(1994; 60 pages)
2. Manpower imbalances in pharmacy
Throughout the Third World, wherever there are severe shortages of medical services there are corresponding shortages of pharmaceutical services and of pharmacists, and most of the people have no access to basic life-saving drugs. At the same time, medicinal drugs, many of which are useless or dangerous and unnecessary, are available in extensive open, unregulated markets. In some of the more advanced developing countries, the ratio of pharmacists to population is relatively high in urban areas but extremely low in rural areas. In general, however, ratios of less than 1:100 000 are common and some countries have very much lower ratios. Within countries, ratios may vary from 1:12 000 in the capital city to 1:700 000 or less in the provinces, reflecting, and associated with, the shortage and mal distribution of professional health manpower in general, and the very low levels of socioeconomic development. This must be compared with an average ratio of around 1:2300 in the industrialized countries.
The great shortage of pharmacists in developing countries, especially in government health services, is part of a general health manpower problem - of a numerical and qualitative imbalance between need (and demand) and supply. The adoption of a rational policy on essential drugs necessarily requires the development of a rational pharmacy manpower policy in the context of a general policy on health services and manpower development. As an interim measure, until their production of pharmacists and pharmacy technicians can meet their needs, many developing countries must depend to a greater or less extent on manpower substitution, allocating to non-pharmacist health personnel (medical, nursing, or community health workers) certain functions performed by pharmacists and pharmacy technicians in developed countries. To ensure that such substitution achieves its purposes, pharmacists are needed in management/administrative/education roles, to provide organization, supervision, support and training to those pharmacists and non-pharmacist health workers providing the essential pharmaceutical services to the public. They are needed also to man crucial posts in government concerned with quality control of imported and locally manufactured drugs, local manufacture of drugs, regulation of drugs, legislation concerned with pharmacy, formulating and advising on drug policy, and in general assuring the operation of national essential-drug programmes.
The principal professional categories of pharmacists are:
• community and hospital pharmacists,
• specialists in the various scientific aspects of pharmacy,
• occupational specialists, mainly industrial pharmacists engaged particularly in pharmaceutical technology and research, and
• teachers, and managers and administrators of pharmaceutical services and systems.
Pharmacy technicians or aides perform a variety of tasks according to the countries in which they are employed, in principle under the supervision of licensed pharmacists. Other health professional and non-professional personnel may be allocated (or delegated) pharmaceutical functions, especially in developing countries, in order to assure essential drug needs. Other categories, who are not considered professional pharmacists, such as druggists and herbalists, may be permitted to sell non-prescription drugs.
Imbalance with regard to categories of manpower takes the form mainly of an excess of generalist, or community (retail), pharmacists in the market-economy countries, compared with the other categories, such as hospital pharmacists (especially in the smaller hospitals), industrial pharmacists concerned with technology and research, and pharmacists in government services responsible for administration of pharmaceutical services. In some developing countries with a growing pharmaceutical industry (Egypt, India and Pakistan, for instance), pharmacy graduates are attracted to industry rather than to community and hospital pharmacy, both of which are areas of manpower shortage in those countries.