a. Clarification of terms

“Harmonization” was described using expressions such as “synchronization”, “coming together”, “alignment” or “similarity of outcomes”. It is not “a common baseline”, or an agreement “on commonality” or on “transferability of students between schools”. “Strategy” was described as a “deliberate means to an end”. “Curriculum” was seen as a “broad framework, including learning outcomes, assessment and teaching methods”.

b. Problem definition

The problem with UPC in Southern and Eastern Africa is a lack of common basic competencies of pharmacists within the region. It was identified that:

• pharmacists’ skills differ;

• competencies differ, and there is a lack of common basic competencies;

• roles differ;

• practice and training standards differ;

• financial and human resources are not utilized optimally;

• there is no UPC harmonization strategy.

c. Why harmonize UPC in Southern and Eastern Africa?

The first objective of harmonization of UPC is to improve people's health by ensuring a minimum range of competencies for pharmacists in the region. In addition, harmonization would enable the sharing of human, physical and financial resources, which are scarce. While there is a willingness to harmonize no harmonization strategy has been developed yet. As resources are scarce in all countries, there is a need to raise the efficiency of drug management systems.

d. Elements of a harmonization strategy

The harmonization strategy may be divided into two elements - communication and the processes that are needed to achieve harmonization.

Communication may be considered as a first priority and involves: verifying competencies in the region; identifying and consulting with critical stakeholders; involving all countries of the region; setting up a communications network; and engaging policy makers. Policy makers include representatives from statutory organizations and regulatory authorities.

The processes of a harmonization strategy should include: collecting baseline data from countries of the region, agreeing the roles and competencies of pharmacists (“university exit and professional entry”); developing a process model e.g. a toolkit and resources for the development of a UPC and training for trainers; developing a framework to ensure common outcomes to be achieved e.g. external validation and internal audit; and establishing guidelines and accreditation of trainers through situation analysis and voluntary buy-in. A harmonization strategy should also explore the role of pharmacy technicians.

e. Mutual recognition

Mutual recognition should define competencies in terms of levels of qualification e.g. assistant, technician and pharmacist. The criteria for mutual recognition include a harmonization framework and identification of competencies to be achieved during different stages of the pharmacy training programme.

Mutual recognition should also look into competencies and their assessment, e.g. the practical training year, registration requirements for pharmacists, including legal issues, and entry qualifications at various levels.

f. Strengthening relations

The development of a harmonization framework should involve key stakeholders from schools of pharmacy, pharmacy councils and drug regulatory authorities. There is also a need to lobby for political will and support. An example of a framework is provided below.

Relations can be strengthened by establishing associations e.g. Association of Pharmacy/Medical Councils of Southern African Development Community (SADC). The African Drug Regulatory Network (AFDRAN) is another active network, in which South Africa is responsible for good manufacturing practices (GMP) inspections, and Zimbabwe for legal issues, while Nigeria is involved in issues related to counterfeit drugs.

g. Baseline data

The harmonization process should start with the collection of baseline data on education and training, the roles of various bodies and regulatory information. The data needed on education and training should include entry levels, duration of courses, course outcomes, available resources, assessment and teaching methods, and information on staff and student research projects.

Surveys on the roles of academic and professional councils and drug regulatory authorities, and surveys on societal needs and university requirements should be undertaken in Southern and Eastern African countries. Regulatory data should also be collected, such as requirements for pharmacist registration and registration requirements for drugs and medicines entering the local market.

Example of a harmonization framework