Address personnel shortages in pharmaceutical sector

HEALTH | MEDICINE

By Rachel Nandelenga

Most of us are familiar with the conventional role of pharmacists, which is dispensing medicines.

However, their role spans beyond dispensing to include planning and inventory management, ordering/procurement, storage and distribution and dispensing of medicines and health supplies, report writing and personnel management.

Pharmacists also monitor and advise other health workers and patients on medicine use and other public health issues. At a health facility level, these roles should be visualised in a structure that provides for managerial, professional and support functions.

Unfortunately, due to the shortage of pharmacists in many developing countries, including Uganda, the role of many pharmacists has been reduced to dispensing medicine or performing logistical and administrative function in the drug stores.

Only about 700 pharmacists whose geographical location is skewed towards Kampala and other towns and cities serve Uganda's population of 37 million people.

This is far below the WHO recommended ratio of one pharmacist per 2,000 population is required for optimal health care to be delivered. It also means that trained pharmacists do not serve health facilities and pharmacies that are far from cities and towns. Moreover, a number of these pharmacists have been attracted to the private sector that pays better, leaving public health facilities where the majority of the people seek treatment, under-served.

This leaves some of the above-mentioned functions of pharmacists not performed or performed by other workers without accredited pharmaceutical training.

However, medicines require special management skills that have to be performed by only trained professionals.

One of the consequences of personnel shortages in pharmaceutical sector is the irrational dispensing and use of medicines that is now prevalent in many health facilities in the country. There are reports of gross misuse of medicines such as antibiotics and anti-malarial drugs that continues to create resistance and other negative effects in the population.

Relatedly, pharmacists are supposed to make ward visits and interact with patients and health personnel as a way of monitoring medicine use in health facilities. This enables them to spot any medicines management challenges such as patient drug interactions and to address them immediately.

However, due to work overload, most of the pharmacists are unable to perform these functions, thus distancing them from one of their core function of patient care.

The recurrent reports of drug stock outs and expiries in many public health facilities in the country arises from poor or lack of rational quantification of medicines and health supplies, record keeping, inventory management and reporting.

Some health facilities report and place their orders with the warehouses late, thus delaying the delivery of medicines to their respective facilities. If all health facilities had sufficient pharmacy personnel to perform these functions, most of these problems would be averted.

As the country moves towards meeting the 90:90:90 targets of having 90% of the population tested for HIV, 90% of those who test positive being on treatment and 90% of those on treatment achieving viral suppression, the role of pharmacists in supporting the expansion and scale-up antiretroviral therapy (ART) services cannot be over-emphasised.

Meeting other national targets of eliminating and addressing conditions such as malaria, immunisable and noncommunicable diseases and infections will also require meticulous selection, procurement, warehousing, distribution, rational use and quality assurance of medicines and health supplies. These functions naturally lend themselves to the expertise of pharmacists.

It is, therefore, important that the Government employs enough pharmaceutical cadre with the right skill mix in order to improve availability and rational use of medicines and hence ensure positive health outcomes for the population. It also goes without saying they are motivated and well facilitated to do their work.

Pharmaceutical and supply chain management should also be integrated in the educational curriculum of all healthcare professionals, so that they are capacitated to contribute to appropriate medicines management in the country.

The writer is a member of ReAct Africa, which is a global catalyst, advocating and stimulating for global engagement on antibiotic resistance.