Essential Medicine Training –
New Initiatives in the South Pacific for
Health care worker Training
Andrew Brown
Lecturer in Pharmacy
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Contents
• A brief Introduction of Andrew and UC
• Explanation of the challenge in PICs.
• Human resource issues
• 1. Mapping the scope, competencies and workforce
needs of heath care workers in PICs.
• 2. What are the cultural influences on the learning
approaches of South Pacific Students? .
• 3. Integrating parallel program training into existing
essential medicines training a UNFPA initiative.
• Where are we headed?
• Strategic Partners.
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Introducing Andrew Brown
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Community Pharmacy
Hospital Pharmacy
Solomon Islands
Managing Pharmacies
Academic Pharmacy
- Teaching (Pharmacy Practice, Health Professional Practice)
- Research (Equipping healthcare workers for essential
Medicines management)
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The University of Canberra
Faculty of Health:
-Pharmacy (2005)
-Physiotherapy
-Nutrition
-Nursing
-Midwifery
-Psychology
-Sports Science
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Explanation of the challenge
• 20 sovereign states.
• Population of 9.6million
dispersed over 1000’s of
islands.
• Lack of consistent supply of
Essential Medicines in the
clinics of many of these
countries. (WHO, AUSAID)
• Millennium Development
Goals not improving. (World Bank,
UNPA.)
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How is Essential Medicine Supply Conducted?
The Systems
The Staff
• National Medical Stores
• Pharmacists (If you’re lucky)
and pharmacy assistants
(Essential Medicines & Equipment)
• Regional Centres
• Pharmacy
Assistants/Nurses
• Remote Clinics
• Nurses
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Human Resource Issues
• Just over 300 pharmacy staff in the region (Excluding PNG)
distributed throughout the public sector of these countries.
• 80% of these post filled by pharmacy technicians.
• The majority of health care in the region is supplied through the public
sector and therefore warrants particular attention.
• The Fiji School of Medicine and the University of Papua New Guinea
are the only universities in the region providing locally trained
pharmacists to a degree level with most of these graduates going to
the private sector.
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Human Resource Issues
• There is no formal certificate training available for pharmacy
technicians in the region apart from semi structured localised training
in the Solomon Islands and Samoa.
• Recent WHO systematic review and consultation with chief
pharmacists of the region show that health resource issues are a
leading factoring hindering essential drug supply.
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Method
• Date of inception to April 2009:
• MEDLINE, EMBASE, PubMed, Google Scholar
• World Wide Web for grey literature
• Others.
• Search terms included;
Culture, customs, learning approaches, pedagogy, pacific, South
Pacific, training, teaching, students and health.
• Review Method
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A Systematic Review Addressing;
Competencies, Training and Work force
Requirements, for any Health Care Worker in
Pacific Island Countries Involved in
Essential Medicines Supply Provision,
January 1998 to July 2009
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Method
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Review and analysis of WPRO provided papers, consultancy reports and
other relevant documents as provided by WPRO through their Fiji Office.
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A systematic review of available bibliographic data bases including
“INFORMIT” (Containing the Australasian Medical Index), “EMBASE” and
the expanded range of “EbscoHost” Data Bases including Medline.
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Direct communication with NGO’s active in the region.
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Direct communication with the major government donors to the region.
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Targeted review of the grey literature (Internet based publications not
tracked by bibliographic databases.)
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Key Words
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Health care worker; Includes all levels of pharmacy staff (including
pharmacists, pharmacy technicians and pharmacy stores), storeman (not
within a pharmacy department but responsible for any aspect of essential
medicines supply), nurses, nurses aids or any health care worker,
responsible for any aspect of essential medicines supply.
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Pacific Island Countries; The 20 independent countries and regions in the
South Pacific including; Cook Islands, Federated States of Micronesia, Fiji,
Kiribati, Marshall Islands, Niue, Nauru, Palau, Papua New Guinea, Samoa,
Solomon Islands, Tonga, Tokelau, Tuvalu and Vanuatu, Guam, Northern
Mariana islands, American Samoa, New Caledonia and French Polynesia
(Tahiti).
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WHO/WPRO Reports
WHO/WPRO Reports on individual Pharmaceutical Services activities
Country and Date
Cook Islands, 8-29 July 2006
Niue, 1-15 September 2006
Kiribati, 1-15 December 2006
Tuvalu, 10 July to 5 August 2007
Papua New Guinea, 2-22 October 2007
Nauru, 1-30 June 2008
Samoa, 8-19 September 2008
Vanuatu, 8-19 September 2008
Fiji, 22 March- 9 April 2009
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WHO/WPRO Regional PIC meetings on Essential Medicines
Country and Date
Workshop on Improving Access to Essential Medicines and Strengthening Vaccine Security for Pacific
Island Countries
Fiji, 25-27 November 2003
Human Resource Development in Pharmaceuticals
Fiji, 1-2 November 2004
Workshop for Pacific Island Countries on the EC-WHO Partnership on Pharmaceutical Policies and the
Implementation of the regional Strategy for Improving Access to Essential Medicines.
Fiji, 3-5 November 2004
Workshop on Pharmaceutical Policies and Access to Good Quality Essential Medicines for Pacific Island
Countries
Fiji, 30 August – 1 September 2006
Workshop on Pharmaceutical policies, Intellectual Property Rights and Access to Essential Medicines for
Pacific Island Countries
Tonga, 7-9 August 2007
Workshop on Pharmaceutical Policies and Access to Essential Medicines for Pacific Island Countries
Fiji, 25-27 August 2008
Training Course on Improving Medicines Supply Management for Pacific Island Countries
Australia, 20-25 July 2009
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WHO/WPRO
• WHO/WPRO HRH provided individual health
workforce plans for 10 PICs prepared in 1998
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Organisations Contacted and Websites Reviewed
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Ausaid
Australian Nursing and Midwifery Council
European Union
Fiji School of Medicine
Human Resources for Health Recourse
Centre
International Council of Nurses
International Pharmaceutical Federation
(FIP)
Japan International Cooperation Agency
New Zealand’s International Aid &
Development Agency
Pacific Human Resources for Health
Alliance
Pacific Islands Development Program
Pacific Islands Forum Secretariat
Secretariat of the Pacific Community.
South Pacific Board for Educational
Assessment
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South Pacific Board for Educational
Assessment
Taiwan International Cooperation and
Development Fund
UNFPA in the Pacific
UNICEF Pacific Islands
United Kingdom AID
United Nations Education, Scientific and
Cultural Organisation
United States AID
University of Papua New Guinea
University of the South Pacific
WHO Regional Office for the Western
Pacific
WHO Geneva
World Bank
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Limitations
• E-mail as a primary mode of communication.
• Key organizations were followed up with a phone call if a
timely response to e-mail was not received but this was
not systematically done for all the organizations.
• Individual governments of the countries covered in the
review were not contacted.
• Very limited material retrieved containing data specifically
relating to PICs satisfied the Health Development Agency
Evidence Base 2000 standards (Swann 2005).
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Results Competencies
• There is a scarcity of information documenting
the competencies required by health care
workers in the region.
• Currently available competency documentation is
limited to higher domain competencies or only to
certain cadres. All the relevant information
retrieved for this part of the review was from the
grey literature.
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Results Competencies
• UPNG.
• Fiji Review by Griffith University.
• The Australian Nursing and Midwifery Council,
WSPEAR consultation process resulted in the
publication of “Common Competencies for
Registered Nurses” in 2006.
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Observations Competencies
• Very little data.
• No detailed competency sets.
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Results - Workforce
• WHO Human Resources for Health provided,
individual health workforce plans for 10 PICs.
• UNSW detailed review of 15 countries March
2009.
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Observations Workforce
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Variations in the availability of workforce data
Varied HRH data repositories
Lack of disaggregated workforce data
Limited continuing education and training
development
• Limited coordination among external partners
engaged in HRH support
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Results - Training
• Individual PIC workforce plans from 1998.
• In country reviews of the pharmaceutical services
of individual PICs 2006 to 2009,
• Annual regional workshops where PICs have
discussed issues relating to training 2003 to
2009.
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Observations Training
• Hands on training required.
• Flexibility to start and stop training based on workforce requirements.
• Preference for training to occur in country.
• Strengthening of in country teaching ability.
• External support and training should be consistent with health
workforce plans.
• Training is focused on pharmacists not pharmacy assistants.
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Observations Training
• External support is needed to provide in-country training.
• Pharmacists via UPNG or FSMed. Pharmacy assistants noncertified on the job training.
• Nationals trained overseas not returning.
• Recognition that nursing staff have a significant role in
pharmaceutical services and need to be trained in this.
(Pharmacy staff need the skills to be able to do this training)
• Modular approach to curriculum design to allow sharing of materials
across sectors.
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Training Observations
– Summary
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The need for training is clear.
An individual country approach is desired.
A systematic approach to human resources management is desired.
Support from regional institutions requested.
A collaborative regional workforce is ideal.
A collaborative approach to training is ideal.
A review of available training materials is essential.
NGO parallel programs should work to integrate into PIC structures.
The approach to training needs specific features.
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• The approach to training needs specific features.
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Flexible in their delivery in relation to time and approach,
Applied to the local environment,
Involve local senior staff where possible,
Be competency/skill based (On the job),
Consider cultural aspects of learning and teaching,
Be conducted in the local country where possible,
Involve the use of local colleges or facilities where available and
useful.
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Potential
Recommendations
• Conduct comprehensive individual country HRH assessments
relating to cadres involved in essential medicines supply
provision.
• Strengthen and facilitate collaboration of regional pharmacy
institutions.
• Form and support a Pacific Island Countries HRH pharmacy
working group.
• Undertake a comprehensive review of available essential
medicines training resources in the region.
• Strengthen the ability to monitor and plan for HRH.
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Cultural Influences on
Learning Approaches for
Students in the South Pacific,
with a view to Pharmacy
Assistant Training
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Method
• Date of inception to April 2009:
• MEDLINE, EMBASE, PubMed, Google Scholar
• World Wide Web for grey literature
• Others.
• Search terms included;
Culture, customs, learning approaches, pedagogy, pacific, South
Pacific, training, teaching, students and health.
• Review Method
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Results
• 52 full text articles and 12 books retrieved.
• Reviewed by theme as some overlapping of
themes occurred:
• 25 papers and 5 books for
South Pacific student learning
approaches
• 21 papers and 4 books for
culture,
• 11 papers and 4 books for
broader educational issues
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Results –
South Pacific student learning
approaches
• The use and relevance of Western learning style
inventories as measurement tools
• Other research not involving learning style
inventories
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Results –
Culture
• Cultural practices which have surrounded and
modeled their upbringing from birth
• South Pacific indirect style of communication
• ‘Pasin bilong Pasifika’ (‘The Pacific Way’)
• Health Beliefs
• Learning to be and learning to live together
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Results –
Broader educational issues
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The effect of Colonial History
Impact of Globalization
Educational Aid
A Pacific Vision for Education
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Discussion
• Limitations
• Use of learning approaches.
• The Need for more research
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Conclusions
1. A surface approach to learning is the result of
a number of regional, social, historical and
cultural contexts and is often a strategic
learning method used by students in the
South Pacific.
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Conclusion
2. Students do understand and possess skills
for critical thinking and a deep approach to
learning. This can be facilitated by integrated,
holistic, culturally sensitive & contextualised
methods of teaching in accordance with ‘The
Pacific Way’, utilising their traditional
learning strategies and involving critical
reflection.
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Conclusion
3. We need to be aware that isolation faced by
students, is a significant factor requiring the
need to utilise technology and multimodal
teaching methods to facilitate deep learning.
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The Development of a
Reproductive Health
Commodities Security (RHCS)
Training Manual for First Level
Primary Health Care
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Brief Overview
• Role of UNFPA.
• Project Description
• Current review of materials.
• Desk audit.
• Focus group
• New materials Development
• Trial to be conducted in Vanuatu.
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Preliminary Analysis
WHO Drug Supply
USAID Logistics
UNFPA Pocket Guide Management Training Handbook
Required Teaching
More elements than
Elements for Medicines
required by first level
Supply
Appropriate Elements Appropriate Elements worker
8.5-12 With most
Readability (Gunning FOG 11.5-14 With most
sections approximately 9-14.88 With most
Index)
sections above 11
9.5
sections above 11
Length of Manual
35 Pages
70 Pages
196 Pages
Use of White Space
Poor
Good
Poor
Evidence of PIC localised
examples
None
None
None
Pictures of a localised
nature
No Pictures
Generic Pictures only Generic pictures only
Opportunity to apply the
Training to the local
environment
None
Limited
Limited
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Suggested Approach
to Training Materials
• Students do understand and possess skills for critical thinking
and a deep approach to learning. This can be facilitated by
integrated, holistic, culturally sensitive & contextualised
methods of teaching in accordance with ‘The Pacific Way’,
utilising their traditional learning strategies and involving
critical reflection.
• Wherever possible use student centred leaning methods that
challenge passive, rote learning.
• Encourage group activities that promote group involvement in
learning, and encourage students to take responsibility for their
own learning.
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Suggested Approach
to Training Materials
• Create a framework within which students are encouraged to
think critically.
• An individual country approach is desired.
• The approach to training needs specific features.
• Training should seek to integrate NGO parallel programs into
PIC structures.
• A Gunning Fog Index of 7-8 is ideal when the intended audience
in First Level Primary Health Care Workers.
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Suggested Approach
to Training Materials
• Ensure that the content reflects the competencies required for
these workers.
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Be consistent with the use of technical jargon and terms.
Where necessary explain the various terms used that are
equivalent in nature.
• Training material layout should be considered for easy of use
and easy reference by learners.
• Include the use of localizing features including diagrams and
examples.
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Suggested Approach
to Training Materials
• Include sufficient exercises and working space to allow learners
to apply their learning to day to day tasks in their work
environment.
• Create sufficient flexibility to be inclusive of the different
systems that are used across the region.
• Current training materials in this area already contain the main
components required but the delivery needs to be improved.
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Trialling a New
Methodology
• Country chosen based on training need and
request from MOH via pharmacy or nursing.
• Preliminary country survey of supply procedures.
• Training template assembled.
• Training materials reviewed by country.
• Materials printed.
• Work shop conducted.
• Follow up support offered.
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Preliminary Country
Survey
• Diagrammatic representation of the medicine supply system
• Diagrammatic representation of the medical equipment supply
system (If different)
• Copy of essential medical equipment list (If available)
• Copy of standard treatment guidelines.
• Does a national medicines policy exist?
• Standard operating procedures for;
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ordering stock,
delivery stock
unpacking stock
layout of stock in a clinic
putting away stock
Electronic copies of;
• bin cards, ordering forms , packing slips, Coat of arms, Country map
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Workshop Innovations
• Multiple opportunities for practical experience
• Skills Games
• Site visits
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Intervention Strategy - Aims
A two year proposal designed to:
• Improved the availability of Essential Medicine supplies in the
clinics of the least developed countries of the region.
• Demonstrate improved competencies in the areas of Essential
Medicine supplies in the three main work force levels
responsible for this delivery.
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Intervention Strategy
- Activities and Indicators
Activities
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1. Tool Development and Validation
2. Mapping of scope competencies and workforce needs
3. Training development and delivery
4. Demonstrated Improvement in essential medicines supply
Indicators for Success
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Demonstrated development of competencies using before and after
competency testing.
Demonstrated improvement in the supply of medications through the use of
level two indicators before and after.
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Intervention Strategy - Activities
1. Tool Development and Validation
• Modify and validate the use of the existing case study approach
developed by the International Pharmacy Federation and
Modify and develop a pharmacy assistant competency level
framework using The Competency Development and Evaluation
Group tools. (Oxford University and the University of London.)
2. Mapping
• Use the modified tools to map the scope, competencies and workforce
requirements of four of the least developed countries in the region;
Vanuatu, Kiribati, Samoa, Tuvalu.
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Intervention Strategy - Activities
3. Training
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Compare the identified competencies to existing training structures then
develop, trial and evaluate a localized (in country) skills based pharmacy
assistant certificate training program. The program would be trialed in four
countries with local counterparts.
The training would be provided in the local country with supervision, support
and certification from the Fiji School of Medicine or University of Papua New
Guinea or the University of Canberra. Competencies of participating students
will be assessed before and after the training to measure competency
development.
4. Demonstrated improvement in Essential Medication Supply
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Conduct modified WHO level 2 indicator surveys in each of the countries
where training will be conducted both before training is conducted and twelve
months after training has been conducted to determine if the competency
improvement elements are resulting in improved supply.
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Strategic Partners
• University of Canberra (Lead organisation)
• International Pharmacy Federation
• World Health Organisation
• United Nations Population Fund
• University of Papua New Guinea
• Fiji School of Medicine
• Pharmacy departments from Pacific Island Countries
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Problems can be overcome
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Working toward a vision of Essential
Medicines Supply for all...
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Acknowledgements;
Dr Budiono Santoso,
Regional Advisor in Pharmaceuticals, WHO/WPRO
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Ms Vanchinsuren Lkhagvadorj,
Technical Officer in Pharmaceuticals, WHO/WPRO
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Dr Juliet Fleischl,
Technical Officer in Human Resources and Health Systems, WHO/WPRO
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Dr Suzanne Hill
Scientist, Medicines, Access and Rational Use, WHO
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Mr Peter Zinck
Technical Officer, UNFPA in the Pacific
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