POLICY AND TREATMENT GUIDELINES

DEVELOPMENT/REVIEW OFFICE:

MINISTRY OF HEALTH AND WELLNESS

GAONE MPHO
NNETE JESSICA MOUMAKWA
DUNCAN MPUSETSANG
VENIAH LEDIMO
MOMPATI LETSWELETSE

THE ROLES OF A
PHARMACISTAT MINISTRY
LEVEL
Acknowledgement

We would like to express our sincere gratitude to our coordinator Dr Joyce Kgatlwane for the
opportunity as well as motivation to interview chief pharmacist at the Ministry of Health and
Wellness to enable us to carry out the research. Sincere gratitude also to the chief pharmacists Dr
Sebako and Mrs Seepo for giving as an in depth insight of what actually occurs in the
pharmaceutical service at the Ministry of Health and Wellness.

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Glossary/Acronyms and Abbreviations

NASPA- National Pharmaceutical Service Administration

WHO- World Health Organization

BEDAP- Botswana Essential Drug Action Programme

BNDP- Botswana National Drug Policy

NASCOD-National Standing Committee on Drugs

BEDL-Botswana Essential Drug List

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ABSTRACT

National Health Policy strategies and plans play an essential role in defining a country's vision,
policy directions and strategies for ensuring the health of its population. Health is a fundamental
human right. Various stakeholders are involved in ensuring that every citizen is not deprived of
this right. Medicines play an indispensable role in the delivery of quality preventative and
curative health services and are (medicines) a key to the success of any primary health care. It is
clear that pharmacy has an important role to play in the health sector reform process. To do so,
however, the role of the pharmacist needs to be redefined and reoriented. Pharmacists have the
potential to improve therapeutic outcomes and patients' quality of life within available resources.
Hence they must position themselves at the forefront of the healthcare system. The movement
towards pharmaceutical care is a critical factor in this process. The aim of this report is to outline
the role of a pharmacist at ministry level and the challenges they face and the stakeholders they
work with (willian, 2013)

OBJECTIVES

To clearly understand roles of a pharmacist at the ministry level the following objectives
were considered:

To assess the composition of pharmaceutical services at ministry level

To discuss the role and responsibilities of each unit under the pharmaceutical services
To identify and discuss the challenges faced by the different units under the
pharmaceutical services
To list career paths taken by pharmacists
To discuss the roles of different stakeholders under the pharmaceutical services

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INTRODUCTION

Medicines shortages have become a complex global issue, putting lives at risk and creating
difficulties for health care professionals. There is evidence that these shortages are worsening
with time; in some countries, medicine shortages tripled between 2005 and 2010. The causes of
these shortages are multidimensional in the context of a complex global supply chain. As a
result, there is a growing concern among health care professionals about the future of medicines
availability worldwide. However for a developing country like Botswana have come up organs to
address (Yale, 2007)

Health services has grown tremendously in the past few years in terms of numbers and sizes
resulting in the proportional increase in the pharmaceutical services ,therefore is very significant
to have working pharmaceutical structures that insure that the country receives quality
pharmaceutical survives .These structures include NPSA AND BEDAP. The Department of
Pharmaceutical Services is located within the Directorate of Health Services of the Ministry of
Health. It is headed by the Chief Pharmacist who is responsible for organizing and directing all
pharmaceutical activities in the country (National Pharmaceutical Services Administration) as
well as formulating and providing policy advice and guidance to the MOH while BEDAP
function as a coordinating center for all matters pertaining to drug treatment policies. (Yale,
2007)

Other functions include ensuring regular medicine supply to the public sector, technical
supervision of national referral and regional hospitals and the overall implementation of the
Swaziland National Pharmaceutical Policy.

The administrators deal mostly with administrative issues to ensure quality pharmaceutical
service delivery. BEDAP function as a coordinating center for all matters pertaining to drug
treatment policies .The common challenge experienced by the pharmaceutical division is
shortage of qualified and trained personnel making it difficult for the division to execute its
functions. With reference to countries like Pakistan the role of a pharmacist is to Advise on the
pharmaceutical aspects of policies for care in the community Strategic planning including
pharmaceutical input into needs assessment of local population and the challenges they face

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Essential medicines are those that satisfy the priority health care needs of the population and
offer a cost-effective solution to the problems of drug stock out in healthcare system of
developing countries they should be selected according to the prevalence of disease, affordability
of healthcare system/patient, with assured quality and availability in the appropriate dosage
forms. Botswana like other developing countries have an essential drug list which is coordinated
by BEDAP together with NASCOD. MEDICINES offer a simple, cost-effective answer to many
health problems in Africa, provided they are available, accessible, affordable, and properly used.
BEDAP is a focal point for coordinating all matter pertaining to drug treatment policies .Among
other responsibilities if BEDAP is to select essential medicines it does this be ensuring that only
registered medicines of proven efficacy, safety, and quality are selected to satisfy the needs of
the majority of the population .The selection of medicines of BEDL is in accordance with the
essential drug list concept as defined by the world health organization. (How to develop and
implement a national drug polciy, 1988)

THE MINISTRY OF HEALTH AND WELLNESS ‘S HIERARCHY

Permanent secretary

Deputy permanent secretary

Director clinical services

Department of clinical services

Department of technical services which includes 3 divisions which are:

 Pharmacy
 Laboratory services
 Biomedical engineering

Pharmacy division
 National pharmaceutical Administration services (1 chief pharmacist and 1
principal pharmacist)
 BEDAP (3 chief pharmacists)

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 All this 3 units are headed by a chief pharmacist

CAREER PATH (Chief pharmacist)

While at ministry level a pharmacist may specialize in the following specialties .These are
required when formulating policies, guidelines and in the administration of pharmaceutical
services

 Clinical Pharmacist
 Clinical oncology Pharmacist
 Pediatrician Pharmacist
 Geriatric Pharmacist
 Pharmacist Consultant
 Regulatory Pharmacist
 Infectious disease Pharmacist

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NATIONAL PHARMACEUTICAL SERVICES ADMINISTRATION (NPSA)

Roles and responsibilities:

Pharmacists in administration participate in formulating health and drug policies, particularly

those on the selection, procurement and distribution of drugs. For instance they are board
members of the committee that proposes guidelines and policies. Examples of committees
include Botswana National Drug Policy which is in use and integrated HIV clinical care
guideline. They also serve as sources of information for health care professionals and the public,
and participate in the preparation of official documents. (willian, 2013)

Manage and control the distribution of pharmaceuticals in the public sector they do this by
working together with the CMS which one of their stakeholders.

They monitor the extent at which medicines are available or not at the clinics, DHMTs and
hospitals. These public sectors send reports of availability of medicines every month and the
NSPA aggregate the data. Sending the report is one way to monitor which medicines are
available and the quality of services provided. (willian, 2013)

They Coordinate internship programmers for pharmacists after graduation .They Coordinate
employment of qualified pharmacy techs and pharmacists and that is they decide on their
placement in health facilities around the country .Moreover they alias with the human resources
management office for promotion of pharmacy officers. On top of that they advocate positions
for pharmacy officers. Furthermore they advise on the layout of the pharmacy, in cases where
they are new hospitals built lastly they develop standard Operating procedures (SOPs) e.g. sops
for dispensing, for drug management (willian, 2013)

CHALLENGES

Despite the pharmaceutical structure striving to achieve the mandate of providing quality
pharmaceutical quality services, they face a number of common challenges which include:

The pharmaceutical workforce ids a vital part of the medicine supply system .Yet its
effectiveness has been hindered by insufficient numbers and skills so there is a need for skilled

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professionals to deal with ever increasing complexity of assessing technologically advanced
systems

Secondly is shortage of medicines. Medicine shortages have become the all too common and
affect all aspect of the health care delivery .The increased number of medicine shortages has had
a negative impact on patient care as well as costly financial implication which consequently
leading to the pharmaceutical national service administration failing to achieve its mandate
(Botswana essential drug list , 2012)

Limited internship spaces for graduated pharmacy officers which leads them to not being able to
perform their roles place them in different public sectors

BOTSWANA ESSENTIAL DRUGS ACTION PROGRAMME (BEDAP)

According to (Botswana national drug(Medicine ) policy , 2005) BEDAP was established with a
purpose to implement some of the key components of the BNDP and monitoring the
implementation of the BNDP. The Ministry of Health and Wellness established this programme
to specifically address areas identified as either completely lacking or experiencing significant
deficiencies. The head of unit shall be a pharmacist or medical practitioner with a background on
essential drugs concept. The unit shall function as a coordinating center for all matters pertaining
to drug treatment policies

BEDAP`S VITAL ROLES INCLUDE:

Selection of Medicines: select of medicines for the public is done through NASCOD (National
Standing Committee on Drugs, in which BEDAP is the secretariat. NASCOD is a
multidisciplinary committee consisting of pharmacists, specialists, e.g. dermatologists,
oncologists who then work together to produce an essential medicine list (EML) which is a list of
selected medicines for the public registered and approved from the Drug Regulatory Unit
(DRU).The selection of medicines in the essential medicine list is guided by the treatment
guidelines and antimicrobial guidelines. Therefore NASCOD also produces and revises the
Botswana Treatment Guidelines and the Antimicrobial guidelines. The rationale for selecting a
limited number of essential medicines is that it may lead to better supply, more rationale and

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better and lower costs. Essential medicines are those that are deemed to satisfy the health care
needs of the majority of the population and that should be available in the appropriate dosage
forms and strengths at all times. As selection of medicines has a considerate impact on quality of
care and cost treatment, it is one of the most effective areas of intervention. The drug selection
process ensures that only the registered drugs of proven efficacy, safety and quality are selected
to satisfy the health needs of the majority of the population of Botswana. The selection of drugs
for the Botswana Essential Drugs List is in accordance with the essential drug list concept as
defines by the world health organization as per the following criteria: (Botswana national
drug(Medicine ) policy , 2005)

1. Disease pattern/ prevalence in Botswana

2. Registration status according to Drugs and related substance act and DRA requirements
3. Well documented efficacy and safety of the drug
4. The quality including stability of the product
5. Single pharmacologically active ingredient except in very special circumstances
6. cost

In case of medicines being requested to treat a certain patient, and the medicines are not included
in the (EML) a special order form is filled by a specialists which is then processed and accessed
by BEDAP, alternatively if there are many requests of the medicines through the special order
form, the medicine can be included in the Essential Medicine List.

Ensuring rationale use of medicines: according to world health organization the rationale use
of drugs requires that patients receive medications appropriate to their clinical needs, in doses
that meet their own individual requirements for an adequate period of time, and at the lowest cost
to them and their community.

Rational use of medicines is a major problem worldwide. WHO estimates that more than half of
all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to
take them correctly? The overuse, underuse or misuse of medicines results in wastage of scarce
resources and widespread health hazards. Examples of irrational use of medicines include: use of
too many medicines per patient ("poly-pharmacy"); inappropriate use of antimicrobials, often in
inadequate dosage, for non-bacterial infections; over-use of injections when oral formulations
would be more appropriate; failure to prescribe in accordance with clinical guidelines;

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inappropriate self-medication, often of prescription-only medicines; non-adherence to dosing
regimens.

To ensure rationale use of medicines the Ministry of Health through BEDAP provides scientific
drug information for professionals and the community, through training and education for both
health professionals and patients, the service receivers, establishing good prescribing, dispensing,
advertising and marketing practices as well as conduct relevant research and developments
aiming towards the rationale use of drugs country wide. Committees such as the Drug
Therapeutic committee have also been formulated. BEDAP encourages these committees to be
established in the vast array of Health Facilities both public and private. The committees as they
act like mini BEDAP in facilities can also produce an essential drug list consistent with the
BEDL, monitor the use of the list in ordering and procurement of drugs, promote and monitor
safe , cost effective and rationale drug use, promote adherence to standard treatment guidelines
and function as a formal link to BEDAP and NASCOD. (Botswana national health policy, 2012)

Monitoring and implementing the BNDP

CHALLENGES

Shortage of stuff: there is shortage of pharmacy personnel both pharmacists and pharmacy
technicians, the bulk of the work hence becomes overwhelming to the existing workers, therefore
poor service delivery in facilities across the country.

Donations: these include medical equipment, non-medicines and medicines. Some

pharmaceutical companies donate medicines to health facilities and patients adhere to them, as
such some medicines are forced to be added into the BEDL without any testing.

Transcribing: people visit private hospitals and take prescriptions to government facilities,
which is not allowed, as they have not underwent the right procedure of service delivery in the
government settings as such they want to be aided with their prescriptions.

Inactive DTC: some DTC are inactive hence leads to irrational use of drugs in facilities, the
government is trying by all means to resuscitate these committees

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Irrational use of medicines: even through education and training some health care proffesionals
choose not to adhere to these concepts, they still practice irrational prescribing which refers to
prescribing that fails to comform to good standards of treatment. This may manifest in 5 different
ways namely under prescribing, over prescribing, incorrect prescribing, extravagant prescribing
and multiple prescribing. Irrational prescribing can expose patients to the possibility of
developing drug dependence to a certain medicines such as painkillers and tranquillizers.
Patients also do not adhere to prescriptions and do not take hid of advices given by pharmacists.
(willian, 2013)

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CONCLUSION

Health is a fundamental human right, access to health care which includes access to essential
medicines is a pre requisites for realizing that right. Essential drug plays a critical in many aspect
of health if available, affordable of good quality and properly used, drugs can offer a simple, cost
effective answer to many health problems. This is made possible by regulatory affair (DRA)
which plays a critical role in the pharmaceutical industry because is concerned about the
healthcare product lifecycle. All this organs being National pharmaceutical national
administration and BEDAP ensure that one particular patient receives quality pharmaceutical
care to ensure which consequently leads to the potential for being a prosperous and innovative
nation because prosperity for all can only be attained with a healthy nation (Botswana national
drug(Medicine ) policy , 2005)

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Bibliography
Botswana essential drug list . (2012). Botswana : Government Printers.
Botswana national drug(Medicine ) policy . (2005, January). Gaborone, Botswana: Goverment
Printers .
Botswana national health policy. (2012). Gaborone, Botswana: Government printers.
How to develop and implement a national drug polciy. (1988). Malta: WHO Library
Cataloguing-in-Publication Data.
willian, M. (2013, July 2). Who stardars. Retrieved from Datum corpotation :
www.whostadards.com
Yale, J. k. (2007). Medicine shortage case study Ethopia. Retrieved from
https://www.fip.org/Medicines-shortages

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