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.
Highlights
District and sub-district pharmacist positions were created during health sector reform in South Africa
District and sub-district pharmacist positions have been created across South Africa since 1994 as part of health sector reform in which health services have moved from a fragmented, hospital-based service to a primary health care (PHC) approach based on the district health system [1]
This paper describes the systematic identification of new roles and related competencies of district and sub-district pharmacists in Cape Town, during a period of structural reorganization
Summary
District and sub-district pharmacist positions were created during health sector reform in South Africa. Within the DMT, district and sub-district pharmacists generally have responsibility for medicine supply and management at the PHC level, with other pharmacists, pharmacy support workers and nurses performing a variety of tasks such as ordering of medicines, stock management and dispensing [3]. These government district health structures provide for the health needs of approximately 85% of South Africa’s population, with PHC services free at the point of care [4]. The remaining 15% of the population have private health insurance and utilize private general practitioners, retail pharmacies and private hospitals
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