4.Healthcare Systems and Health care team.pptx

Healthcare system and health care team

1. Healthcare Systems M r Sikulya H . 2 3 Rd S e p t ember , 2 2 4

2. Health WHO health definition 2

3. Introduction Health care is the total societal effort, organized or not, whether private or public, that attempts to guarantee, provide, finance, and promote health Health systems are defined by WHO as comprising all the organizations, institutions and resources that are devoted to producing health actions A health action is defined as any effort, whether in personal health care, public health services or through inter-sectoral initiatives, whose primary purpose is to improve health 3

4. Introduction Health resources are all the means of the health care system available for its operation, including manpower, buildings, equipment, supplies, funds, knowledge and technology Health sector includes governmental ministries and departments, organizations and services, social security and health insurance schemes, voluntary organizations and private individuals and groups providing health services 4

5. Introduction Health services is a permanent countrywide system of established institutions, the multipurpose objective of which is to cope with the various health needs and demands of the population H ealth care delivery services involves the organized public or private efforts that assist individuals primarily in regaining health, but also in preventing disease and disability All health services organizations can be classified by ownership and mode of financing 5

6. Models of national health care systems based on the sources of funding Based on the source of their funding and degree of state intervention, three main models of national healthcare systems can be distinguished Beveridge model Bismarck model Free market private insurance mode 6

7. Free Market System Govt Monopoly Private insurance Social insurance National health service USA UK New Zealand Sweden Germany Japan Netherlands Taiwan Individualistic Communitarian Egalitarian Models of national health care systems based on the sources of funding 7

8. Beveridge Model Funding is based mainly on taxation and is characterized by a centrally organized National Health Service where the services are provided by mainly public health providers In this model, healthcare budgets compete with other spending priorities The countries using this model, beside United Kingdom, are Ireland, Nordic countries, Spain, Portugal, Italy, Greece, Canada and Australia 8

9. Strengths •pools risks for whole population •relies on many different revenue sources •potential for administrative efficiency and cost control Limitations variations in funding and budgetary allocations due to changing gov’t priorities Potentially inefficient due to complex public sector rules and procedures Beveridge Model 9

10. Bismack Model Funds are provided mainly by a premium-financed social/mandatory insurance This model results in a mix of private and public providers, and allows more flexible spending on healthcare 10

11. Strengths Perceived as a ‘benefit’ tax with more ‘willingness to pay’ P rotects health financing from gov’t annual budgetary process Limitation P otential to exclude the poor and vulnerable unless subsidized by govt A dministrative cost can be high if f ragmented P otential negative impact on employment because of increased cost of production 11

12. Free market Private Insurance Model Funding of the system is based on premiums, paid into private insurance companies, and in its pure form actually exists only in the USA In this system, the funding is predominantly private, with the exception of social care for poor and elderly The great majority of providers in this model belong to the private sector H ealthcare is a commodity that should be bought and sold on the open market 12

13. Strengths I mprove efficiency F iscal relief for gov’t G reater opportunities of choice given to individuals A shorter waiting time if you pay more Limitations Decrease equity Weak health security uninsured: vulnerable population Hispanics>African Americans>Asians> other whites // the poor // unemployed // employees in small business or par-time work Rising costs 13

14. Model of Health Care System and country in which the model exists Source of funding Main features Beveridge model Taxation (State Budget) Universal access to health care for all citizens based on residency Comprehensive coverage with basic health benefits Strong controls by Ministry of Health and finances facilities B ureaucracy, underfunding, rigidness Bismark model Compulsory health insurance, earmarked premiums paid by employers and employees Related to income Health care as guaranteed, insured good, Coverage of 60-80% with basic "basket" of health services Intermediate role of the state in regulating the system Client-friendly, professional autonomy, earmarked budgets High costs difficult to control Free-market private insurance model Private insurance and funding Medicare Medicaid Health care as a commodity Weak state control, in general Providers are private entrepreneurs Health care systems based on the sources of funding 14

15. Levels of organization of health care systems and health care delivery Four levels of healthcare and delivery systems are recognized from the the following factors; S ize of the population served Specificities of the disease conditions treated at a certain level Organizational characteristics 15

16. Primary care C are of the “first contact” of the individual with the health care service P rovided in ambulatory settings by qualified health professionals (general practitioner-GP, family doctor, or nurse) when a patient comes, usually for the first time, with certain symptoms or signs of disease The most common role of the physician is “gate keeper”, which means that the doctor is empowered to treat and cure broader scope of illnesses and conditions GP can also select and refer patients to higher levels of the health care system when necessary 16

17. Secondary care General specialist care, delivered by “general specialist doctor” for more complex conditions, which couldn’t be resolved at primary care level Usually patient is directed by the general practitioner from primary level to the secondary level as the first referral level of care Tertiary or central level of care S ub-specialist care including highly specific services, which might be delivered in specialized institutions or by highly specialized health The specialized institutions, which provide this type of care are, also, educational institutions for health manpower (university hospitals) 17

18. Typical functions of the overall health care system are: Health services - environmental, health promotion, prevention of diseases and injuries, primary care, specialist medicine, hospital services, services for specific groups, self-help Financing health care- mobilization of funds, allocation of finances Production of health resources construction and maintenance of health facilities, production and distribution of medicines, production, distribution and maintenance of instruments and equipment Education and training of health manpower- undergraduate training, postgraduate training Research and development - health research, technology development, assessment and transfer, quality control Management of a National Health System -health policy and strategy development and it's implementation by action plans, information, coordination with other sectors, regulation of activities and utilization of health manpower, physical resources and environmental health services 18

19. Challenges Facing The Healthcare System Change in new emerging and re-emerging diseases Changing disease profile New Technical and diagnostic advances, The issue of Longevity of life Rising cost of healthcare 19

20. HEALTH CARE SYSTEM IN ZAMBIA

21. The Zambian Healthcare system 1 st Zambian Health Care Policy created in 1992 Health Service Act 1995 Goal:- to provide equitable , cost-effective quality health services as close to the family as possible 21

22. The Zambian Healthcare system C onsisted of: MOH-responsible for policy, fi n a n cing and regulation CBOH-Service Implementation 2005-Health policy became outdated -1995 Health Service Act repealed 2006-CBOH dissolved and replaced with the current 4-tier structure Nationa l Health Strategic Plan(NHSP)- developed every 5 years 22

23. Introduction The focus is in the provision of continuum of care with particular emphasis on ; promotional , preventive , curative and rehabilitation health services The provision of continuum of care is challenged by the high burden of diseases It is characterised by high prevalence of communicable diseases and an emerging burden of Non Communicable Diseases (NCDs ) This has had a very significant impact on the morbidity and mortality levels across the country . 23

24. Introduction Healthcare mainly consist of; Public sector – Teaching, Central, General & District Hospitals, rural and urban health centers, and health posts Faith based institutions – supported by Churches Health Association of Zambia (CHAZ) Private sector:- private clinics, private surgeries or consulting rooms, private hospitals, private pharmacies, nursing homes and hospices Traditional medicine practice is popular especially in rural areas and may be referred to as complementary and alternative medicine practices 24

25. Public Sector Health Services Public sector vision is the defining aspect of the goals of the Health Care Team Government policy is a commitment to attain certain milestones in the provision of health care. A Nation of Healthy and Productive People The vision is to provide equity of access to cost effective quality health services, as close to the family as possible’. 25

26. GUIDING PRINCIPLES Equity of access : To ensure equitable access to healthcare for all the people of Zambia, regardless of their geographical location, gender, age, race, social , economic, cultural or political status Primary Health Care Approach : To consistently adhere to the PHC approach to organisation , management and control of the health service delivery systems Affordability : To ensure affordability of healthcare services to all, taking into account the socio-economic status of the people Cost-effectiveness : To ensure efficient and cost-effective delivery of healthcare services, always ensuring ‘ Value for Money ’ Leadership : To ensure appropriate, visionary, efficient and effective leadership in the management and control of the health sector at all levels Global Health : To ensure that Zambia participates actively in global health, both in terms of research and in adhering to jointly agreed principles for services delivery and health management 26

27. Public Health Sector Goals Achieve equity in health opportunities – access to treatment should be the same in the treatment of infection, malaria, tuberculosis, HIV/AIDS, reproductive health and family planning in rural and urban set-ups To increase life expectancy of Zambians – prevailing factors in society determine the life expectancy of a newly born baby. Elimination of early childhood diseases increases life expectancy and improving the living standards. To create an environment which supports health – for example promoting tobacco free societies by discouraging smoking in public places through organisations like pharmacists against tobacco based in Netherlands . 27

28. Public Health Sector Goals To encourage lifestyles which support health; Tobacco free , Alcohol free , safer sexual practices, f amily planning, d ietary habits Improve individual and family health through efficiently administered population based activities. To fight communicable diseases which include HIV/AIDS, tuberculosis, malaria, respiratory tract diseases and diarrhoeal diseases To fight non – communicable diseases which include diabetes, hypertension, asthma and pharmaco -genetic developments To improve the welfare of the mother and the child 28

29. Organisation Of The Public Health Sector MINISTRY OF HEALTH :- It is involved in the following; Policy formulation, analysis, advice, monitoring and evaluation. It is mandated to check the implementation of the policies Legislation – involved in the making of laws, making government policies legally binding through parliament. Resource mobilisation, that is, human resources, financial resources and infrastructure. Advocacy – to advocate for better health care services for each member of the community whether in rural or urban set-up Strategic planning To ascertain the plans how to achieve provision of maternity care, family planning and antiretroviral therapy Human resources to perform the duties enshrined in the policies formulated by the ministry in proportion to the financial resources available Overall supervision of all activities pertaining to the health care system 29

30. Provincial Health Office This Is Involved In Technical Support To Ministry Of Health And Looks Into The Performance Assessment Of The Health System This Office Has 6 Main Areas Of Activity: Technical Support Function Development Of Action Plans And Budget Advice On Implementation Of Action Plans Provide Counselling On Specific Identified Needs Training Financial Management HR Development Epidemic Preparedness 30

31. Provincial Health Office 2. Monitoring And Evaluation Action Plan Implementation, Quality Assurance, Financial Management And Systems Development And Management Of Districts Health management information system and health research Logistical Support Supply of equipment, drugs, vaccines, etc. supplied from national level Economy of scale functions e.g. maintenance of cold chain Communication – national policies – instructions for District Health offices Mediation The Provincial health office reports to the Ministry of Health 31

32. District Health Offices, Health Centers & Health Posts These are responsible for the actual health service delivery, which is, curative, preventive, promotive, and rehabilitative health delivery Their role includes: Primary management unit in the decentralised health system Administer the affairs of the district health services Responsible for planning for the district Responsible for ensuring that local priorities are recognised and addressed Responsible for coordinating with other sectors e.g. agriculture, local government, etc. Responsible for monitoring performance of Health Centers and level 1 hospitals against established standards Responsible for providing training to district staff 32

33. Structure Of The Public Health Sector Facilities In Zambia THIRD LEVEL REFERAL HOSPITAL TEACHING/CENTRAL HOSPITAL HEALTH POST HEALTH POST HEALTH POST HEALTH CENTER FIRST LEVEL REFERAL HOSPITAL DISTRICT HOSPITAL SECOND LEVEL REFERAL HOSPITAL GENERAL HOSPITAL 33

34. Health Post The first point of contact for provision of health services Catchment area for is away for health post Areas that are away from health center Cover 500 households Approximate population of 3500 people 5km radius The staffing comprises of : Community health workers (CHW) CHW may be trained for a specified or packed type of care and outreach activities (health promotion activities such as cleaning surroundings, promoting healthy lifestyles ) Community health workers initiate and supervise health activities in the communities and refer patients to the health centers 34

35. Health Centres C ategorised into urban health centers and rural health centers Urban Health Centres cater for a catchment population of 30 000 to 50 000 people A Rural Health Centre caters for catchment areas within a 29 Km radius or population of 10 000 people Currently these are level of first contact for the health care system B ed capacity of up to 30 beds with admission wards Staffing includes: pharmacy technologist, assistant dispensers, clinical officers, registered and/or enrolled nurses and environmental technologist Health centers operate 24 hours for ambulatory patients and refer patients to specialised health care system 35

36. First Referal Hospital- District Hospital P rovide inpatient and outpatient facilities and many basic specialist services are provided Hospital capacity Caters for a population of 80 000-200, 000 people B ed occupancy is between 100 to 200 bed S taffing is a minimum level of professional distinction Includes; medical doctors, dental surgeons, pharmacists, nurses, midwives, radiographers, laboratory technologist and physiotherapists 36

37. First Level Referal Hospital- District Hospital Scope of services provided include: outpatient and inpatient, general medicine, surgical, obstetrics and gynaecology, basic pharmacy, radiological services, emergency care, support functions and training function (for health centers ) Offer referral services to provincial and central for cases that cannot be handled at the district hospital There should be at least one Level-1 Hospital in every district. Level-1 hospitals will be supported with outreach and mobile health services from Level-2 Hospitals 37

38. Second Level Referral Hospital- General Hospital P rovides specialised health care services. Hospital capacity Caters for a population of 200,000 to 800,000 inhabitants. B ed occupancy ranges from 200 to 250 bed The staffing is a minimum level of professional distinction I nclude medical doctors, dental surgeons, pharmacists, pharmacy technologists, nutritionists, nurses, midwives, radiographers, laboratory technologist and physiotherapists 38

39. Second Level Referral Hospital- General Hospital Scope of services: Full stock of services are provided and include the following: outpatient and inpatient, general medicine, obstetrics and gynaecology, well defined pharmacy services, intensive care services, psychiatry, radiological services, emergency care, support functions and training function (for level one hospital, medical care students and health centres) Offers referral services to central and higher hospitals for cases that cannot be handled at the general hospital They act as referral centres for the first level Hospitals Level-2 Hospitals provide technical support and training and form the base for provincial mobile health services 39

40. Third Level Referral Hospital- Central Hospital Provide highly specialised health care with highly skilled health care team and provides teaching facilities Hospital Capacity Caters for a population of 800, 000 or more people H as a bed capacity between 300 and 800 beds 40

41. Third Level Referral Hospital- Central Hospital Scope of services provided include The specialised health care team provides a full range of services with sub- specialisations in internal medicines, general surgery, paediatrics, obstetrics and gynaecology, pharmaceutical services, medical laboratory, radiology, physiotherapy, emergency care, research and internal collaboration Training and support services are provided for second level hospital staff and training of technical staff The hospitals serve as referral centres for second level hospitals 41

42. National Referral Hospital- UTH The university teaching hospital is also categorised as a big central hospital but with more pronounced characteristics It is a national referral hospital to which all hospitals and health centers refer patients whom they cannot manage The specialised health care team provides a full range of services in internal medicines, general surgery, paediatrics, obstetrics and gynaecology, pharmaceutical services, medical laboratory, radiology, physiotherapy, emergency care, research and internal collaboration Training and support services are provided for second level hospital staff and training of technical staff 42

43. Challenges Facing Public Health In Zambia The following are some of the challenges facing the delivery of health care to the people of Zambia Man power Finances Political will Poor conditions of service Lack of infrastructure 43

44. Man Power The healthcare system lacks human resources and this impacts the delivery of services Health personnel continue to be trained in the few government colleges and the university at a huge cost to the government This problem is due to three factors: Medical staff leaving abroad mainly to the US and UK Medical staff leaving the Public Sector for the Private Sector in Zambia The impact of HIV/AIDS on health workers For example in 2003 from 42 graduates from the Medical School only 20 stayed in the public sector the rest went to the Private Sector or abroad Lack of funded positions and incentives adversely affect retention This is due to the financial resources and conditions of service not being very attractive compared to abroad and the private sector 44

45. Doctor: patient Nurse:patient Current status 1:12000 1:1500 WHO standard 1:5000 1:700 Comparison of Zambia to the WHO standard for the ratio of doctor, nurse to that of patient 45

46. Finances In Zambia, health services are largely financed from public tax, donor community grants and direct payments by households and are provided by the government, private not-for-profit and private for-profit providers A general lack of information exists with regards to cost-sharing schemes, fees needing to be paid and referral pathways While the basic health care package at first point of referral level has been identified and cost at $11.5 per capita, the health sector has made available only $10.5 per capita for the whole system 46

47. Finances The lack of adequate finances leads to shortage of drugs and inadequate and obsolete equipment in the health facilities in the country Despite the provision of free drugs and certain services these are non existent due to lack of finances. 47

48. Political Will Government has put in place certain policies in place to promote the local industry in the country However , it has been unable to promote the local health industry as lack of finances and complicated procedures to open such facilities has led to gaps in the provision of health care For example product licences are required for the importation of drugs into the country in a view of promoting manufacture of drugs in the country However , this has lead to shortages of drugs in the health facilities as product licences are costly 48

49. Poor Condition Of Services This has lead to the brain drain in the public health sector as better conditions such as personal vehicles, free accommodation and education allowances are provided in the private sector and other foreign countries However , this can be overcome by government improving the condition of services. 49

50. Lack of Adequate Infrastructure Poor infrastructure in the public health facilities is a hindrances in the attainment of goals of public health in the country For example in the rural areas grass thatched structures are used as health centres On the other hand pharmacies are allocated inadequate space to allow for full scale pharmacy activities such as extemporaneous preparations Lack of proper storage conditions for drugs as air conditioning is non-existent in many health facilities thereby compromising on the quality of drugs 50

51. Lack of Equipment Lack of pharmacy equipment in most public health institutions hinders the preparation of certain dosage forms that are not readily available for paediatric and geriatric patients Certain diagnostic equipment is not available leading to patient being flown abroad for specialist treatment yet health personnel in the country can do the same if equipment where available 51

52. Challenges Facing Public Health In Zambia The following are some of the challenges facing the delivery of health care to the people of Zambia Government has introduced health Insurance to cover those in the public sector and will gradually be introduced to the private sector The government vision to universal access to health is hope to be achieved through such interventions The Zambian public sector supply chain receives an annual investment of over USD $250 million worth of health commodities and related technical assistance meant to address key disease conditions 52

53. 53 Health Care Team

54. Objectives List members of a health care team Describe roles of a pharmacist which allow interaction with other members of a health care team Describe the scope of pharmacy and the functions of pharmacists List the extended roles of a pharmacist List the characteristics of a 10 star pharmacist 54

55. Introduction - Health Care Team It is a multidisciplinary group of people who share a common health goal and common objectives determined by community needs, to be achieved by each member of the team It is made up of health workers from different professional backgrounds whose main expertise is to improve the quality and length of life for patients and their families. Team members offer different services and programs based on their unique knowledge, skills and competences 55

56. 56 A medical doctor A medical licentiate A clinical officer An emergency care officer A dental surgeon A dental technologist A dental therapist An oral hygienist A pharmacist A pharmacy technologist A nurse A radiographer X-ray assistant A biomedical scientific officer A medical laboratory technologist A medical laboratory technician A physiotherapist An osteopath An orthopaedic technologist An occupational therapist A clinical psychologist A medical sociologist A medical social worker A nutritionist and dietician An audiometrist An optician and dispensing optician An environmental health officer An environmental health technologist Health Care Team

57. Core Traits of HCT 1.Sharing a common purpose 2.Having a clear understanding of one’s own role 3.Recognizing common interests 4.Understanding the roles and responsibilities of others 5.Pooling knowledge, skills and resources 6.Sharing a responsibility for outcomes 57

58. 58 Relationship between the pharmacist and other members of the HCT Physicians When patients need medical care, they first go to primary care doctors. Primary care doctors focus on preventive healthcare This includes regular check-ups, disease screening tests, immunizations and health counseling Primary care doctors may be family practitioners, internal medicine or Osteopathic Doctors

59. 59 Relationship between the pharmacist and other members of the HCT Physicians Interaction occurs during handling of prescription Consulting the prescriber Rational decision making Responsibility for all decisions made on pharmaceutical care

60. Dentists Patient handling is the same as with physicians Dentist pay attention to the dental needs of the patients Pharmacist should pay special attention to drugs used in dental procedures 60

61. Nurses Mid wives, registered nurses and enrolled nurses A pharmacists role allowing interaction with patients includes : Understanding laws on handling of medicines Management of Ward Pharmacy, ward stocks and emergency trays Conduct regular ward visits – performing pharmaceutical services storage, expiration, accountability and utilization Handling of in-patient charts 61

62. Law Enforcement Agencies Medicines are heavily regulated world wide Pharmacists work with: Zambia Medicines Regulatory Authority (ZAMRA) Health Professions Council of Zambia (HPCZ). Drug Enforcement Commission (DEC) Police officers from the Ministry of Home Affairs International drug regulatory authorities 62

63. Custom And Excise Deal with enforcement and control of medicines and allied substances which are brought into the country at all ports of entry Works hand in hand with Zambia Revenue Authority (ZRA) Some health products are exempted from paying certain taxes Require understanding the cold chain e.g. Insulin, vaccines and other biological products 63

64. The Role of the Pharmacist in the Health Care System At all levels of health care, the provision of care is multi-professional The health care team, which is inevitably concerned with the use of drugs, must therefore include a pharmacist This has been adequately demonstrated in the team approach to clinical care in hospitals and health center's 64

65. Uniqueness of Qualifications of a Pharmacist Pharmacist are uniquely qualified because; They understand the principles of quality control and assurance as they apply to medicines and medical supplies They understand the intricacies of the principles of distribution chain and the principles of efficient stock management They are familiar with the pricing structures that apply to medicinal products that obtain within the market in which they operate 65

66. SCOPE OF PHARMACY & FUNCTIONS OF PHARMACISTS Regulatory Control and Drug management Community Pharmacy Hospital Pharmacy Industrial Pharmacy (Pharmaceutical Manufacturing) Academics Pharmaceutical Marketing Extended roles 66

67. 67 Regulatory Control and Drug Management Health policy and medicine policy Management (drug selection, procurement, distribution and buying) and suppliers of medicines and the terms of payment and at affordable prices Administration to ensure that things pertaining to the day to day management of pharmaceutical aspects are in place Educational policy for provision of in-house training, refresher courses to keep pharmacy personnel up to date with professional and allied developments

68. 68 Regulatory Control and Drug Management Regulatory and enforcement agents to ensure control, safety and efficacy of medicines and infrastructure in which these activities are done are suitable Involved in professional registration authorities and involved in self regulation Involved in liaison with professional bodies and international organizations championing global health e.g., the World Health Organization, the International Narcotics Control Board, the United Nations Division of Narcotic Drugs, the United Nations Commission on Narcotic Drugs, the United Nations Fund for Drug Abuse Control, Interpol, national pharmacopoeial committees, and pharmaceutical societies

69. 69 Community Pharmacy This is the most accessible primary health care and roles of pharmacists include; A dvisers and regularly assist patients in the management of their medication. Maintenance of computerized patient medication records (PMRs) and by the increasing deregulation of drugs available for over the counter (OTC) sale, Management of patients/clients which enables them to advise and treat a wider range of minor symptoms and to refer patients to established healthcare facilities for further diagnosis of complicated cases Pharmacists were required to counsel patients personally and ensure that prescription details were understood

70. 70 Community Pharmacy Monitor the use of medicines both at individual and community level – knowledge of drugs that are highly abused in the community and advising the community on the importance of compliance Extemporaneous preparations and small scale compounding of medicines Providing complementary and alternative medicines Informing health care professional and the community on drug related services. Pharmacists provide expert information to health workers and the community drug information data bank. Provide public with health education and promotion by advising the community on maintaining a quality healthy lifestyle e.g. Pharmacist against tobacco, alcohol, marijuana and illicit drug abuse. Provide domiciliary services such as home based care for the elderly and homeless. Visit certain categories of house-bound patients to provide the counselling service that the patients would have received had they been able to visit the pharmacy. Provide agricultural and veterinary services as custodians of all medicines

71. 71 Hospital Pharmacy Hospitals and other institutions and facilities may be operated by the government or privately, such as ; Outpatient clinics Inpatient clinics Drug-dependency treatment facilities Poison control centers Drug information centers Long-term care facilities While many of the pharmacist’s activities in such facilities may be similar to those performed by community pharmacists, they differ in a number of ways

72. 72 Hospital Pharmacy Additionally, the hospital or institutional pharmacist: Interacts closely with the prescriber and, therefore, to promote the rational prescribing and use of drugs In larger hospital and institutional pharmacies, pharmacists has a greater opportunity to interact with others, specialize and gain greater expertise ; Having access to medical records, puts pharmacist in a position to influence the selection of drugs and dosage regimens, to monitor patient compliance and therapeutic response to drugs, and to recognize and report adverse drug reactions Can more easily than the community pharmacist assess and monitor patterns of drug usage and thus recommend changes where necessary;

73. Hospital Pharmacy Serves as a member of policy-making committees, including those concerned with formulation of Drug and Therapeutics Committees, and thereby influences the preparation and composition of an essential-drug list or formulary Is in a better position to educate other health professionals about the rational use of drugs More easily participates in studies to determine the beneficial or adverse effects of drugs, and is involved in the analysis of drugs in body fluids Can control hospital manufacture and procurement of drugs to ensure the supply of high-quality products Takes part in the planning and implementation of clinical trials 73

74. 74 Industrial Pharmacy (Pharmaceutical Manufacturing) Statutory provisions in some countries may require that certain positions be held by pharmacists The main activities of industrial pharmacists are described below Research and development - contribute to research, and their expertise in formulation development is of particular relevance to the biological availability of active ingredients Manufacture and quality assurance - broad knowledge of the pharmaceutical sciences ensures an integrated approach to quality assurance (including good manufacturing practice) through the validation of the various stages of production and the testing of products before release Drug information - has the knowledge and expertise to provide detailed information on medicines to members of the health professions and the public. Also, pharmacists provide an information service within the company

75. 75 Industrial Pharmacy (Pharmaceutical Manufacturing) Patent applications and drug registration - is ideally qualified to understand and collate the diverse information required for patent and authorization submissions Clinical trials and post-marketing surveillance - has the knowledge of drugs and health care provision required to facilitate collaboration between companies, health professionals and governments in relation to clinical trials and surveillance Sales and marketing - professional ethics demand a concern for the interest of patients, can make a contribution to proper marketing practices related to health care and to the provision of appropriate information to health professionals and the public Management - inclusion of pharmacists in all levels of management promotes an ethical approach within management policies .

76. 76 Academics Academic pharmacists engage in education, pharmaceutical practice, and research in schools of pharmacy These three aspects of academic activity are interrelated, and at the same time connected with manpower planning and management Undergraduate, postgraduate and continuing education require the educators to have expertise in the various pharmaceutical sciences Professional and vocational goals of pharmacy education and the necessary interaction of education and research with service, the academic staff must also include a substantial component of pharmacists with appropriate postgraduate education

77. 77 Pharmaceutical Marketing Pharmaceutical marketing and promotion provides value to physicians by providing regulated educational and scientific information about new medicines Marketing of new medicines by pharmaceutical companies is only one factor considered by health workers This marketing does not exist in a vacuum—health workers’ judgment and experience, many other sources of information, formularies and other utilization management techniques all play a large role in determining what, if any, medicine a patient receives

78. 78 Pharmaceutical Marketing Pharmaceutical marketing is far from the sole source of information for health workers It plays an important role in providing information about brand medicines and helps balance other factors that emphasize promoting older treatments and that reduce use of needed medicines

79. 79 Extended Roles Nuffield Report 1986 Highlighted pharmacist have a unique and important role to play in providing health care to the community, such as ; Advise patients on ailments Advise patients on sensible and effective ways of using medicines Provision of domiciliary services to house bound or isolated patients. Providing health education and promotion Participation in continuing education of community health practitioners Supervision of supply and safe custody of medicines in residential homes Maintain records of prescribing and purchase of medicines

80. 80 Extended Roles Nuffield Report 1986 Highlighted pharmacist have a unique and important role to play in providing health care to the community, such as ; Registration of elderly patients Advise prescribers on medicines Monitoring and reporting adverse effects and drug interactions Advising general practitioners on administration and handling of complex substances Provision of diagnostic testing such as, measurement of blood pressure, glucose, cholesterol, body weight, height and body mass index. Pregnancy, malaria, HIV and electrolytes testing