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Compounding, manufacturing, and supplying medicines have traditionally been the primary functions of pharmacists. In recent years, however, their role has evolved into one that is much more focused on a patient-centered approach, which better supports adherence to long-term therapy for chronic conditions, such as diabetes, hypertension, asthma, and even HIV.
According to the World Health Organization (WHO), adherence to treatment regimens for these and other long-term conditions averages 50 percent in developed countries, with even lower rates in low- and middle-income countries. This makes pharmacists an integral member of a multidisciplinary healthcare team, where they play a critical role not only in the procurement and supply of medications, but also in developing an evidence-based care plan, establishing an ongoing and supportive relationship with patients, and providing follow-up care, advice, and support to improve health outcomes.
Working closely with WHO, the International Pharmaceutical Federation developed a “seven-star concept” in which a pharmacist is described as a caregiver, communicator, decision-maker, teacher, lifelong learner, leader, and manager. This holistic and patient-centered approach — also known as clinical pharmacy — helps optimize patient care and outcomes, particularly in overburdened health systems in low-resource settings.
AIHA’s Clinical Pharmacy Program
AIHA has some 25 years of experience working in close collaboration with governments, healthcare institutions, and schools of the health professions to build sustainable human resource and institutional capacity to improve access to high quality, patient-centered medical services in developing and transitioning countries around the globe.
We began working with local stakeholders in Africa in late 2004, establishing our first pharmacy partnership in 2006 by linking University Teaching Hospital in Lusaka and Livingstone Central Hospital in Zambia with a Milwaukee-based consortium led by the Center for International Health. From day one, a key objective of this partnership has been to develop in-country training capacity that enables pharmacists to more effectively organize and manage pharmacy services as a way to better ensure high quality HIV-related treatment and care to mothers, infants, and children.
The following year, we established a second pharmacy partnership, linking Addis Ababa University School of Pharmacy in Ethiopia with Howard University in Washington, D.C. Due to Ethiopia’s severe shortage of doctors and nurses, there was an urgent need for pharmacists to play an increasing role in patient-oriented services, particularly the provision of ART. Because pharmacy education in Ethiopia at that time focused on products and traditional drug supply functions, our partners collaborated with the Ministry of Health and other local stakeholders to shift toward clinical pharmacy education, training, and practice.
In response to the South African Pharmacy Council’s call to more than double annual production of pharmacy support personnel from 1,000 to 2,500, AIHA established in 2013 a partnership linking Nelson Mandela Metropolitan University (NMMU) and the St. Louis College of Pharmacy (STLCOP). NMMU is the first university in South Africa to introduce a new and enhanced Pharmacy Technician Training Program. Together, the partners are working to strengthen NMMU’s capacity and to support this important new mid-level pharmacy cadre.
Each of these partnerships works together to first identify specific clinical pharmacy needs and gaps in training and service. Then they collaborate to develop and implement locally-driven and locally-owned interventions that help bridge these gaps to help ensure high quality, integrated healthcare services are accessible to the communities they serve. In particular, AIHA’s pharmacy partnerships often focus on improving quality and efficiency by expanding training and developing new scopes of work for pharmacists and mid-level pharmacy professionals to facilitate task shifting as a way to overcome severe shortages in the healthcare workforce.
Partnerships in Action
Selected Program Results
- Partners at Zambia’s University Teaching Hospital and Livingstone Central Hospital have successfully integrated pharmacists into multidisciplinary ART care teams as a way to improve quality of care for PLHIV. To help ensure timely access to medications and advice, they’ve also established satellite pharmacies in a number of high-volume wards, including ob/gyn and pediatrics.
- Working together, AIHA partners at Addis Ababa University and Howard University developed a new five-year bachelor’s degree program in clinical pharmacy, along with clinical rotation guidelines for five hospital and nine community pharmacy rotation sites where students gain much-needed practical experience. They also trained 90 pharmacists and physicians from 10 institutions to serve as preceptors to support the clinical pharmacy students during their rotations. In addition, six Ethiopian physicians completed a two-week training at U.S. teaching hospitals to gain a better understanding of the role clinical pharmacy plays in the healthcare system.
- Addis Ababa University graduated its first cohort of 52 students using the clinical pharmacy curriculum they developed jointly with their Howard partners in 2013 and the new curriculum was adopted by six other public universities in the country. Collectively these institutions graduated and deployed more than 800 clinical pharmacists by 2014.
- Looking to provide a career path for the clinical pharmacy graduates, the Addis Ababa University partners launched a master of science program in pharmacy practice (MPharm) in 2010. By the time this partnership was graduated from AIHA’s HIV/AIDS Twinning Center Program in 2014, 44 students had already earned their MPharm.
- In 2013, four pharmacists working at AIHA’s Zambian partner institutions in Lusaka and Livingstone successfully completed a 3.5-month PharmD-level infectious disease pharmacy course at Concordia University School of Pharmacy in Milwaukee, Wisconsin.In 2013, U.S. partners at SLTCOP collaborated with their counterparts at NMMU, providing technical assistance with a strong focus on curriculum development. This included developing a comprehensive South Africa-specific Pharmacy Technician Manual with teaching and learning resources. They also worked together to strengthen the experiential learning components of NMMU’s new mid-level pharmacy programs by introducing a practical rotation for students at both levels — pharmacy technicians and pharmacy technical assistants.
- AIHA partners at Addis Ababa University School of Pharmacy established Ethiopia’s first Drug Information Center (DIC) at Tikur Anbessa Specialized Hospital in May 2009. DIC staff use evidence-based information and resources to respond to queries from hospital staff. They also participate in clinical rounds, serving as a critical resource on drug information as it relates to patient care. Based on the success of the Tikur Anbessa DIC, partners opened eight satellite DICs at regional universities across Ethiopia.
- In February 2014, the NMMU and SLTCOP partners completed a comprehensive practice analysis of the pharmacy technician, pharmacy technical assistant, and pharmacy assistant professions. This report is being used to help develop and revise curricula to ensure that current training programs reflect the actual responsibilities, competencies, and needs relevant to all major practice settings.
- In support of the transformations they spearheaded in pharmacy education and practice, the Addis Ababa University partners led several advocacy efforts to help change both the image and the role of pharmacists in the country. They met with senior pharmacists from various sectors and held national consensus building and sensitization workshops with the Ethiopian Pharmaceutical Association (EPA) to discuss the roles, responsibilities, and future of new clinical pharmacy graduates. They also prepared a scope of practice and submitted it to the Ethiopian Food, Medicines and Health Care Administration and Control Authority. These activities were critical for ensuring that the Ministry of Health deployed the new graduates throughout the country.
- The Addis Ababa University partners also worked closely with the EPA to develop national accreditation guidelines and training modules for continuous professional development (CPD). They, along with their Howard University partners, also serve as faculty for several of these in-service training programs that are provided to EPA members.
- As a result of their partnership, University Teaching Hospital in Lusaka and Livingstone Central Hospital have emerged as national centers of excellence in delivering HIV/AIDS pharmaceutical care. They are leaders in the profession and, as such, are now providing clinical training and mentorship for pharmacists and pharmacy assistants working at provincial level health sites throughout Zambia.
- Overall, Addis Ababa University’s partnership with Howard University has transformed the role of pharmacists in Ethiopia from being drug specialists to drug therapy specialists, which is especially relevant for patients on ART. Pharmacists have been able to provide education and support to manage the medication needs of PLHIV, improve ART adherence, address drug therapy problems, and reduce costs. Moreover, pharmacists in Ethiopia are now considered an integral part of the healthcare team.