It was not difficult for me to choose the topic of this lecture when I reflected on the impact of Prof. Marquis on Pharmacy education at the “Great Ife”. My conviction that “people make the difference” was strengthened and I decided to talk about pharmacy human resources.
Human resources, as defined by the Wikipedia, “is the set of individuals who make up the workforce of an organisation, business sector, or economy.” It is the most important asset of the enterprise whose value can be enhanced by further learning and development. It is the human capital that, through creative thinking, brings other resources together for appropriate deployment and engagement which will lead to the achievement of the set target.
For Pharmacy to fulfil its role in the society, we must pay adequate attention to human resources. The approach will be to look at what is considered as the proper fit, what is the current situation and what should we do to bridge the gap.
There is an acute shortage of health human resources (HHR) in the world. The World Health Organisation (WHO) estimates a shortage of 4.3 million health workers, including pharmacists. The shortage is most severe in the poorest countries especially in sub-Saharan Africa. The situation was so serious that WHO declared it “health workforce crisis” on World Health Day 2006. This situation was attributed to decades of underinvestment in health workers education, training, wages, working environment and management.
There are peculiarities which vary from one country to the other. In Nigeria, a critical examination of the situation will show not only a shortage of pharmacists in particular, but a paradoxical underutilisation of the available number. A discussion on pharmacy human resources should not be restricted to pharmacists alone but must include others like the pharmacy technicians, biologists, chemists and others who are involved in one way or the other. However, the scope of this address will be limited to pharmacists only.
A good policy or strategy should be adopted to plan the human resources need for Pharmacy. The objective of the plan is to provide:
– The right number of pharmacists required within a stated period with provision for future need.
– Right knowledge(education and training)
– Right skills and competencies (expertise, proficiency).
– Right attitudes
– Performing the right tasks in the right place at the right time to achieve pre-determined targets.
In other words, whatever we do, we must consider each element of the objective for us to achieve the best result for Pharmacy.
Pharmacists are health care professionals whose practice is mainly concerned or focused on safe and effective use of medication. Historically, the role of the pharmacist was to check and distribute drugs to doctors and institutions; but in modern times, this role has been expanded to include but not limited to:
- clinical medication management, including reviewing and monitoring of medication regimens
- assessment of patients with undiagnosed or diagnosed conditions, and ascertaining clinical medication management needs
- specialised monitoring of disease states, such as dosing drugs in kidney and liver failure
- compounding medicines
- providing pharmaceutical information
- providing patients with health monitoring and advice, including advice and treatment of common ailments and disease states
- supervising pharmacy technician and other staff
- oversight of dispensing medicines on prescription
- provision of non-prescription or over the counter drugs
- education and counselling for patients and other health care providers on optimal use of medicines (e.g., proper use, avoidance of overmedication)
- referrals to other health professionals if necessary
- pharmacokinetic evaluation
Pharmacists are often the first point of contact for patients with health inquiries and the emphasis on pharmaceutical care will involve taking responsibility for patients and their disease states, medications and management for improved outcome. The argument will be: how prepared are the pharmacists to take up this role even if the environment permits?
The current system of pharmacy education in Nigeria is well known to us. We are transiting from the five-year Bachelor of Pharmacy degree to a uniform six-year Doctor of Pharmacy programme. The Nigeria Academy of Pharmacy has just concluded an education summit and the outcome, if implemented, will bring the desired changes.
The possible areas of practice specialisation include:
– Academic pharmacist (teaching, research, etc)- Hospital pharmacist (including administrators)- Community pharmacist- Industrial pharmacist
Each practice area also has sub-specialities like production, quality, regulatory or sales/marketing in industrial pharmacy.
The distribution of health workers in Nigeria shows a preference for urban practice which is even more glaring in the pharmaceutical sector. There are 19,559 Pharmacists in the register of the Pharmacists Council of Nigeria (PCN) but only 11,336 of this number renewed their licences in 2014.
With a population of about 170 million, Nigeria has one of the poorest “pharmacists to 10,000” population figures (less than 1). However, we shall be more concerned with the utilisation of the existing figures and not the alarm that the ratio suggests. How do we account for the 8, 223 Pharmacists that are “missing” in the PCN data? Our universities (17 of them) produced an average of 1,165 pharmacists per year (2012-2014 data). At the current rate, it will take about seven years to produce the missing number.
Again, of the 11, 336 pharmacists who renewed their licences in 2014, how many of them are actually practising Pharmacy in the real sense of it? Within the numbers that are practising, how many of them have the right knowledge, skills and attitudes and are performing the right functions or tasks at the right place and right time? These are questions that will need research-based answers.
My observation over the years has led me to conclude that pharmacy human resource in Nigeria is largely sub-optimised. The very sound education received by the average pharmaceutical scientist has not been properly translated into tangible, recognisable or widespread benefit to the system for a variety of reasons. At the government level, the issue of wages, working environment and management are negative factors limiting the professional advancement of pharmacists. This is particularly true in the hospital system. There are also the obvious gaps in the knowledge, skills and attitudes of the individuals in the profession. The capacity to fill these gaps is within our control as individuals and groups (PSN and her technical groups).
To get the very best from pharmacists in academia, the career path must be chosen very early and a practice opportunity must be created. We just have to figure out how to make this possible. It has even been suggested that pharmacy teachers should take some courses in Education as part of the drive for the right teaching knowledge. Every other practice area will also require the acquisition of the requisite skills either as part of on-the-job training or specially designed and specific training courses.
Some of the functional and behavioural skills or competencies which need to be acquired within or most probably outside pharmacy schools include but not limited to:
– Self-development: learning continuously and developing professional potential and ability
– Sense of urgency: creating a focused , agile, productive and fast learning system
– Accountability for achievement: setting, communicating and committing to the critical, few and clear expectations
– Performance with integrity: delivering on promises with organisational and individual trustworthiness.
– Innovation and entrepreneurship: creating and sustaining competitive advantage through well-executed ingenuity.
– Initiating action
– Strategic thinking
– Business management
– Enhancing the performance of others
The list is long and cannot be exhausted in this lecture. What is apparent is that so many people do not acquire these skills either through personal negligence or the way their career path is configured which gives no room for exposure and learning.
We have a lot of work to do to get the best from the available pharmacy human resources and to ensure that new ones are adequately prepared to take on the challenges of the contemporary pharmacy practice. I will put this responsibility on the duo of the Pharmacists Council of Nigeria (PCN) and the Pharmaceutical Society of Nigeria (PSN). We must account for everyone and get them to fulfil their roles in the society.
There are many pharmacists out there who are more or less “economic slaves”, renting out their certificates as the only means of livelihood. There are others who are practising sub-optimally. They only have fond memories of their “hot” pharmaceutical classes and examinations, having no sellable skills or competencies. There must be rehabilitation or career renewal programmes to accommodate the “lost sheep of Israel”.
The review of the academic curriculum must put adequate emphasis on career development. As much as possible, the new graduates must be exposed to their role expectations before leaving school. They must not be allowed to be roaming the streets looking for internship placement. The task of creating new pharmacists in the mould of the late Prof V.O. Marquis should be seen as a moving target which must be hotly pursued. We owe our profession and the society a duty to build vibrant, responsible and responsive pharmacy human resources for a better health care delivery system in Nigeria.
God bless Pharmacy, God bless Nigeria.
(Extracts of the keynote address delivered by Dr Lolu Ojo FPSN at the Annual Prof. Marquis Memorial Lecture at the Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife on 6 May, 2015)