trainining options analysis for sdsi 10222012

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MAKERERE UNIVERSITY

Ensuring Continuous Availability of Trained Accredited Drug Shop (ADS) SellersA SDSI(MSH)/MakCHS COLLABORATION

Options Analysis Report

October 2012

SUBMITTED TO;

SDSI PROJECT TEAM,

Management Sciences for Health


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Table of Contents

TABLE OF CONTENTS............................................................................2

EXECUTIVE SUMMARY...........................................................................3

ACKNOWLEDGEMENTS..........................................................................4

LIST OF ABBREVIATIONS.......................................................................4

1.0. INTRODUCTION..............................................................................5

2.0.OPTIONS ANALYSIS.........................................................................6

2.1.TRAINING OPTIONS.........................................................................7

3.0.RECOMMENDATIONS:....................................................................11

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EXECUTIVE SUMMARY

The ADS training program piloted in Kibaale district presented a unique opportunity for sellers

and owners of drug shops to improve their knowledge and skills. The sustainability of the

successes achieved under the EADSI program depends highly on the availability of well

trained and competent sellers who can provide services in the established outlets. There is a

need for exploring more options for sustainability of the training program instead of depending

on donor funds.

An analysis of the current training model reveals that there a number of strengths and

opportunities that can be exploited, and a number of weaknesses and threats that should be

mitigated. Based on the situational analysis of training in Kibaale, the different stake holders

had pertinent and promising suggestions for ensuring sustainability.

Carrying out an options analysis reveals that there a number of merits and demerits for each of

options. The options look at who, how, the duration of training.

Both pre-service and in service training be opted for ADS sellers training. Refresher courses

should also be carried out biannually to ensure knowledge and skills acquisition/ retention. The

pharmacy training institutions should carry out the initial/accreditation course and this training

should be carried out physically at these institutions. The refresher/on-going courses should be

carried out by ADS association and local health teams supported and monitored by the

pharmacy training institutions. These on-going courses should be held at venues close to the

ADS sellers. To ensure financial sustainability, self-funding by the sellers is the only viable

option.

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ACKNOWLEDGEMENTS

We wish to acknowledge the contributions of the following towards the successful completion

of the options analysis process:-

Heads of the pharmacy training institutions of Mbarara University of Science and

Technology, Kampala International University, Gulu University and Mulago

Paramedical Schools.

The selected officials from; PSU, NDA, Allied health Professionals Council, SURE

project and UHMG

Selected government officials from the Ministry of Health and Ministry of Education

The SDSI technical team

LIST OF ABBREVIATIONS

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ADS Accredited Drug Shop

EADSI East African Drug Seller Initiative

DHT District Health Team

NDA National Drug Authority

PSU Pharmaceutical Society of Uganda

MSH Management Science for Health

ADDO Accredited Drug Dispensing Outlet

1.0. INTRODUCTION

Training is one of the key success factors that the ADS program in Uganda in hinged on.

Before the ADS was introduced in Uganda, there was no structured training program for

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sellers and owners of drug shops. The ADS training program presented a unique opportunity

for sellers and owners of drug shops to improve their knowledge and skills. The training

covered several areas that directly impact on the day to day operations of the drug shops.

The sustainability of the successes achieved under the EADSI program depends highly on the

availability of well trained and competent sellers who can provide services in the establishedoutlets. Currently, the demand for and attrition of sellers has been met through continuous

training and retraining of new and old sellers with donor funds. This situation raises concern for

program stakeholders, including regulatory authorities, because a more sustainable way of

training sellers is needed in order for the program to continue achieving positive results in the

short and long term.

Objective

To analyse the different options for a sustainable ADS sellers training program using

pharmaceutical training institutions or other organizations

Methods

The following methods were utilised for the options analysis process

Desk review

Review of the situational analysis report

Focused group discussion; made up of key stakeholders from ADS association,

pharmacy training institutions, allied health professions council, Allied Health

Examinations Board, MoH, NDA, and PSU.

2.0.OPTIONSANALYSIS

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SWOTanalysis of the current training model

Strengths:

The importance of the training is highly appreciated by both owners and sellers

The training of the owners were done separately from that of the sellers

It has registered great improvement on the quality of pharmaceutical services provided.

It was carried out at venues closer to the sellers making it very convenient for the

trainees.

Weaknesses

The duration of course is short (3 weeks); all the ADS trainees and former trainer found

it very inadequate.

Lack of financial sustainability; all the training activities are funded by MSH.

Some of the potential trainees are not able to fit in the time table of the trainings

The training sessions are less frequent and regular.

Opportunities

The training is a pre-requisite to accreditation of a class C drugs shop which enables

them handle an expanded list of medicines.

Stake holders appreciation of the need for ADS training

Threats

Communities are not well sensitized , for example, patients insist on single doses of

antibiotics

Non availability of trained ADS sellers in cases of attrition; the current model does not

create a pool of adequately trained personnel.

Opening up of illegal drug shops by trained ADS sellers

2.1.Training Options

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TrainingModalities

Option 1: Pre-service Training

This encompasses a structured comprehensive training program design for people before they

begin working as ADS sellers. This kind of training equips the trainees with knowledge needed

to provide quality pharmaceutical services. It is competency based training.

Merits

Pre-service training creates a pool of ADS sellers that would be available in cases of

attrition and demand for sellers to work in new ADS sellers.

It is a medium and long-term solution to ensuring availability of trained ADS sellers and

therefore addresses sustainability and continuity issues

There is a career growth path for the individual as they can go on to do a diploma of

pharmacy/nursing

Demerits

It does not immediately address the need for adequately trained sellers. Being

competency based, it requires proper selection of trainees; involves longer periods of

training and is usually more expensive.

This may be seen by some stake holders as new cadre creation that is not supervised

by a professional council in the Ministry of Health Structure.

Option 2: In-Service TrainingIn-Service Training refers to training for sellers who are already working in the class C drug

shops. This training is job-related and provides the sellers (most of whom are nursing

assistants) with additional knowledge and skills to carry out new job functions or to improve

their performance of existing job functions.

Merits

Improvement of quality of pharmaceutical services in the existing class C drug shops

Immediately addresses the need for adequately trained sellers

The training durations is usually shorter and is less costly.

Involves also refresher/ on-going training.

Demerits

The training involves getting sellers from their work places which may be difficult.

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The minimum requirements for one to be trained are usually more lax and so it does not

adequately address the issue of quality.

It is a short term strategy; it doesnt create a pool of adequately trained sellers to meet

the need for ADS sellers created by attrition.

Who shouldtrain the ADS sellers?

Option 1: Pharmaceutical Training Institutions

These include Mulago Paramedical School, Departments of Pharmacy in Gulu, Mbarara,

Makerere and Kampala International Universities.

Merits

Resources , in form of human resource and infrastructure, are available for doing thetrainings

All are already running some short courses and so have great expertise and regulatory

systems in-place to ensure quality.

Demerits

The minimum entry requirements might be well over those for most sellers

The course fees might not be affordable to the sellers

Involves travelling and staying at these institutions; which makes it more costly.

The trainings have to be fitted into the academic calendars; most pharmacy training

institutions dont have adequate staffing numbers and have very busy program

schedules.

Option 2: Other Interested Organizations

These are institutions that have carried out such training before. They usually pick a number of

professionals and carry out a training of trainers (TOTs). The trainers eventually are the ones

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that train the ADS sellers. These organizations could include ADS association and other

private enterprises.

Merits

They are able to offer flexible training schedules, hence better for on-going trainings

Better acceptability by the trainees if the trainers are some of their fellow locals

They are able to run on-site/close to workplace trainings

Demerits

TOTs have to be carried out before every training; making it expensive and non-

uniform.

May lack proper systems in place to check quality and also run initial training.

Sustainability/continuity of the program remains a challenge.

Need extra support and monitoring from other key stakeholders.

Place of training

Option 1: Distance learning

This involves designing modules which are sent to the drug sellers with minimal face to face

trainings. This would make the training cheaper but is not appropriate for the level of

knowledge of the ADS sellers.

Option 2: On job training

This involves on job mentoring. It would give excellent results, but it is not practical.

Option 3: Training organized in the districts

This is what was employed in the ADS pilot in Kibaale. It has had some successes. However it

is costly and sellers may not adequately attend the training.

Duration of Training

The duration for the current training program is three (3) weeks. The ADDO pilot in Ruvuma

was six (6) weeks. These are all in-service training models.

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Option 1: initial training duration

This training is can be pre-service or in-service and requires adequate time for the sellers to

adequately learn and internalize knowledge and develop the skill required. The in-service

trainings involve training of persons already working as sellers, hence with some experience

and the philosophy is to improve on practices so the duration of the training must be shorter

than that required for Pre-service that is competency based.

Options 2: on-going training duration

These are refresher courses carried out as often as deemed necessary. They must be regular

and focused to given areas of weakness identified and so are short; half to full day.

Costs of training

Option 1: self-sponsorship

This involves the ADS sellers paying for their training, both initial and on-going. This is a very

financially sustainable option but could greatly limit the numbers of sellers undergoing the

training hence not addressing the great need for ADS sellers to cover gaps caused by attrition.

Option 2: drug shop/Owner

This option will ensure that enough sellers are trained depending on numbers of the owners

who wish to have their drug shops accredited. However, it comes with two great setbacks;

firstly, the expense might be passed on to the clients by increasing the selling prices hence

limiting access to pharmaceutical services. Secondly, the owners will feel they the sellers owe

them a lot and this could lead to disrespect and abuse of human rights.

Options 3: external funding

This can ensure an adequate number of sellers is trained in the short term, but is not

sustainable in the long term.

3.0.RECOMMENDATIONS:

Type of training

Both pre-service and in service training be opted for ADS sellers training. The in-service

training will address short term ADS seller needs. It should be 4-6 weeks depending on the

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training content. In order to ensure quality pharmaceutical services provision, the minimum

education requirements for in-service should be O-level certificate. Pre-service should be

considered for the provision of higher cadre (pharmacy assistants) for ADS on Medium and

Long term. It should be a nine months certificate course whose minimum entry requirement is

A-level with science base.

Refresher courses should also be carried out biannually to ensure knowledge and skills

acquisition/ retention; it should be a full day long course.

Who should carry out the training and how?

The pharmacy training institutions should carry out the initial/accreditation course and this

training should be carried out physically at these institutions. The refresher/on-going courses

should be carried out by ADS association and local health teams supported and monitored by

the pharmacy training institutions. These on-going courses should be held at venues close to

the ADS sellers.

Funding mechanisms

To ensure financial sustainability, self-funding by the sellers is the only viable option.

4.0 REFERENCES

Aziz Maija, Saul Kidde, Kate Kikule, Dennis Mwesigwa, Nasser Lubowa, Martha

Embrey, Keith Johnson; Increasing access to quality essential medicines and

services provided by drug shops in Uganda through accreditation and regulation;

Management Sciences for Health

EADSI; Situational Analysis for the Pharmaceutical Sector and Access to

Medicines in Uganda; 2008.

Centre for Pharmaceutical Management; 2003; Defining and Measuring Access

to Essential Drugs, Vaccines, and Health Commodities: Report of the WHO-MSH

Consultative Meeting, Ferney-Voltaire, France, December 1113, 2000.

Prepared for the Strategies for Enhancing Access to Medicines Program.Arlington, VA: Management Sciences for Health.

ADRET (2011) Assessment of the transferability and Scalability of the ADS

Program in Uganda

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trainining options analysis for sdsi 10222012

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