Pharmacy careers in developing countries

Beverley Snell Centre for International Health, Macfarlane Burnet Institute for Medical Research and Public Health bev@burnet.edu.au July, 2006

 Capacity building Filling gaps Developing systems

Common problems in developing countries

Enteric conditions (diarrhoeas, hepatitis A,B,E, parasites) Respiratory - acute infections, TB Malaria Measles and other vaccine preventable diseases Nutritional deficiencies Reproductive health problems - men & women Neo-natal problems Area-specific problems eg bilharzia .. HIV transmission

Components of Primary Health Care

(PHC)
education about disease theory integration with other community activities adequate safe water & basic sanitation adequate production of food & good nutrition comprehensive MCH care with child spacing education & immunisation against major diseases prevention of locally endemic diseases & injuries curative services

provision of essential drugs aimed at the real needs of most of the people

Essential drugs
selected drugs of the utmost importance basic and indispensable for health needs must be therapeutically effective, have acceptable safety & be affordable

SANE

Standard Drug List

disease patterns are analysed drugs needed for the REAL NEEDS of MOST of the people are chosen safe & reliable treatment is available most efficient use of available money, stops waste on unnecessary drugs products which are unsuitable, unfamiliar, dangerous, irrelevant are EXCLUDED

Treatment guidelines
associated with a standard drug list are a key step in promoting rational prescribing practices
disease patterns are analysed most appropriate standard treatments decided drugs needed for treatment determined (WHO model list can be used as reference)

Involved in developing parts of National Drug Policy

Developing systems

Activities of medical supply system - not just store-keeping

management of procurement proper storage & distribution inventory control record-keeping evaluation of information eg orders from camps, districts, villages drug list modification (based on feedback, new info) calculation of future needs & ordering education of staff and public about all the above

Jobs that have been done

Somalia 1980

Around 1 million refugees in a population of 4 million Ethiopia

camps War 1977 re Ethiopian control of the Ogaden

Refugee Health Unit

coordinated centrally & in 5 regions

Pharmacists have to know about logistics Air transport:

Need to know aircraft runway need

expensive!

Road transport: usually some of the way

By sea usually: ~ 9 mths needs ETA check etc prompt clearance

Somalia PHC program (1983--> 1986)

Standard drug list and treatment guidelines

Referral level MCH

CHWs: the basis of the program

Pharmacists are expected to do everything

National policy development, community education, training

Fabian Kong
East Timor: Develop essential drugs program and medical supplies system East Timor is looking for more pharmacists

Kiribati - 2 assignments (2004/5)

In collaboration with Pharmacy dept and Ministry of Health Develop National Medicines Policy Review and re-draft Pharmacy-related legislation and make recommendations for regulations

Jean Spinks B Pharm, Master

Kingdom of Tonga (2002): Develop drug registration system (6 months)

Public Health [MPH], Master Health Science Public Health Practice [MHSc(PHP)]

Aceh 2005: Develop logistic system for Red Cross medical supplies (3 months initial)

Jobs available

Pharmacist required - Ethiopia - August 2006 Extensive experience in HIV/AIDS-related supply chain management in developing countries; experience in supply chain management of HIV-related laboratory supplies is a plus Background in pharmacy, medical supply management, public health or (bio)-medical sciences; International experience in dealing with government, bi-lateral and multi-lateral organizations; Strong problem solving skills and analytical capabilities; Proactive, creative and result-oriented; Excellent communications (written and oral) and interpersonal skills; High level of proficiency in relevant computer applications particularly Excel, Access, Powerpoint and Word; Strong dedication to improving the lives of people living with HIV in Ethiopia.

Pharmacist required - Pacific Island country - now

supply management background/experience but also can drive the development and implementation of the NMP which means the whole lot.

examples

PNG - 12 months AusAID Team Leader - Pharmaceutical Upgrade Program

Qualifications: PG qual such as a Master in Public Health (MPH). Experience:

(Tim Dodd, no Australian available)

1. Demonstrated achievement and competence in health services management, and associated information systems. 2. High level experience in pharmaceutical services management and budgeting/ financial management. 3. Previous work in developing countries (5 years), preferably including work as a project team leader or health ministry section head.

examples

PNG: experience required contd

plus 1. Experience in pharmaceutical procurement and distribution 2. Education and training capability 3. Experience in planning, coordinating and delivering pharmaceutical education 4. Experience in information systems management 5. Experience in developing and implementing national drug policy and 6. teaching rational drug use

Volunteering : Major Agencies

AVI - Australian Volunteers International
http://www.australianvolunteers.com

VIDA - Volunteers in International Development Assistance

http://www.vidavolunteers.com.au

AYAD - Australian Youth Ambassadors for Development

http://www.ayad.com.au/public/assignments.aspx

Australian Volunteers International

http://www.australianvolunteers.org.au/volunteer/more

Assignments 6 months to 2.5 years (was 2 years) Salaries - local with support

Current jobs

AVI Kiribati - hospital pharmacist - 6 months - 2 years

PIMSCode-10527346

http://www.australianvolunteers.com/where/pacific
1. To become familiar with the situation in the country, and in consultation with staff, develop training modules that could be appropriate for staff practising in the outer Islands. To conduct workshops and training for the staff identified by the Department of Pharmaceutical Services and covering matters determined by the Department of Pharmaceutical Services
Volunteer = volunteer salary and conditions

2.

See next slide

Current jobs

Kiribati contd

Modules could cover the importance of Good storage practices Adherence to Kiribati Standard Treatment Guidelines for prescribing Dispensing in accordance with the requirements of the Department of Pharmaceutical Services and National Medicines Policy Accurate documentation of patients prescribed medications Regular tally of medications used Regular report to CMS of medicines used Re-ordering supplies in accordance with the requirements of the Department of Pharmaceutical Services

Current jobs

AVI: Malawi - Pharmacist - 2 years Christian Health Services of Malawi (CHAM)

PIMSCode- 10527618

Provide drugs, medical supplies and other consumables Supervise drug selection and use of supplies to ensure continuous availability Provide technical inputs into management of the hospital Human resource management Control and maintenance of fixed asset register.

Current jobs

AVI: Malawi - Pharmacist - contd Essential Pharmacy degree - Bachelor of Science in Pharmacy or Bachelor of Pharmacy Ability to forecast supplies requirements for the hospital Coordinating drug, medical supplies and consumables supply service Good communication skills Ability to work within a team. Desirable Certificate in management.

Current jobs

Australian Youth Ambassadors Age < 30 6 months - 18 months Salary - local salary + support

http://www.ayad.com.au/public/assignments.aspx

Current jobs

AYA - East Timor - 12 months (closed - BUT

may not be filled)

The AYA will train, supervise and review current systems in the central pharmacy (Autonomous Medical Store = SAMES)

Tasks will include: Organisation of drugs and medical supplies to minimise the wastage of drugs and medical supplies and through the counterpart, extend this training to district medical stores Strengthening the current relationship of the supply of drugs and medical supplies from SAMES to district health facilities Introducing rational drug use through the promotion of newly developed Standard Treatment Guidelines and National Formulary
http://www.ayad.com.au/public/assignmentDetails.aspx?code=15ETHE13

Current jobs

AYA East Timor contd

The AYA will perform these duties by developing and applying new Pharmacy Laws and Policies relating to the procurement (including importation), distribution and sale of pharmaceuticals The AYA will also work with the Ministry of Health Pharmaceutical Services (MoHPS) to enforce its legal requirements and provide feedback regarding its implementation to relevant ministries external to the MoH Dissemination of the new Pharmacy Laws shall be undertaken predominantly through community consultation with the Association of Pharmacists

More info on Timor Leste health sector

http://www.burnet.internationalhealth.edu.au/resources/conf_docs/ tlconf05 More Timor Leste jobs Supervising pharmacist - revised (AYA) Pharmacist Advisor - PALMS (living allowance) Logistics/supplies management - UNFPA - UNV position
For info on Timor Leste jobs contact Fabian Kong

"fabian kong" fabian.kong@development-partners-int.com

Courses

Courses - WHO example covers

most common problems in the pharmaceutical sector in developing and transitional countries how WHO and the UNICEF Supply Division provide support importance of National Drug Policies as the best approach to make essential medicines of good quality available to all who need them, and ensure the rational use of medicines ways to strengthen collaboration with WHO etc impact of international agreements on pharmaceuticals current issues such as pharmacovigilance, pricing issues, adherence, traditional medicines and counterfeit medicines

Courses - another WHO example

25 years of essential medicines - impact and challenges Selection of Essential Medicines- Standard Lists What is access?
To essential medicines, HIV medicines, to antimalarial medicines, to anti TB medicines, The Global Fund

Procurement and supply What is quality? Regulation and quality assurance Medicine Prices and Financing Promoting rational medicine use Country programs examples Monitoring medicines donations Global issues, Global medicines funds, International coordination, international trade agreements

Courses - INRUD example

Historic milestones - different health care systems Essential medicines, primary health care rational medicine management Roles of different stakeholders including health workers, traditional healers, research organisations and the pharmaceutical industry International context, global treaties and national medicine policy Treatment guidelines, essential medicine lists Patterns of medicine use, strategies for the promotion of rational medicine use, community medicine use Antimicrobial resistance and approaches for control Medicine quality and quality assurance HIV, malaria and tuberculosis related treatment within their respective global initiatives Medicine supply system inc procurement and distribution Medicine costs, affordability and financing options Medicine information management

Courses - ARV supply focus

National infrastructure & assessment of current system Intro to ARV pharmacy Quality assurance Diagnostics Legal issues Financing: Intro and global financing mechanisms Procurement, Procurement planning

Reception & quality control Storage & distribution Supply chain planning Stores management Distribution planning Challenges at stores Financial mgmt: budgets Communication Human resources management Monitoring & evaluation Rational use

Program planning
Project management Selection Supplier selection & prequalification, Quantification

RMU Course INRUD support

Essential medicines concept What influences medicine use by consumers? Investigating medicine use pattern and identifying problems Prioritizing community medicine use problems Conducting rapid appraisal to analyze problems and identification of solutions Developing problem analysis diagram Making appraisal matrix and preparing tools for field study, Focused group discussion, Face to face education Field visit to study problems with rational use of medicines in community Data analysis Monitoring and evaluation Formulating advice Linking research to intervention Advocacy and networking Project preparation and presentation

D&TC Course - practical aspects of starting / running a DTC - MSH

Structure and functions of a DTC Formulary management Cost evaluation of formulary drugs STGs for improving quality of care Assessing drug efficacy, safety, quality Strategies to improve drug use
Drug utilisation review Identifying drug use problems Understanding drug use problems

Monitoring and evaluating a DTC

Drug policy Course - Sri Suriyawati, Indonesia Monitoring and Evaluating National Drug Policies and Access to Drugs: Developing and Implementing a National Drug Policy: Case studies. Selection of drugs in Formularies, and Treatment Guidelines: different countries examples Procurement issues and options Quality Assurance: procurement, production, and use of drugs. Financing and Pharmaco-economic Issues Global trade treaties: FTAs,TRIPS, WTO. Human Resource Planning and Development: numbers, training needs of pharmacists and pharmacy technicians Consumer Issues Promoting Rational Use of Drugs: Measuring and changing usage Hospital Drug and Therapeutic Committees Drug Policies and Public Health: Effects of eg HIV, TB, Decentralization

Course - EDM / MSH

Drug Policy and Regulation Selection and Quantification of Drugs Procurement Methods and Strategies Quality Assurance Kit Distribution Financing Drug Supply Store Management Inventory Control Distribution Strategies Rational Drug Use Drug Supply Management Information Systems Indicator-based Assessments

Websites
WHO EDM: http://www.who.int/medicines/ MSH: http://www.msh.org/ Management
Sciences for Health (lots of great resources) Drug Price Indicator Guide -http://erc.msh.org/
low on left of screen

Sources of supplies
International Dispensary Association http://www.ida.nl/, UNICEF - http://www.supply.unicef.dk

Sites for downloading guidelines

International Guidelines
Drug donations Equipment donations Guidelines for disposal of medical waste, etc http://www.drugdonations.org/eng/richtlijnen/eng_richtlij nenmainpage.html Australian Donation Guidelines http://www.burnet.internationalhealth.edu.au/freestyl er/gui/files/AustDonationGuide.pdf