Postgraduate Pharmacy Education in Developing Countries

Mary J. Berg, PharmD

Disclosures

October 19, 2001

In This Article

Developing Pharmaceutical Care in South Africa

The presentation on this topic was given by 2 South African pharmacists, Rubin Moss, BPharm, MSc Pharm (recently retired from King Edward VIII Hospital of Durban), and Andy Gray, BPharm, MSc Pharm, and Discipline Chair of Pharmacy Practice at the University of Durban-Westville. In South Africa, the pressure for change was top-down through legislative mandate. Additionally, the approach chosen for the initiative was essentially self-contained, eschewing cooperative input from international partners.

When South Africa was liberated in the early 1990s, almost all legislation was rewritten. The Pharmacy Act (Act 88 of 1997) entrenched the pharmaceutical care module, defined roles of pharmacists and 2 categories of pharmacists' assistants, and required accreditation of all education providers.

Durban is considered a good site for training and development because it has:

  1. Primary, regional and tertiary hospitals

  2. A school of pharmacy

  3. Nelson R. Mandela School of Medicine

  4. Other health sciences departments

However, it is still lacking in trained preceptors due to the issues of increased workload. Additionally, there has been a "brain drain" because of the emigration of many of Durban's best and brightest instructors to the United States and United Kingdom.

A "certificate program" was initiated in an attempt to improve the practice of pharmacy in South Africa without help from the West. Under this program, a pharmacist would complete modules over a flexible, part-time, 2-year period in the pharmaceutical care areas of infectious diseases, therapeutic drug management, and pharmacy and therapeutics committee.

Infectious Diseases. The need for a infectious diseases module in Durban is great because of the complex regimens and patient case mix that are seen there and because of the urgent need to manage drug resistance. This module component involves an interdisciplinary approach that encompasses antibiotic pharmacology, management of antibiotic policy in a hospital, epidemiology, and health economics. Problem-oriented learning is emphasized; the pharmacist would be part of the actual hospital team and would be required to make case-based presentations.

Therapeutic Drug Management. There is a high prevalence of altered organ function in South Africa, and therefore, the clinical cases become complex. The therapeutic drug management module would involve the principles of pharmacokinetics and pharmacodynamics, population kinetics, and practical skills for therapeutic drug monitoring. This section is taught through problem-oriented, case-based presentations.

Pharmacy and Therapeutics Committee. Provincial (regional) and national policies with regard to selection of medications must be implemented, and pharmacists must learn to work with the private sector in this area. In order to create a module on the pharmacy and therapeutics committee, epidemiology and health economics would have to be studied along with drug use evaluation, evidence-based practice, and determinants of prescribing habits. Again, the individual would be required to present problem-oriented situations with case-based presentations.

There is a definite need for partnering with international colleagues who could assist with joint teaching as well as joint exchanges. This involves collaborative funding. Also, there is a need for materials, such as current references. All of this would lead to eventual accreditation, but again, international assistance is needed.

These presentations gave conference participants insight on how to offer a nontraditional approach to a "certificate" program for the pharmacist to improve his/her skills in the area of pharmaceutical care. This is in contrast to the traditional postgraduate training degree programs. This model fits Durban, South Africa. However as was noted, there is need for international partnering from the West to make their "certificate" program more viable.

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