Emerging roles and competencies of district and sub-district pharmacists: a case study from Cape Town

Abstract

BackgroundDistrict and sub-district pharmacist positions were created during health sector reform in South Africa. High prevalence of HIV/AIDS, tuberculosis and increasing chronic non-communicable diseases have drawn attention to their pivotal roles in improving accessibility and appropriate use of medicines at the primary level. This research describes new roles and related competencies of district and sub-district pharmacists in Cape Town.MethodsBetween 2008 and 2011, the author (HB) conducted participatory action research in Cape Town Metro District, an urban district in the Western Cape Province of South Africa, partnering with pharmacists and managers of the two government primary health care (PHC) providers. The two providers function independently delivering complementary PHC services across the entire geographic area, with one provider employing district pharmacists and the other sub-district pharmacists. After an initiation phase, the research evolved into a series of iterative cycles of action and reflection, each providing increasing understanding of district and sub-district pharmacists’ roles and competencies. Data was generated through workshops, semi-structured interviews and focus groups with pharmacists and managers which were recorded and transcribed. Thematic analysis was carried out iteratively during the 4-year engagement and triangulated with document reviews and published literature.ResultsFive main roles for district and sub-district pharmacists were identified: district/sub-district management; planning, co-ordination and monitoring of pharmaceuticals; information and advice; quality assurance and clinical governance; and research (district pharmacists)/dispensing at clinics (sub-district pharmacists). Although the roles looked similar, there were important differences, reflecting the differing governance and leadership models and services of each provider. Five competency clusters were identified: professional pharmacy practice; health system and public health; management; leadership; and personal, interpersonal and cognitive competencies. Whilst professional pharmacy competencies were important, generic management and leadership competencies were considered critical for pharmacists working in these positions.ConclusionsSimilar roles and competencies for district and sub-district pharmacists were identified in the two PHC providers in Cape Town, although contextual factors influenced precise specifications. These insights are important for pharmacists and managers from other districts and sub-districts in South Africa and inform health workforce planning and capacity development initiatives in countries with similar health systems.

Evaluation of the Participation of Community Pharmacists in Primary Healthcare Services in Nigeria: A Mixed-Method Survey

“…This runs against obvious gains experienced in health outcomes engendered by the participation of community pharmacists in other climes such as the United States, 30 United Kingdom, 31 Australia, 32 and South Africa. 33,34 The findings of the survey agree with the positions of key informants particularly in the under-explored potentials of community pharmacists for immunization services. The evidence equally underscore the claim that community pharmacy clients are getting more sophisticated such that a significant gap exists between customer expectations and service fulfilment (t = 14.59, P = .001).…”

“…38 Recent evidence from South Africa also shows a shift to a multidisciplinary team approach. 33,34 In Nigeria however, the study found a lack of team approach to patient care with most community pharmacies operating as 'silos. ' About 80% (258) of the pharmacists either agreed or strongly agreed that this was a significant challenge, as corroborated by an Australian study.…”

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“…Forbes T. et al (2004) carried out a survey of experts in Scotland and found that many doctors have decided to perform the duties of a manager to "protect their profession from influence by unauthorized persons or those they consider as inappropriate persons for the role of the healthcare leader" (36). Similar results were obtained in a survey of experts in Norway (37,38). According to Edmonstone J.…”

“…In particular, Norway is one of the countries where this category of health care workers directly compete with doctors for management positions. According to Johansen and Gjerberg (2009), Norwegian nurses occupy management positions to improve their professional status (38). This fact confirms the sociological theory, according to which the post of the manager is seen as a tool to strengthen the position in the main profession.…”

Individual capacity-building approaches in a global pharmaceutical systems strengthening program: a selected review

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