A Case For Pharmacist Independent Prescribers (PIP) In Ghana?

Article: Pharm. K.K. Owusu

Health is arguably the most important ingredient required for the well being and growth of any country. A nation can only be built with healthy people, It is thus no coincidence that almost invariably, the better the public health indicators of a country the greater the tendency for her to be prosperous. Health as in any other endeavor is continually evolving and as such policy makers and stakeholders should always make it a point to change and improve and not necessarily rely on and be content with the status quo.

In Ghana as in many parts of Sub-Saharan Africa, the Government and its Ministry of Health have always been highlighting the lack of trained health professionals due to the ever present brain drain. Little has been done to change the trend since training more personnel does not seem to turn the tide due to the inherent low wages and lack of challenging opportunities. It is worthy of note, however, that very laudable and commendable policies such as the introduction of the concept of Medical Assistants have really helped the Health fortunes of this country particularly in improving healthcare delivery to the rural majority as compared to the situation in other developing countries that failed to adopt similar measures. Again, it has also created a career progression path for some very vibrant and highly skilled nurses. I believe the contribution of Medical Assistants is very obvious and those who facilitated its introduction should indeed be commended. It is such policies and brave innovations that must be encouraged in order to ensure the maximum output and efficiency from the limited staff available to our Health system. The need for realigning of staff roles training and responsibilities in the Health sector was indeed recently brought up by the Auditor Generals Department in the report on management of human resource for effective primary health care delivery.

Training of Ghanaian Pharmacists

The fact that Ghana - trained pharmacists are one of the best in the world is quite apparent to all, a look at the curricula and training for these professionals at the KNUST would help explain why. The emphasis on laboratory work, research and sense of professionalism is acclaimed worldwide. It is of no surprise therefore that countries such as the United Kingdom, USA and Canada have for years deliberately opened their doors so widely to Ghana - trained pharmacists. Indeed, Pharmacists have arguably the highest rate of brain drain the country’s health sector.

The Rate of Attrition of Pharmacists and possible reasons

According to the Global pharmacy workforce and migration report, nearly two thirds of Ghana’s 140 pharmacy graduates in 2003 migrated from the country and according to the publication this continued upward trend could have dire long term implications. Again, the Human Resources for Health Organization in a recent qualitative study examining the professional aspirations of Ghanaian pharmacy students found that most final-year pharmacy students planned to migrate, with the main reasons for migration cited among others as further postgraduate study. Students also perceived pharmacists abroad to be better respected and to hold more desirable professional and clinical roles. Interestingly, most of the students interviewed expressed a desire to return to Ghana after achieving their objectives abroad. Significantly, quite a very large number of Ghanaian pharmacists (gradually nearing those practicing in Ghana) are registered in the United Kingdom alone. Very often we assume that people leave the shores of this country for financial benefits alone and are very quick to point out the lack of patriotism in such people. We however fail to realize that some also leave due to the lack of challenging opportunities at home.

Concept of Pharmacist Independent Prescribers

It is very strange that a country like the United Kingdom that has a doctor to patient ratio of 1:416 (Office of Health Economics, UK-2005) as compared to our woeful 1:13,683 (2006/7, Ministry of Health, Ghana) has introduced the concept of Pharmacist Independent Prescribers. This is to further make adequate use of the talent of pharmacists whereas we are content with underutilizing such highly trained professionals and are passively satisfied with training them at high cost to the nation and letting them go to build nations of others. In fact, according to the Pharmacy Act 489 of 1994 (section 40b) of the Parliament of Ghana, pharmacists are already granted limited prescribing rights in the management of simple ailments of common occurrence. The Health sector unlike in so many advanced and some emerging countries has failed to improve upon this by institutionalizing and further legislating the concept of Pharmacists who are further trained with full prescribing rights.

The case of the United Kingdom

The United Kingdom as always is the best reference point for our health sector since most of our structures and training of personnel were fashioned along the lines of our colonial masters. Pharmacist Independent Prescribers in the United Kingdom are pharmacists who have a number of years experience practicing in a clinical environment and have received added postgraduate training (usually from six to eighteen months) and are empowered to carry out prescribing duties. A Pharmacist Independent Prescriber in the UK must be a registered pharmacist whose name is held on the membership register of the Royal Pharmaceutical Society of Great Britain (RPSGB), with an annotation signifying that the pharmacist has successfully completed an education and training programme accredited by the RPSGB and is qualified as an independent prescriber. Once qualified, Pharmacist Independent Prescribers are able to prescribe any licensed medicine for any medical condition within their competence. This only recognizes the fact that pharmacists as creators and producers of all drugs are in a unique position as their expertise in the use of drugs is absolutely incomparable.

The UK’s Department of Health’s working definition of independent prescribing is prescribing by a practitioner (e.g. doctor, dentist, pharmacist) responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management required, including prescribing.

Aims of independent prescribing by pharmacists

According to the Department of health, it is the UK governments’ policy to extend prescribing responsibilities to nonmedical professions to:-

o improve patient care without compromising patient safety;

o make it easier for patients to get the medicines they need;

o increase patient choice in accessing medicines;

o make better use of the skills of health professionals;

o contribute to the introduction of more flexible team working across their National Health Service (NHS).

Conclusion

Even though introducing the concept of Pharmacist Prescribers does and will not guarantee the cessation of the brain among Pharmacists in this country, it will undoubtedly make a significant impact on healthcare delivery in the country especially with patient numbers skyrocketing since the inception of the National Health Insurance Scheme (NHIS). As well, it will provide more challenging opportunities for these highly trained professionals and may help in retaining and alleviating this excessively negative trend. I thus believe in the light of the foregoing that policy makers such as the Minister of Health, Director General of the Ghana Health Service, Chief Pharmacist, Pharmacy Council, Pharmaceutical Society of Ghana (PSGh), Faculty of Pharmacy of the KNUST as well as other stakeholders have to brainstorm and delve into the demerits and the potentially numerous benefits of introducing such a policy in Ghana. It is indeed very unfortunate that we continue to spend the nation’s scarce resources in providing very good training for pharmacists and look on helplessly as they continually leave in search of more challenging and fulfilling opportunities. Even more disheartening is the fact that they ultimately end up further strengthening the healthcare systems of advanced countries who are willing to continually think up ingenious ways of fully utilizing their potentials whilst our people continue to suffer from the so called lack of available human expertise. We indeed as already known have very limited if any resources to spare and as such the country should always be looking out for ways of realigning and harnessing all available resources particularly human to ensure the successful attainment of the country’s medium term goals of achieving middle income status.

As we continue with our usual public discussion and argument about who or which political party has the best strategy to save our economy we should always remember the famous statement by the great Winston Churchill (British Orator, Nobel prize laureate, Author and Prime Minister during World War II. 1874-1965) that “Healthy citizens are the greatest asset any country can have”

You can reach the writer who is a hospital pharmacist with the Ministry of Health through koduahowusu@yahoo.com