharmacies in the country. This means as many as 71% of the pharmacies are served by other cadres outside the pharmacy profession.

14. Next Steps The tools are been finalized on the basis of recommendations form the Abuja workshop WHO will continue to support countries in the following: Assessments in more ACP countries that need to generate baseline evidence for pharmaceutical human resource capacity strengthening Using the results as an advocacy tool to support HR planning strategies and implementation for the sector. Development of framework for HR planning for the pharmaceutical sector.

15. Nigeria Case Study Results Mrs Bridget Okala (MoH Nigeria)

16. Background

17. DISTRIBUTION • Males are more likely to work in the manufacturing sector and private retail and wholesale than women

18. Where pharmacists work (Council data)

19. MIGRATION CHARACTERISTICS Migration within - Generous salary - Professional growth - Extra benefits Migration outside - Professional learning opportunities - Salary considerations

20. LABOUR MARKET FOR PHARMACISTS

21. Job satisfaction – generally satisfied

22. Job satisfaction – generally dissatisfied

23. PRODUCTION OF PHARMACISTS

24. Production of pharmacists

25. Current/future challenges

26. Recommendations

27. Ghana Case Study Results Mr Daniel Amaning Danquah (Pharmacy Council, Ghana)

28. The Country profile Health structure & pharmaceutical system Findings Recommendations Outline

29. Country Profile Source Pharmaceutical Council Ghana, GSS-PHC 2000

30. General and Health Indicators

31. Structure of Health and Pharmaceutical System

32. FINDINGS- Practice areas of respondents

33. Demography of Respondents

34. Size of pharmacy workforce As at 2009, 1,637 (62%) of pharmacists on register are actively practising Pharm Techs 918 (46%) and Pharm. Asst 1642 (86%)

35. Where do pharmacists practice? Most (85%) are in private retail 3.3% in manufacturing

36. Regional distribution of pharmaceutical personnel and pharmacies per 10,000 pop. Maldistribtion Who is doing the work of pharmacists in these regions?

37. Pharmacist distribution per Regional and Teaching hospitals

38. Providers of pharmaceutical services

39. Job satisfactionAttendance of CE programmes

40. Many Pharmacists do not feel their professional aspirations can be met

41. 16% do not think they have opportunities to improve their skills 22.7% do not know

42. My job is challenging and interesting 24% disagree? What is the problem? – review of training of undergraduate? or CPD 26.3% do not know?

43. Is there a disconnect? Change must be accompanied with need and wider stakeholder involvement

44. Workforce Retention% of Pharmacists practising in country 36% of respondents considered changing job in the last 5 years. Public sector now more favoured than private sector Overall, NGOs are preferred destination

45. Motivating factors for changing job Motivations for migration are multi-factorial

46. Training capacity Numbers will dramatically increase in the next 5 years. Three pharmacy training schools (one private) Annual enrolment (130 + 35 + 75) = 240 Name of degree Bachelor of Pharmacy One pharmacy technician training school Name of diploma HND

47. Challenges of training institutions Finance/Budget Physical infrastructure Do the institutions have capacity to provide needs based competency education? Lack of staff with non-terminal degrees – basic sciences

48. RECOMENDATIONS 3% of pharmacists are in the manufacturing sector – what opportunities does this present? Imbalance in distribution- 1. Admission processes to deliberately include applicants from underserved areas 2. curricula specific to health needs in underserved areas and exposure to practice in such areas 3. Financial incentives – i.e. Loan repayment waivers for service in rural areas

49. There is adesire to remain in country but also a high level of dissatisfaction with conditions. This requires further investigation as motivating factors are multi-factorial Private sector is the largest employer – strategic partnership between private sector and government required. Increased production should be seen as an opportunity to change practice RECOMMENDATIONS (2)

50. Acknowledgements World Health Organization European Commission The HR Directorate, MoH & GHS The Pharmacy Council Stakeholders Lead Consultant, Prof Mahama-KNUST Respondents Data Collectors