Here is the reality: The lack of trained pharmaceutical personnel in the church health sector has been an ongoing problem. Many Church Health Facilities (CHFs) in sub-Saharan Africa struggle to attract and retain trained pharmacists, pharmaceutical technicians or assistants. Healthcare in least developed countries relies heavily on medicine-based interventions and therefore it is critical that those responsible for their management have a basic understanding on how to handle them in a manner that optimizes their benefit to patient care. 

What typically happens is one of two things: (1) overwhelmed trained professionals train the available low-level staff to take over some of their duties; (2) pharmaceutical duties are run by someone who isn’t formally trained but has had on-the-job-training. Why does this happen, you may ask? Well, many Church Health Facilities are located in remote rural and/or peri-urban areas. These rural towns and villages are underdeveloped and underserviced; therefore, turnover of qualified staff is high. Another reason is that the salaries offered by CHFs can barely compete with salaries from the private and public sectors. Further, many CHFs are not allocated a resource budget line within national budgets and as a result, they are underfinanced and heavily dependent on funding and donations.

Here is the effect if we do nothing: Irrational use of medicines is the blanket threat which deconstructs to a host of issues some of which include i.e. violation of standard pharmaceutical practices; poor commodity management e.g. stock outs; incorrect medication dispensing and prescribing practices, all which typically leads to a plethora of adverse effects to the general public such as addiction, increasing the threat of AMR and even death due to miss-prescribed medication.

Here is the logic: The unqualified pharmaceutical staff working at the CHF pharmacies are truly “diamonds in the rough”. Though untrained, they have already bought into the duties of healthcare service and are familiar with the health facility, the locale, and its community members. The choice to leave employment and forfeit a steady salary, in order to pursue formal education, has adverse effects on their and their families’ livelihood. Besides, formal education in pharmacy is beyond their financial reach. It simply isn’t an option. What is a logical option is to reward their commitment and support their training. Therefore, the overall goal of this project is to fill the pharmaceutical human resource capacity gaps in Sub-Saharan Africa as a means to increase professionalism and good governance in the church health systems.

Here is the plan: The Ecumenical Scholarship Program (in pharmaceuticals), run by the Ecumenical Pharmaceutical Network (EPN), is a scholarship program to formally train pharmaceutical staff within CHFs. The ESP initiative is funded by Bread for the World and is deployed through the EPN members, mainly from sub-Saharan countries. Church Health Associations across 37 member countries identify and nominate pharmaceutical staff without formal training to enter the ESP initiative. Reputable tertiary institutions and universities are recognized and these candidates are placed in pharmaceutical diploma programs in their countries of residence. This is a very relevant move towards improving the pharmaceutical capacity gaps in targeted facilities: as a sustainability and knowledge transfer measure, candidates commit to returning to their facilities or placed in other facilities with a greater need, for a period equal to the years of sponsored study.

Here is where we are today: Between 2011 and 2017 a total of 56 candidates from 9 countries, South Sudan, DRC, Cameroon, Kenya, Uganda, Tanzania, Ghana, Chad, and Zambia, have been supported by the ESP initiative. To date, over 90% of candidates from hospitals in disadvantaged areas were enrolled for training that led to successful completion and awarded a recognized pharmacy qualification. A 2014 external evaluation on the impact of the scholarship program reported that administrators involved confirmed that the newly graduated staff had improved skills, knowledge and confidence and embarked on increasing the capacity of their colleagues. Additionally, the 2014/17 scholarship announcement received 80 applications from 9 countries; an indication of continued need.

Here is one example, the Chitokoloki Mission Hospital in Zambia under the Church Health Association of Zambia (CHAZ). The Mission Hospital is a 200-bed hospital that serves a patient population of 150,000 in the Northwest Province of Zambia. The hospital is located on the Zambezi River. The hospital facility includes four large wards and three smaller wards including a 25-bed pediatrics ward and a 25-bed OBG ward. There is also a seven-bed ICU, an ER, pharmacy, kitchen, and a laundry area. Another block of buildings houses three operating theatres, an X-ray department, and an eye and dental clinic. There is an on-site outpatient clinic that services up to 400 persons each day. A laboratory, an HIV/AIDS clinic, a 110-bed leprosy/TB colony with its own staff completes the campus. The hospital is usually filled to capacity with extra mattresses on the floor. Current hospital staff includes both nationals and expatriates.

Staffing numbers, Chitokoloki Mission Hospital

Cadre No. in place Positions available Percentage filled
Doctors / Clinical Officers 7 10 70%
Nurses 23 40 51%
Pharmtech 3 2 110%

*data as of December 2017

Emmanuel is a recipient of the ESP initiative and currently placed at Chitokoloki Mission Hospital. On a weekly basis, Emmanuel is involved in dispensing medicines; in the pharmacy and in the hospital wards; managing ARVs; labeling and repacking medicines, and at the end of each month, he generates consolidated reports and submits them to the Central Medical Stores.

“The EPN scholarship support and training at college made a positive change in my life”, he said, “with all that I learned and the support from facility staff, I have been able to fit in well and apply my knowledge and skill extensively. In the 9 months at this hospital, I have managed to improve the medical stores, inventory management (updated Stock Control Cards) and ensured documentation of all transactions following a ‘first expiry, first out’ (FEFO) system, thereby averting wastage.”

Here is who ultimately wins: The final beneficiaries of the improved pharmaceutical care are patients. Increased access and availability of quality-assured medicines is always a priority, however, care in dispensing and prescribing is just as important – if not more so. The ESP initiative remains an active program and we envision it spreading to other Network members. However, it is a vital stepping stone to making everyone a winner: patients, pharmacists, and Church Health Facilities.


Contribution by Ecumenical Pharmaceutical Network EPN to the Annual Report 2017 of the MMI Network

Author: Kareen Shawa-Durand. Communications Officer, EPN

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