WHO Technical Briefing seminar Geneva, 16 – 20 November 2009

WHO Technical Briefing Seminar 16 – 20 November 2009Salle M505

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WHO Technical Briefing seminarGeneva, 16 – 20 November 2009.

Pharmaceutical Workforce situation analysisCountry cases studies

Mrs Helen Tata (WHO/EMP)

Mr Daniel Amaning (MOH/Ghana

Mrs Bridget Okala (MOH/Nigeria)

WHO Technical Briefing seminarGeneva, 16 – 20 November 2009.

Pharmaceutical Workforce situation analysisCountry cases studies

Mrs Helen Tata (WHO/EMP)

Mr Daniel Amaning (MOH/Ghana

Mrs Bridget Okala (MOH/Nigeria)


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OverviewOverview

Context

Objective

Methodology

Next steps

Case study findings– Nigeria– Ghana


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Context (1)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.


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Context (2)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.

ObjectivesObjectives

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


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Levels of Health Care involvedLevels 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


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SamplingSampling

Not possible to visit all the facilities, thus sampling for:

– Geographical areas - 6

– Facility types - 180


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Tool: Level III IndicatorsTool: 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


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Tool: Level III IndicatorsTool: 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


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Countries involvedCountries involved

The following ACP countries were involved in the assessment:

1. Ghana

2. Nigeria

3. Sudan

4. Tanzania


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Preliminary resultsPreliminary 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

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

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

Availability of Pharmacies per 1000 of the population at state level.


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TANZNIA: Availability of Pharmacies and Pharmacists in different sectorsTANZNIA: 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.


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Next StepsNext StepsThe 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.


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NigeriaNigeria

Case Study Results

Mrs Bridget Okala (MoH Nigeria)


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BackgroundBackground


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DISTRIBUTIONDISTRIBUTION

SectorMaleFemaleRatio

Retail or wholesale84233.7

Manufacturing174276.4

Public sector3644300.8

Total6224801.3

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

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


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Where pharmacists work (Council data)Where pharmacists work (Council data)

0%

0.3%

1%

2%

4%

15%

16%

22%

40%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

Multilateral/bilateral/NGOs

Faith-based healthfacilities

Private-for-profit facilities

Academia/teaching

Pharm. manufacturers

Public sector

Not currently working

Private wholesalers

Private retail pharmacies


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MIGRATION CHARACTERISTICSMIGRATION CHARACTERISTICS

Migration outside

-Professional learning opportunities

-Salary considerations

Migration within

-Generous salary

-Professional growth

-Extra benefits


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LABOUR MARKET FOR PHARMACISTS LABOUR MARKET FOR PHARMACISTS


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Job satisfaction – generally satisfied Job satisfaction – generally satisfied Item Agree NeutralDisagree

I am given opportunities to improve my professional skills

592021

My job is challenging and interesting721513

I receive training in the skills that are critical for me to succeed.

472429

Rules here are fair453118

Suggestions made by workers on how to improve the work are usually taken into consideration

433126


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Job satisfaction – generally dissatisfied Job satisfaction – generally dissatisfied Item Agree NeutralDisagree

This organization pays me fairly for the work I do382638

My job offers adequate pay compared with similar jobs

282348

Rates of pay and pay raises are decided fairly.243145

My work is rarely disrupted by bureaucratic processes.

332839

I have the resources I need to do my work (e.g. equipment and supplies)

292249

There is genuine management concern for the problems employees face

303040


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PRODUCTION OF PHARMACISTSPRODUCTION OF PHARMACISTS


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Production of pharmacistsProduction of pharmacists


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Current/future challengesCurrent/future challenges


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RecommendationsRecommendations


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GhanaGhanaCase Study Results

Mr Daniel Amaning Danquah (Pharmacy Council, Ghana)


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The Country profile

Health structure & pharmaceutical system

Findings

Recommendations

OutlineOutline

Country Profile Source Pharmaceutical Council Ghana, GSS-PHC 2000

Country Profile Source Pharmaceutical Council Ghana, GSS-PHC 2000


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IndicatorDataYear of data

Total population23.5 m2007

Annual growth of the GDP (US$)6.3%2007

Life expectancy at birth males (years)58.7

Life expectancy at birth females (years)60.4

Total expenditure on health as a percentage of the GDP 6.2%2006

Per capita expenditure on health in US$ 6.72003

Population below 1 US$ per day 29%

Literacy rate74.8%2009

Total number of Medical Doctors in the country1:13,683 people2007

Total number of Nurses/midwives in the country1:1,4512007

General and Health IndicatorsGeneral and Health Indicators

Structure of Health and Pharmaceutical System

Structure of Health and Pharmaceutical System


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FINDINGS- Practice areas of respondentsFINDINGS- Practice areas of respondents


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Demography of RespondentsDemography of Respondents


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Size of pharmacy workforceSize 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%)


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Where do pharmacists practice? Where do pharmacists practice?

Most (85%) are in private retail

3.3% in manufacturing

Regional distribution of pharmaceutical personnel and pharmacies per 10,000

pop.

Regional distribution of pharmaceutical personnel and pharmacies per 10,000

pop.

Maldistribtion

Who is doing the work of pharmacists in these regions?

Pharmacist distribution per Regional and Teaching hospitals

Pharmacist distribution per Regional and Teaching hospitals

Providers of pharmaceutical services

Providers of pharmaceutical services


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Job satisfaction Attendance of CE programmes

Job satisfaction Attendance of CE programmes


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

professional aspirations can be met


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16% do not think they have opportunities to improve their skills

22.7% do not know


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My job is challenging and interesting

My job is challenging and interesting

24% disagree?

What is the problem? – review of training of undergraduate? or CPD

26.3% do not know?


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Is there a disconnect?Is there a disconnect?

Change must be accompanied with need and wider stakeholder involvement


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Workforce Retention % of Pharmacists practising in country

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


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Motivating factors for changing jobMotivating factors for changing job

Motivations for migration are multi-factorial


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Training capacityTraining 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


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Challenges of training institutionsChallenges 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


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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


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There is a desire 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)RECOMMENDATIONS (2)


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Acknowledgements Acknowledgements

World Health Organization

European Commission

The HR Directorate, MoH & GHS

The Pharmacy Council

Stakeholders

Lead Consultant, Prof Mahama-KNUST

Respondents

Data Collectors


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MERCI

Documents

WHO Technical Briefing seminar Geneva, 16 – 20 November 2009