Global Perspectives of Pharmacy Education and Practice

World Medical & Health Policy www.psocommons.org/wmhp

Vol. 2: Iss. 1, Article 2 (2010)

Global Perspectives of Pharmacy Education and Practice

Claire Anderson, University of Nottingham Ian Bates, FIP Collaborating Centre, University of London

Billy Futter, Rhodes University, South Africa Diane Gal, International Pharmaceutical Federation

Mike Rouse, Accreditation Council for Pharmacy Education Sarah Whitmarsh, University of London

Abstract

Pharmacists have been shown to reduce morbidity and mortality, reduce medication errors, improve rational use and prescribing of medicines, and increase access to health care and medicines. Unfortunately, in many countries there is a severe shortage of appropriately trained pharmacists and pharmaceutical human resources. The WHO UNESCO FIP Pharmacy Education Taskforce is steering sustainable pharmacy education and pharmacy workforce action to support and strengthen local, national, regional, and international efforts. The Taskforce advocates for a needs-based approach, which aims to meet the pharmaceutical needs of the local population. This paper explains the concept of needs-based education, describes the work of the Pharmacy Education Taskforce, and explores key issues in pharmacy education development and quality assurance.

Keywords: pharmacy, education, needs-based education, education development, academic capacity, quality assurance, competency

Author Notes: Conflicts of interest: None declared. Corresponding author: Sarah Whitmarsh. E-mail: [email protected].

Recommended Citation: Anderson, Claire; Bates, Ian; Futter, Billy; Gal, Diane; Rouse, Mike; and Whitmarsh, Sarah (2010) “Global Perspectives of Pharmacy Education and Practice,” World Medical & Health Policy: Vol. 2: Iss. 1, Article 2. DOI: 10.2202/1948-4682.1052 http://www.psocommons.org/wmhp/vol2/iss1/art2

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© 2010 Policy Studies Organization

Introduction Pharmacists can influence health outcomes and public health in a variety of ways. Pharmacists in community, hospital, and other settings promote cost-effective use of medicines, reduce morbidity and mortality, reduce avoidable hospital admissions, reduce medication errors, improve rational use and prescribing of medicines, and increase access to healthcare and medicines, particularly for underserved populations (W. L. Boyko Jr. et al. 1997; L. Gilbert. 1998; S. T. McMullin et al. 1999; L. L. Leape et al. 1999; S. I. Benrimoj et al. 2000; R. L. Howard et al. 2003; F. Hourihan et al. 2003; A. Blenkinsopp et al. 2003; C Anderson et al 2009; C. A. Bond et al 2006, 2001, 1999, 1999, 1999; A. Borja-Lopetegi et al. 2008). Unfortunately, in many countries there is a severe shortage of health workers, including appropriately trained pharmacists and pharmaceutical human resources (WHO 2006). In order to have a fully functional, competent workforce capable of improving patient-focused services, strong and robust educational systems must be in place to prepare both current and future pharmacists to provide these services. For the purposes of this paper, the term “pharmacy education” refers to the educational design and capacity to develop the workforce for a diversity of settings (e.g., community, hospital, research and development, academia), across varying levels of service provision and competence (e.g., technical support staff, pharmacist practitioners, pharmaceutical scientists, preservice students), and scope of education (e.g., undergraduate, post-registration/licensure, life-long learning). From this perspective, the International Pharmaceutical Federation (FIP), along with the World Health Organization (WHO) and United Nations Educational, Scientific and Cultural Organization (UNESCO), formed the Pharmacy Education Taskforce. FIP is the global, nonprofit federation of national associations of pharmacists and pharmaceutical scientists, representing almost two million pharmacists worldwide. Needs-Based Education Healthcare demands are incredibly diverse and complex, often varying widely within and between regions. Therefore, a “one size fits all” educational model or system is neither practical nor desirable; it does not offer the authenticity for buy-in or sustainability at the local level. Needs-based education is a development strategy that calls for any given system to

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World Medical & Health Policy, Vol. 2 [2010], Iss. 1, Art. 2

http://www.psocommons.org/wmhp/vol2/iss1/art2DOI: 10.2202/1948-4682.1052

assess the needs of its community and then develop or adapt the supporting educational system accordingly.

In essence, needs-based education asks the question: What does the community need pharmacists to do, and what do pharmacists need to learn to deliver those services to the community?

The authors propose that the development of optimal educational systems should progress through a Needs-Services-Competencies-Education cycle (Figure 1). First, local and national health-related needs must be assessed and understood. Second, the services required to meet those needs—such as research and development, production, distribution, patient care, and public health—are defined. Third, the competencies of the workforce are identified to enable optimal quality in the delivery of these services. Finally, educational programs are designed to prepare a workforce that achieves, maintains, and enhances the desired competencies.

Figure 1

The development of optimal educational systems should progress through a cycle that first seeks to assess and understand local needs. Upon determining local needs, the services required to meet those needs can be defined and the competencies of the workforce should be aligned to the delivery of these services.

There is often a lack of consensus in assessing the needs of communities as each stakeholder engaged in the process has a different

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Anderson et al.: Global Perspectives of Pharmacy Education and Practice


perspective. Some stakeholders confuse and even subvert local needs with their own "wants." For instance, in many countries, the focus is on curative care-oriented education with limited consideration given for preventive care and public health, which may be more greatly needed in the community (Majoor, G 2004). Therefore it is all the more important to have a clear, shared vision of how pharmaceutical services can meet the health-related needs of each country and to extend this vision to all those involved in meeting these needs, from industry to hospital, from professionals to funders, from educators to politicians, and ultimately to patients and their caregivers. It also highlights the importance of adopting a vision and action plan for global pharmacy that is grounded in a hierarchy of healthcare needs, progressing from local to regional, to national, and then international needs. Many countries are introducing, expanding, or undertaking major reform of pharmacy education. Such developments must, however, be accompanied by robust systems to assure the quality of educational structures, processes, and outcomes. The WHO UNESCO FIP Pharmacy Education Taskforce Established on this tenet of needs-based and quality-assured education, the WHO UNESCO FIP Pharmacy Education Taskforce seeks to provide guidance for competency and education development and engage stakeholders to reach consensus on a global vision for pharmacy education. The purpose of the Pharmacy Education Taskforce is to oversee the implementation of the Pharmacy Education Action Plan 2008–2010 (FIP 2008), identify resources, and serve as a connection for stakeholders. The aim and objectives of the Action Plan, which have been described previously (FIP WHO 2006), were built upon recommendations from two global consultations on pharmacy education at FIP Congresses in 2006 and 2007. At these consultations, key stakeholders in pharmacy education identified seven domains for global action and reached a consensus prioritizing development of four domains: academic workforce capacity, quality assurance, vision, and competency. Each domain of action represents a work stream that is phased over three years to include country case studies, consensus building, and policy guidance. The focus of these case studies is the sub-Saharan African region, because of the urgency of the health workforce crisis and extreme pharmacy

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workforce shortages. Three Taskforce Project Leads were appointed to oversee the activities in these domains.

The Taskforce, which serves as the coordination, analysis, and dissemination hub, includes both a core of key stakeholders and a dynamic shell of collaborators most attuned to the needs of their regions. The Taskforce Advisory Group, which has global representation, counsels the Taskforce during quarterly teleconference meetings.

Academic and Institutional Capacity

Given the expansion of the pharmacy workforce over recent years, there has been an increased demand for the academic faculty workforce to train new pharmacists and pharmacy personnel. Many of the issues highlighted by the International Campaign to Revitalise Academic Medicine also apply to academic pharmacy (ICRAM 2004). These issues include disincentives toward careers in pharmacy academia, such as lack of pay parity compared with pharmacy practice; absence of clear career pathways, particularly for clinical teachers; and a culture that often prioritizes grants and peer-reviewed publications over effective teaching efforts.

One of the major bottlenecks to providing pharmaceutical services is maintaining sufficient numbers of competent and committed academics to train new pharmacists and other support staff. Another bottleneck is accessible and appropriately resourced academic institutions.

The Academic Capacity project team is spearheading an in-depth case study that will investigate barriers and facilitators to capacity building in pharmacy education; define roles and responsibilities of pharmacists in enhancing health in African countries; and attempt to synthesize innovative strategies for recruiting and developing the academic workforce. It will also examine stakeholder issues at ministry, university, and practice levels with a view to using these qualitative data to produce a survey instrument to use with a number of other countries.

The team is also exploring cases where poor physical infrastructure (e.g., safety concerns, absence of even basic facilities, resources and physical capacity) serves as a primary barrier to good education and capacity building.

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Quality Assurance The quality assurance (QA) project team is continuing and advancing the work of the FIP International Forum for Quality Assurance of Pharmacy Education. Formed in 2001, the Forum advocated that, while pharmacy education was not yet at a point at which global standards could be applied, the principles and core elements for QA of pharmacy education would not differ significantly—if at all—from country to country. This Forum has collected and examined national quality standards and systems that reflect contemporary pharmaceutical services and meet the needs of the specific country for which they were developed. These systems have been examined to identify the principles and core elements of QA that are unlikely to vary by location or culture. In September 2008, the Global Framework for Quality Assurance of Pharmacy Education was finalized, formally adopted by FIP’s Board of Directors, and officially launched at the Third Global Pharmacy Education Consultation in Basel, Switzerland (International Pharmaceutical Federation 2008). The Framework provides the context for QA of pharmacy education and the important role that it plays not only to assure quality but also to support initiatives to expand and advance pharmacy education; presents a framework for a national QA system; and offers quality criteria for pharmacy education, primarily in terms of outcomes, structure, and process. The Framework is intended to be a foundation that can be adapted and built upon to suit national needs, systems, and conditions. It focuses more on the elements that need to be included and how these elements are applied in principle rather than being too specific or prescriptive. The Framework does not advocate for any one overall model or QA system but comments on different approaches that exist and outlines some emerging trends. To maximize the value and global applicability of the Framework, input was sought and received from individuals and organizations in as many countries as possible, thereby drawing on the experience and perspectives of countries with different education, QA, and health systems. Where regional similarities and collaborations exist or are possible, the Framework may also be adapted and applied at a regional rather than national level. Where resources or other constraints limit the immediate application of some of the principles outlined, the document can serve as a “roadmap” for the future. In 2009, the Framework underwent validation; the process involved a structured assessment of the components and quality criteria. It is proposed

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that a new version of the Framework will be released after revision by the Taskforce and adoption by FIP in 2010.

The QA project team is also collaborating with WHO to develop an instrument that institutions can use for self-assessment and quality improvement of their academic program in pharmacy. The self-assessment instrument uses the format (Structure, Process, Outcomes) and quality criteria of the Global Framework and was adapted from a generic self-assessment instrument developed by WHO, based on the World Federal for Medical Education (WFME) Standards (World Medical Federation Global Standards). It is proposed that the instrument will be tested and validated in several countries prior to final adoption.

Vision and Competence

The vision and competence project team is developing an “educational roadmap” to guide efforts in and mechanisms for pharmacy education. This domain of work is examining existing competency frameworks and use of these before initiating a consultative and evidence-based process to develop a broad competency framework for the pharmacy workforce.

International initiatives indicate a need for clearly defined standards of practice if useful continuing pharmacy education and training are to assure continued competence in practitioner populations. However, the real challenge lies in the assessment of performance when completing tasks, that is, competence in practice.

To achieve a high-quality global infrastructure for pharmacy, the educational system should be mapped to the required competencies of pharmacists to provide the relevant pharmaceutical services for meeting the health needs in any given country context. Although no one national model may be appropriate for all systems, there are significant global health, labor, and market drivers, which suggest that a competency-based approach is sensible and sustainable for workforce development (Albanese, M. et al. 2006; Knebel, E. et al. 2008; Maitreemit, P. et al. 2008; Pfleger, D. et al. 2008). There is a need to develop approaches to learning that explicitly specify the outcome in terms of competencies that can be taught, learned, and assessed.

A session organized by the Taskforce (FIP WHO UNECP) at the 15th International Social Pharmacy Workshop (ISPW) held in Queenstown, New Zealand, in July 2008, explored the cultural and professional barriers to adopting a common global framework for practitioners. The feasibility of creating a global competency framework for pharmaceutical services was

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also addressed. The outcomes indicated a growing interest in competency development across different settings. Seeking a global generic common framework adaptable to the needs of the countries was positively identified as a way forward. The need for a global competency framework was recognized among the participants but questions remained about how this should be achieved as earlier efforts were unsuccessful. Reviewing existing frameworks (internal and external to pharmacy) and developing a broad, simple framework with functional areas that could be adapted to local situations were suggested as next steps. Providing a Focus: Country Case Studies Since the scaling up of the pharmacy workforce is necessary to ensure improved access to and rational use of medicines and health-related UN Millennium Development Goals, the Taskforce has focused its efforts on planning and coordinating country case studies in sub-Saharan Africa, where workforce needs are greatest. Seven countries agreed to collaborate with the Taskforce; a Dean or Head of School of Pharmacy was appointed from each country to serve as the country case study lead. Leads were identified from Ethiopia (Jimma University), Ghana (Kwame Nkrumah University of Science and Technology), Kenya (University of Nairobi), Malawi (University of Malawi), Tanzania (Muhumbili University of Health and Allied Sciences), Uganda (Makerere University), and Zambia (University of Zambia). The first meeting of the Taskforce and Country Case Study (CCS) Leads was held at FIP Congress 2008 in Basel, Switzerland. During a panel session at the Taskforce’s Third Global Education Consultation, the CCS Leads expressed several challenges they faced, including a severe shortage of practicing pharmacists and few experienced faculty members to educate students (International Pharmaceutical Federation 2009). The Taskforce subsequently organized a workshop in Nairobi, Kenya, in August 2009, to further explore the themes raised during the Basel workshop: academic capacity development, curriculum development and reform, quality assurance, and overcoming the challenge of limited resources. The discussion took place in a roundtable format, with each of the CCS Leads sharing their needs, strategies, experiences, and ideas for collaboration within each of the themes. Taskforce Leads briefly shared their findings and tools from the literature relevant to their domains and areas of responsibility on the Taskforce. The Taskforce and CCS Leads prioritized key activities for collaboration and reached consensus on a proposed program of work. The

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work plan provides an evidence-based approach to operationalize needs-based education capacity development advocated by the Taskforce. It aims to strengthen needs-based pharmacy education capacity in country case studies through regional and international collaboration for academic capacity, QA systems, strategic vision and advocacy; and to develop evidence-based tools and guidance to inform global pharmacy education strategic development.

Conclusion and Policy Implications/Recommendations:

Capacity to Influence Policy

Because of its position globally, FIP is ideally placed to provide guidance, produce policy, and advocate for and influence change. FIP has produced policy statements on good pharmacy education practice and more recently on the QA of pharmacy education.

In order to influence policy, the Taskforce aims to work with WHO, UNESCO, and local African leads to engage ministries of health and education, universities, and local professional pharmaceutical organizations. The Taskforce will advocate for the tools, guidance, and policy developed to be implemented and evaluated on an ongoing basis to monitor the impact of changes in pharmacy education and the pharmacy workforce.

UNITWIN Network

The Taskforce has also formed a networking partnership with UNESCO, with the aim of using the experience of a global agency and link with pharmacy higher education institutions across the world. The designated Global Pharmacy Education Development Network UNITWIN (“university-twinning”) platform will act as a conduit for developing consensus and facilitating the spread of best practice and educational development worldwide. The UNITWIN Network will establish a resource base and collaborative forum for exchange, research, and capacity building dedicated to tackling challenges of academic capacity, QA of educational systems, and workforce competence. This is the first time that a formal global network has been established for pharmacy education.

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FIP Workforce Report During the 69th World Congress of Pharmacy and Pharmaceutical Sciences in Istanbul, FIP launched the 2009 FIP Global Pharmacy Workforce Report. The report is the most comprehensive global report on the pharmacy workforce and includes descriptions of country experiences, guidance, and recommendations to serve as an advocacy tool at country, regional, and global levels (International Pharmaceutical Federation 2009). Statement of Policy on Quality Assurance FIP Council approved the Statement of Policy on Quality Assurance of Pharmacy Education [30] in September 2009. The statement recommends that “in order to support the development of an adequate and appropriate pharmacy workforce and the academic and institutional infrastructure to deliver the required competency-based education and training, each country should have its own standards-based system for the QA of pharmacy education (p. 3).” According to the statement, a standards-based QA system should:

▪ reflect the vision for pharmacy practice and education that has been developed through profession-wide consensus;

▪ allow appropriate input from all stakeholders, including students and the public;

▪ ensure that educational programs are evidence and competency-based, of high quality and meet the needs of the people, the pharmacists, and their country;

▪ evaluate programmatic outcomes as well as institutional structures and processes; be transparent and free of inappropriate influences and appearances of conflicts of interest in its development and implementation;

▪ promote and foster self-assessment and continuous quality improvement of educational institutions; and

▪ be accountable to the appropriate governmental authorities. The statement also recommends and encourages specific action and implementation by national governments, regulatory and QA organizations, FIP member organizations, and universities, colleges, and schools of pharmacy. The statement is a companion to the FIP Statement of Policy on Good Pharmacy Education Practice (International Pharmaceutical Federation 2000).

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In conclusion, there is a need to contribute to the continued development of the global healthcare workforce from this professional sector. A focus on progressing access to medicines, the “essential” in addition to equitable access to the best available pharmacotherapy, is an urgent priority. The appropriate use of medicines involves the application of high levels of technical and professional knowledge and skills, and hence an educational focus is a sensible and rational way forward. Impacting on medicine use and rational pharmacotherapy will have direct and measurable health outcomes for communities and nations. The Taskforce will be advocating for this direct need at policy level in addition to local implementation strategies. For more information, please see www.fip.org/education.

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Erratum

Figure 1. Pharmacy Education Action Plan

Needs:

Local, regional,national &national, &international

Services:Education:

Provided by thepharmacy workforceto meet these needs

VISIONDevelopment,infrastructure and

quality

Competencies:

For service provisionand practitionerpdevelopment

On page 7, Figure 1 should be displayed as follows:

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Global Perspectives of Pharmacy Education and Practice