Capacitating The Last Mile Pharmacy Practitioner: Francophone Vs. Anglophone In Sub-saharan Africa.

• By: NGARUIYA, Lilian (Ecumenical Pharmaceutical Network (EPN), Kenya)
• Co-author(s): Dr Lilian Ngaruiya (Ecumenical Pharmaceutical Network (EPN), Nairobi, Kenya)
  
• Abstract:

  BACKGROUND INFORMATION
  
  The pharmacy educational system is very diverse especially between Anglophone and Francophone nations of sub-Saharan Africa (SSA). With formal training ranging from 3-6 years, SSA countries have one or both systems which more often than not dictates the density of skilled pharmacy workforce. Anglophone countries are generally more economically developed. Further, English dominates in health-related education: academic literature, and public/global health resources.
  
  The Ecumenical Pharmaceutical Network (EPN), which has members in both French and English speaking SSA, conducted a needs assessment survey in remote health facilities which showed less than 25% of the church-based facility staff are qualified, yet they are managing and dispensing medicines. The role of a pharmacist is taken up by other health professionals or community volunteers, who have basic education.
  
  EPN, has instituted capacity building activities in both languages to fill this gap through training for last mile Health Care workers through tailored training sessions e.g. essential pharmaceutical practices and handling Antimicrobial Resistance, that have proven to yield positive results.
  
  PURPOSE
  The study highlights the gaps in the pharmacy workforce in the church health system SSA, more so in marginalized and remote areas where National government health services are limited.
  
  METHOD
  The study used both qualitative and quantitative study design analysis of 114 church health facilities (including dispensaries and health centers). Participants were mainly health facility administrators and pharmacy staff responded to an online questionnaire, and interviews on aspects of institutional, infrastructural and knowledge gaps.
  
  RESULTS
  In francophone Africa, some countries only have 6-year Pharm.D (Niger, Guinea, Togo, Benin) program which is costly and lengthy hence the number of pharmacists enrolling for the programs is low is low and some leave the countries for better opportunities. Others train only one cohort of students at a time, train them for 3 years before enrolling another class (CAR, Chad).
  
  Within Anglophone countries, most countries offer certificate, diploma and degree programs (1, 3, 4-6 years respectively): Kenya, Tanzania, Zimbabwe, Nigeria, resulting in diversity in cadres: dispensers/pharmacy assistants, pharmaceutical technologist and pharmacists respectively.
  
  EPN training sessions are delivered as a hybrid of 3-10 days in-person training and up to 3 days online training with continuous follow-up, and practical implementation of knowledge acquired. This approach has yielded 39% increase in basic pharmaceutical knowledge and more than 90% success rate in implementing public health interventions in facilities with staff that have no skilled pharmacy practitioners.
  EPN also offers scholarship, targeting scholarship program has been very successful with an 80% improvement rate in basic pharmaceutical services. Specialized training can be quite expensive and time consuming but very impactful.
  
  CONCLUSION
  Synergistics efforts in both formal training and continuous on job training, are key bridging the gap in skilled workforce in both regions especially where there are no pharmacists. EPN’s efforts to deliberately tailor make training opportunities for the francophone member countries resulted in improved pharmaceutical services.
  
  There’s still need to empower the last mile pharmacy practitioner though varied innovative channels to bridge the existing gap to assure patient safety in handling medication.