Filling the Gaps in the Pharmacy Workforce in Post-Conflict Areas: Experience from Four Countries in Sub-Saharan Africa
2. Materials and Methods
2.1. Study Design
2.2. Study Setting
2.3. Study Population
2.4. Data Collection
2.5. Data Analysis
3.1. Characteristics of Participants
3.2. Thematic Analysis
3.2.1. Provision of Pharmacy Services
“…because of the war and all this insecurity, it’s difficult for drugs to reach to the community or health facilities in time … And if the drugs are there in the facility, it’s also difficult for the community to get services, as they cannot reach to pharmacy or to hospital to get services. And so drugs expire, many drugs expire … I mean, movement is not free, most of the commodities expire before they reach to the consumers”.(SS02)
3.2.2. The Pharmacy Workforce
“There is lack of profession. When you compare a health center, for example, a primary hospital, a general hospital, the number of pharmacy assistant in a teaching hospital is better, but not enough… Nowadays, the number of hospitals, the number of new health centers, are increasing, especially the new hospitals. Even this makes also the challenge”.(ET03)
“There are people who are even going to America you see, and Namibia … so there are people who are seeking other countries, who have more incentives to live a quality life”.(ET03)
“There are a lot of pharmacists who leave the country, who want to go to other countries. You know that there are pharmacists in Angola, Zambia, Namibia, Zimbabwe, South Africa and even in Europe, who have been trained here. There are also Congolese pharmacists in Canada, in the United States. I must say that overall, living conditions are not very good in low-income countries, which contributes to the tendency to leave the country and go to work elsewhere. But even those who remain in the country are not very well used as I told you”.(translated from French, DC01)
“Because it’s not the work of a normal pharmacy, I didn’t work in the hospital or I didn’t work in the health unit, so it’s difficult to understand what you do during the intervention. So I learnt, I studied a lot a lot before I go, but I really understand after the intervention”.(DC02)
“If the medical logistician is not here and I am covering for the medical logistician, there are more needs for more explanation to be done, to the facility pharmacist, to the dispenser, properly, by a medical logistician, to tell them the proper usage of drug, the proper storage, and in case of side effect. I think there are too much gap, I will be doing the basic work, not the actual work I am [the pharmacist] supposed to do, which is a big challenge”(SS02)
3.2.3. Building a Sustainable and Resilient Workforce
“For me, I don’t mind staying in the country. And you have a lot of country-level challenges, the country has a lot of pharmaceutical challenges. But I believe I can help as a person by providing not only training but also experience from the government’s and the regulator’s perspective. I think I’m more useful staying here than going somewhere else”.(translated from French, DC01)
“But the problem is it’s not acknowledged by the government. That means it’s not recognized by the government. That means it is not incentives to retain these master pharmacists, I mean, clinical pharmacists at the hospitals. They are seeking another job”.(ET03)
“I would like to stay, I like working for the humanitarian, I like working for this organization, they didn’t take any part in anything. It’s like we are here to save anyone is coming, we don’t care your position, we don’t care your religion, we don’t care what you’ve done in your life, here you are sick, I am treating you. I like these ideas”.(CA02)
“In fact, I prefer my role as a pharmacist. And then, it allows you to know other cultures, it allows you to know the health system in another country… You see what you can bring in to improve. That’s why I prefer expatriate work”.(translated from French, CA03)
“I mean, big motive as well as how things are organized within the organization itself. So I had good experiences so far, so I guess that is also very important what organization I’m talking about and what is the reason that we are going somewhere to be in a mission and to improve things there”.(SS03)
“In fact I see myself not working in the same environment. I would prefer to go back to my home country, and practice more with my field … Working in this kind of setting, I don’t improve in my career. So I would prefer to be in a place, a more organized place where I can practice more and have more knowledge on my career”.(SS02)
4.1. Pharmacy Service: Unpredictable Health Needs and Mismatched Pharmaceutical Supply
4.2. Pharmacy Workforce—The Need for Adequate Coverage and Training
4.3. Building a Sustainable and Resilient Workforce—Barriers in Talent Retention and Growth
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|(1) Have worked in one of the following pharmacy capacities in the selected country for at least 3 months:|
Pharmacy strategic planning;
Pharmaceutical product supply chain management;
Rational use of medicine (e.g., antibiotic stewardship program);
Patient counselling and/or treatment compliance assessment;
Clinical pharmacy services (e.g., ward rounds, case management);
Dispensing and/or extemporaneous preparation of medication;
Regulatory affairs and legal compliance.
(2) Are able to communicate effectively in English or French.
(3) Have given informed consent verbally during the audio-recorded interview.
|(1). Informed consent verbally not given during the audio-recorded interview, or was withdrawn during or after the interview.|
(2). Communication was not effective due to language barrier or technical difficulties, such as poor phone connection.
|Total||n = 9|
|Country||The Central African Republic||2|
|The Democratic Republic of Congo||2|
|Years of Experience|
(range: 6–36, median: 10)
|5 to <10 years||3|
|10 to <20 years||4|
|20 years and above||2|
|Experience in other|
|Type||Health center/Hospital/Locum/Mobile/Traditional healer|
|Barrier||Cost/Daily quota/Foreign provider/Free|
|Good||Comprehensive range of service/Inventory control system/Motivated staff/|
Practice according to protocol/Proper medication storage condition/
Staff with good knowledge/Sufficient supervision to identify errors
|Bad||Frequent shortage of drugs/Insufficient equipment/|
Insufficient counselling to patients/
Little documentation/Long waiting time/Medication errors/
Regulation regarding drug product quality/Regulation regarding profession/Staff’s skill not matching task requirement/Unmotivated staff
|Conflict-specific||Service interruption due to volatile security context/|
Shortage of local pharmacy staff due to brain drain/
Shortage of local pharmacy staff due to education interrupted by conflicts/
Transport difficulties due to insecure roads/
Unforeseeable health needs due to displacement/
Unforeseeable health needs due to mass casualty events
|General||Communication with direct manager with non-pharmacy profile/|
Distribution of medication outside scope of care/
Global shortage of pharmaceutical product/
Power shortage and cold chain breakdown
|Pharmacy workforce||Pharmacist Role||Consumption forecast and supply strategy/Consumption unit staff training/|
Drug inventory management/Evaluation of distribution system performance/
Good distribution practice compliance/Inpatient consultation/
Pharmacy staff training/Promotion of rational use of medicine/
Research and teaching/Vaccine campaign for outbreak control
|Filled by Who||National/Expatriate staff;|
Community health worker
|How Recruited||Central recruitment via government posting/|
Central recruitment via NGO posting/
Task shifting due to operational need
|Retention Motivator||Contribution to country profession development/Humanitarianism/|
Opportunity for more diverse work than a career in expatriate’s home country/
Positive experience with current post and organization/Satisfactory remuneration
|Retention Barrier||Availability and expatriate mission duration mismatch/|
Family planning incompatible with high insecurity expatriate mission/
Long working hours with unsatisfactory remuneration/
Preference for more clinical role/Unclear career prospect
|Others||Positive Note||National staff returning from education in foreign countries/|
Organization’s coordination mechanism regarding security/
Staff’s eagerness to learn/Supported by direct manager/Trust in team
|Negative Note||Different sense of normality/Hostility against HCP/|
Individual demotivation/System inertia
|General Description||Gradient in workforce/Service availability and quality across country|
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Wong, A.; Hung, K.K.C.; Mabhala, M.; Tenney, J.W.; Graham, C.A. Filling the Gaps in the Pharmacy Workforce in Post-Conflict Areas: Experience from Four Countries in Sub-Saharan Africa. Int. J. Environ. Res. Public Health 2021, 18, 8132. https://doi.org/10.3390/ijerph18158132
Wong A, Hung KKC, Mabhala M, Tenney JW, Graham CA. Filling the Gaps in the Pharmacy Workforce in Post-Conflict Areas: Experience from Four Countries in Sub-Saharan Africa. International Journal of Environmental Research and Public Health. 2021; 18(15):8132. https://doi.org/10.3390/ijerph18158132Chicago/Turabian Style
Wong, Anabelle, Kevin K. C. Hung, Mzwandile Mabhala, Justin W. Tenney, and Colin A. Graham. 2021. "Filling the Gaps in the Pharmacy Workforce in Post-Conflict Areas: Experience from Four Countries in Sub-Saharan Africa" International Journal of Environmental Research and Public Health 18, no. 15: 8132. https://doi.org/10.3390/ijerph18158132