By Kathryn Utan, American International Health Alliance
Imagine living in rural South Africa, where there is just one practicing doctor for every 4,219 people in many places. Now imagine you’re also living with a chronic condition, such as diabetes, hypertension, asthma, or even HIV.
According to the World Health Organization (WHO), adherence to treatment regimens for these and other long-term conditions averages just 50%in high-income countries, with even lower rates in low- and middle-income countries. For untold millions of people around the world, lack of access to critical care and advice from a qualified health worker is a dangerous fact of life.
Mid-level health workers are in high demand, yet short supply as South Africa works to meet its rapidly increasing needs for health and allied care professionals. Pharmacy services are no exception, which makes pharmacists — and pharmacy technicians — integral members of multidisciplinary health teams. They play a critical role not only in the procurement and supply of medications, but also in developing evidence-based care plans; establishing ongoing and supportive relationships with patients; and providing follow-up care, advice, and support to improve health outcomes.
Teri-Lynne Fogarty, a lecturer and the coordinator of Nelson Mandela Metropolitan University’s (NMMU) Pharmacy Technician Program, explains that given South Africa’s shift toward service delivery at the primary level — including treatment and care for people living with HIV – pharmacy technicians are vital.
Jane Malaka is a recent graduate of NMMU andhas been working as a Pharmacy Technician at Rethabile Community Health Centre in the town of Polokwane in South Africa’s Limpopo Province for about six months.
“After they are diagnosed with HIV, every patient must go through a baseline evaluation to determine which antiretroviral medicines (ARVs) are best suited for them,” Jane says, explaining that while patients are on ARVs, continuous monitoring of blood levels are crucial to determine if the virus is being effectively suppressed.
“The goal for dispensing ARVs is to preserve life. It’s my job to help advise patients on the safe and correct use of these medicines, to answer any questions, and to highlight important information that doctors might have overlooked in a professional manner,” she continues.
Learning from other, more experienced members of the health team at the Centre, Jane says she has already gained valuable skills that help her to identify some side effects of certain ARVs.
“One day, a patient on a fixed-dose combination regimen [a single tablet that combines three separate ARV drugs: tenofovir, emtricitabine, and efavirenz] came to the pharmacy. Her patient history indicated that she had swollen feet and she had a prescription for antibiotics, prednisone, and hydrocortisone to apply to her feet,” Jane recalls, adding, “The doctor had already left when I tried to enquire. I suspected she was experiencing side effects from tenofovir, so I advised her to come back the following day to be seen by him.”
Pharmacy technicians and other mid-level medical support personnel like Jane are frontline health workers who are working with patients every day in South Africa and other low-resource settings around the globe.
Due to severe shortages of trained frontline health workers, pharmacy technicians are playing a critical role in South Africa’s response to HIV/AIDS and efforts to achieve the UNAIDS 90-90-90 targets of ensuring that 90% of all of people living with HIV know their status, 90% of those diagnosed receive sustained ARV treatment, and 90%of those on treatment maintain durable viral suppression by 2020. This new cadre also supports the goals of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) to achieve an AIDS-free generation.
The South African faculty and staff who implement Nelson Mandela Metropolitan University’s Pharmacy Technician Program have been supported in their efforts through a twinning partnership with the St. Louis College of Pharmacy (STLCOP) that was launched in May 2013 by the American International Health Alliance (AIHA) with funding from PEPFAR and CDC in South Africa. This capacity-building partnership is managed through AIHA’s HIV/AIDS Twinning Center Program, which is supported by the U.S. Health Resources and Services Administration (HRSA).
This work to expand access to frontline health workers supported by the US government has been critical beyond the pharmacy technicians directly trained by the program. In July 2016, the partners released The Southern African Pharmacy Technician Training Manual, the first textbook designed specifically for pharmacy technicians in the southern African region. The jointly developed text is the first of its kind and can be used as a learning tool for pharmacy technicians in English-speaking countries throughout southern Africa as part of a university-level course or as part of an on-the-job training program for mid-level pharmacy workers.