By Matṧeliso phulane
The Pharmacy Association of Lesotho (PAL) has warned that government’s reluctance to employ qualified professionals such as pharmacy technicians in its health centres could have serious implications on the health of patients.
While a pharmacist is a health care professional who is specifically trained to store, handle, prepare and dispense various medications, pharmacy technicians are trained in the technical aspects of supplying medicines and medical devices to patients under the supervision of a pharmacist.
In an interview with theReporter, acting president of PAL, Mafaso Mothibeli said it was not uncommon to find an entire government hospital being serviced by one pharmacist and just a handful technicians.
“It is even worse in government health centres especially those in rural ones where there are no pharmacy personnel at all.
“That’s where you find drugs being handled and dispensed by nurses, and staff support such as cleaners and security guards. That could be dangerous when someone is not trained to do the job,” Mothibeli noted.
He indicated that a pharmacist’s major responsibility is to ensure availability of drug supplies and that they are administered to the right people, in the right quantities and at the right times.
A pharmacist also has to be mindful of the side effects of medications and how to manage them.
“There is what we call a ‘drug interaction’, which is how a drug reacts to another drug, or to food, beverages or supplement.
“Someone who is not conversant with such factors can simply give drugs out without taking any precautions, but a trained pharmacist will know that certain medication will be harmful if taken simultaneously,” Mothibeli warned.
The PAL head added that it is also the responsibility of pharmacists to ensure that patients get the correct medication over the correct duration, something that an untrained person cannot be capable of doing.
Mothibeli reiterated that poor handling of medication by untrained persons could have far-reaching implications that might put patients’ lives at risk, especially the more vulnerable ones.
“Medicines themselves can be unsafe if not handled properly. They can cause disability, drug resistance (especially anti-microbial) if the course of medication is not completed or if it is not an optimal dose.
“As a result, a patient will put on more costly medication when they do not respond to the prescribed one. That alone can mean unnecessary expenses for the country since the medicines are subsidised and given for free,” he said.
Sometimes, medication errors may not necessarily result in death, but could still cause side effects leading to long-term health complications.
Apart from that, medication errors can also cause unnecessary expenses such as patients being re-admitted to hospital.
Mothibeli stated that errors like expired medicines are a result of nurses multi-tasking by looking after patients while managing drugs.
“I do not blame the nurses; they are not trained for that and they can only perfect the job they are trained for.
“We have tried to bring the matter up with the ministry of health but we were told to wait because there was a draft law in the pipeline, that would protect us.
“Not only that, we need a medicine regulatory authority to be established to regulate the dispensing of medicines. In spite of everything, I am still optimistic that something concrete and constructive is on the horizon,” he pointed out.
According to Mothibeli, Lesotho produces enough pharmacists, with the National Health Training College producing between 25 and 30 diploma in pharmacy graduates every year, and National University of Lesotho producing between 40 and 50 at degree level.
After graduating, pharmacists are forced by unemployment to leave for countries like Botswana and Zimbabwe in search of better opportunities. The effect of this is that Lesotho loses out as it sponsors people who it does not benefit from.
A qualified pharmacy technician who asked to remain anonymous said he had observed a high unemployment rate of pharmacy technicians, with the ministry of health having last recruited such professionals in 2017.
He indicated that he graduated in 2021 and most of his peers have had to make do with temporary jobs in pharmacies at private clinics.
“It is true that is the kind of job we are already doing just to make ends meet and to acquire vital on-the-job experience, but we’re working too hard. Those of us who are employed in private pharmaceutical outlets work long hours, seven days a week with little remuneration.
“We have always looked to our association to take our issues up with government but to no avail. The government may not employ all of us, but we expect it to at least demonstrate commitment to the safety of patients and reducing unemployment of pharmacists.
“Not every patient can afford the money to go to retail pharmacies, this is why they mostly go to government clinics. Our sector is not taken seriously at all. Nurses are always employed in large numbers, leaving only a handful unemployed. Why can’t the same be done with pharmacists?”
He pointed out that already patients have to contend with poor services, such as shortage of medication supplies at health centres; and having unqualified pharmacy technician to dispense drugs poses yet another problem of patients receiving wrong medications and inaccurate instructions on how to use them.
Commenting on the matter, the public relations officer of the ministry of health, Tumisang Mokoai, conceded that the ministry does indeed have an issue of shortage of pharmacists.
“Yes, we do have a shortage of pharmacy technicians and pharmacists but the ministry is looking at adding more pharmacists.
“In addition, we are going to need more pharmacists for the new hospital, which will be opened soon,” Mokoai said.
He denied suggestions that the ministry does not care much about pharmacists, saying he needed time to get the details and extent of the challenge from the director of pharmacists who was not in office at the time
Mokoai denied that skill-less staff like security guards and cleaners dispense drugs in government hospitals.
The apparent marginalisation of qualified pharmacists has long been a thorn in the flesh for these professionals.
In 2021, outspoken pharmacist Tebello Sarele decried their predicament, stating that while it is dictated by the provisions of the Medical, Dental and Pharmacy Order 1970 that every pharmacy establishment whether public or privately owned should be run and managed by a pharmacist full time as long as the establishment is operational, that has never been the case in all health sectors including the public sector.
Sarele lamented that despite the evident need for the ministry of health to review their staffing pattern of the pharmacy, nothing had been done to address gaps brought by low human capacity of the pharmacy sector.
“While over 15 years ago, the challenge of human resource capacity in the pharmacy was that there was no pharmacy school in Lesotho, and local pharmacists were trained in other countries, in recent years, this is not the challenge. Over the years, the National University of Lesotho has produced graduates since 2007. One would have thought that those graduates would be absorbed to improve patient care in the public health sector, but no, not in Lesotho.
“The Government of Lesotho through the Human Resources Development and Strategic Plan 2005-2025 that was published in 2004 developed “an establishment list”, which stipulated minimum requirements in terms of human resource capacity for all healthcare workers including pharmacists in the public health sector.
“This establishment list was devised following the needs assessment for human resources capacity in the pharmacy and it revealed disparities in engagement of qualified pharmacy personnel (pharmacists and pharmacy technicians) both in CHAL and MOH facilities. It was used as a tool to guide staffing patterns as a way to respond to human resource challenges of that time, with some projections for up to 2025,” Sarele had indicated.
She pointed out that for the pharmacy department, the necessary reviews of the human resource capacity was the only hope for assuring good stewardship of medicines and consequent safety of patients.
She said it was shocking that although this list had been reviewed for all other professional cadres; doctors, nurses, nursing assistants etc. no such reviews have been made for the pharmacy cadre.
“While the establishment list was used as a guiding tool in those days when pharmacists were scarce in the country; it is needless to say that it does not make sense to use that tool as a guide for staffing patterns in 2021! Surely the human resource needs of the public healthcare system today are more than those of the past.
“In recent years, different NGOs have provided support through hiring pharmacists and pharmacy technicians to work in public health facilities. One would have thought that when the NGOs withdraw their support as a result of funding challenges, the government of Lesotho would absorb that workforce to prevent interruption of good quality pharmaceutical care.
“Among the NGOs, there is one that contributed almost 90 percent of the total number of pharmacy personnel in the primary health facilities,” added Sarele.
