Pharmaceutical management is something that Kelliter Chizinga had always wanted to study and pursue as a career. In November 2016, Chizinga’s passion for being of service to the community motivated her to enroll at the Malawi College of Health Sciences in Lilongwe in a two-year pharmacy assistant certificate program that aimed to train and deploy 650 pharmacy assistants across Malawi by 2020.
Mbang’ombe 1 Health Center is in the back yard of Lilongwe International Airport. In terms of access to quality health services however, the facility might as well be far from Lilongwe. At approximately 50 km from the Lilongwe District Health Office and Central Medical Stores, the facility serves a rural community. It has one clinician, four nurses, 11 Health Surveillance Assistants (HSAs) and several support staff who serve over 5,000 households, a total population of 24,762 people. The facility has never had pharmacy personnel.
Laiford Nandolo is one of the two HSAs that help manage the drugstore in the absence of a trained Pharmacy Assistant. Although Laiford has over 10 years of experience as a health worker, most of his drugstore clerk experience has been on the job without formal training, except a one-day training he received back in 2014.
Last week, the Reproductive Health Supplies Coalition (RHSC) brought together hundreds of the top minds in global reproductive health issues at the Coalition’s 17th Annual Meeting. This meeting provided a forum for discussing the many triumphs and continuing challenges of reaching 120 million additional women with reproductive health services by the year 2020. Access to reproductive health commodities allows women to decide if and when to have children. This ability is not only a human right, it can be a life or death situation for many women and young girls. Increasing access to reproductive health is also one of the most effective and cost-efficient ways to reduce infant and maternal deaths. As an active member of the RHSC’s System Strengthening Working Group, VillageReach eagerly engaged in this week of conversation and idea exchange. Many of the central themes reflect the work of VillageReach, allowing us to bring our experience and expertise to the conversation while learning and growing from the experiences of our partners.
Simple ideas can be powerful – a point driven home during my recent trip to Uganda. While I was there, I had the opportunity to tour the Ugandan national medical stores, where medicines for the entire country are warehoused. The head of sales and marketing showed me how each and every commodity that the Government of Uganda procures is marked as a way to safeguard against theft. Every layer of packaging is embossed: “GOVERNMENT OF UGANDA. PUBLIC USE ONLY. NOT FOR SALE.” Even individual tablets are marked “UG.” The government builds this requirement into its procurement contracts with suppliers. I walked away completely floored. What a simple yet brilliant idea to solve a persistent supply chain problem.
One hundred and thirty minutes. That’s just over two hours. It’s a long time to wait to see a doctor no matter where you are in the world. Then after waiting for two hours, patients talk to a healthcare provider for less than 2 minutes – 140 seconds – before they are back out the door. These are the average times spent waiting for and with healthcare providers in a rural health center in Malawi, where a recent study examined the flow of patients to help uncover opportunities for improvement.
Graduation season is upon us. It’s a time of reflection for those about to embark on a new phase of their lives. For many this means entering the workforce for the first time, a pivotal life moment. At VillageReach, we recently celebrated the graduation of the second cohort of pharmacy assistants. Once deployed, these 85 graduates will begin careers as employees of the Malawi Ministry of Health and will be placed in rural, public-sector health facilities across Malawi. The 85 graduates will join their previous cohort who are already working in the field and making significant improvements in the quality of medicines management and patient care at the last mile. But this recent event is not the only graduation we’re celebrating.
I am a clinician by profession, serving a population of over 30, 000 in the 25 villages that my health center serves. I am the only clinician at the health facility with a single nurse to assist covering when possible. We recently lost the only health surveillance assistant that was trained as a drug clerk as she has left to pursue a one and a half year course in midwifery. This leaves me as the only clinician and also the only person to manage stocks in the medicine store (pharmacy). I undertake the majority of dispensing responsibilities as the hospital attendants that sometimes need to fill this role are not knowledgeable about medicines. When it’s month end, I am also responsible for doing the physical inventory and producing a monthly report. Each of these tasks requires time away from my primary responsibility of treating patients. This results in less time with patients, and inadequate reporting of essential information required to manage inventory. For example, I am not sure the reports that I send are even a true representation of the situation on the ground due to the limited time I have to devote to this task.
By Sir Brian Greenwood Professor, Clinical Tropical Medicine London School of Hygiene & Tropical Medicine Advisor, Vitol Foundation
In June I was asked to visit the Village Reach project in Malawi by one of its funders – the Vitol Foundation.
Dispensing is an important but neglected area and VillageReach is to be commended on recognizing the need for more investment in this area. Malawi has very few trained pharmacists or pharmacy technicians and so much dispensing at the health centre level is done by completely untrained people with a substantial risk that drugs will be wasted and that patients may be given the wrong medication. Pharmacists are trained at the School of Health Sciences in Lilongwe. Fully trained pharmacists undertake a four year course, pharmacy technicians a three course leading to a diploma. A new cadre of pharmacy assistants has been created by the Ministry of Health and VillageReach, with 150 enrolled in the first year. The ultimate goal is to place one pharmacy assistant in each health centre.
By LOVENESS KASIYAMPHANJE Pharmacy Assistants Training Program- Class of 2015
My name is Loveness Kasiyamphanje. I am originally from Ntcheu, in the Central Region of Malawi, but I currently live in Namiyango in Blantyre District. I am pursuing a Certificate in Pharmacy Programme at Malawi College of Health Sciences (MCHS), Lilongwe Campus. The programme was created by VillageReach, the Malawi College of Health Sciences (MCHS) and their partners. The Programme is for two years and I am in the first year.
By CLIFFORD KANONO VillageReach Pharmacy Assistants Program Student– Class of 2015
My name is Clifford Kanono. I am enrolled in VillageReach’s Pharmacy Assistant Training Programme. Previously, I worked as a Health Surveillance Assistant in the rural communities of Nkhata Bay District in the Northern part of Malawi. The health facility I worked in had to serve about 14,500 people in a year—a large number given the resources of the facility. This, like most other health facilities in rural communities face many challenges, but one of the most problematic is the adverse effects of non-trained pharmacy personnel: