As part of the debate on health systems in West Africa, WATHI met with Dr. Falla Mané, President of the Union of Young Pharmacists of Senegal, to discuss the training and employment of young pharmacists as well as other challenges facing the pharmaceutical sector. He answers our questions in this second part of the interview:
- Should pharmacists’ training not be expanded to new skills to strengthen their role in the specific context of African health systems?
Well, this is all possible because it’s being done elsewhere. For example, in the United States today, pharmacists-technicians operate in health structures, providing specialized care to patients. They calculate the dietary ratio a patient needs and accompany them in their management. In Canada, many people no longer use the so-called magisterial prescriptions, but rather calculate to the nearest milligram the dosage that a patient needs to control their disease. There, pharmacies are equipped enough to make medicines for their patients. In some countries, the tasks of vaccination and prevention against certain diseases such as influenza can be delegated to the dispensing pharmacist.
- So, what prevents these experiences from being replicated in Senegal in particular, and in other African countries?
In Senegal, it is a question of regulation. The duties of physicians, pharmacists and each health facility are laid down by regulations. No exceptions are permitted. Pharmacists have an advisory mission. When someone comes to the drugstore with a particular condition, the pharmacist has the duty to accompany them with some drugs to relieve them and then refer them to a doctor. If you come to a drugstore for a cold, the flu, fever or pain, you can be relieved but only up to a certain level. However, there are many things pharmacists can do that we don’t do here.
Indeed, training as a whole can be blamed as nothing has changed in our courses since independence. Some improvements were noticed with the Bachelor’s Master’s Doctorate system (in French Système LMD) on the form, but little has changed on the substance. Should there have been real changes in substance, new skills would have been acquired, but this is not the case. Some even blame us for complaining about our insertion whereas we have basic training and should be doing additional training. The problem is that this means that our six-year-higher education diploma is no longer enough, something that is not normal.
At least 90% of the drugs we take are not made in the country
Further training opportunities are available in the fields of quality or logistics, which you must acquire after graduating from medical school if you want to work in certain sectors. Sometimes you even must go abroad to find those training. This is why UJPS is working on a project to list all the positions that may be held by pharmacists in the various sectors of the profession in order to identify the skills required for these positions.
Subsequently, we will be looking for partners to see which diplomas will equip pharmacists with the specific skills required. The results will be made available to our colleagues for their guidance. We will look for sponsors to support pharmacists in their training. This approach could bring a degree of diversity to the pharmaceutical sector in Senegal.
- Are you talking about creating pharmaceutical industries and developing the pharmaceutical sub-sectors as a solution to the unemployment of young pharmacists? What measures should be taken to encourage reform?
In terms of industry, I think it’s a matter of regulation, as this is a very capital-intensive industry and we do not have that much capacity in the country. To date, regulations stipulate that 51% of the capital must be held by pharmacists, preventing funders from integrating this sector. In fact, very few pharmacists actually have the potential to have a minimum of 51% ownership of a pharmaceutical industry, and this has been a significant barrier so far.
However, there is the recently created project “Parenterus,” which is a pharmaceutical industry based in Bayakh. Apart from the “Parenterus” project, two other projects have been initiated by pharmacists and should start very soon. This is the beginning of something new because so far, the manufacturing units in Senegal have never been owned by Senegalese except for Valdafrique.
With a firm political will, we can have industrial units of our own
Local entrepreneurs must be supported by the State through more favorable regulations, but also through provision of resources. That is what happened in Morocco. Moreover, a lot of Moroccan laboratories are setting up in Senegal, while many Moroccans were trained here. The King apparently opened Casablanca as a place for the development of pharmaceutical industries by facilitating the settlement of donors.
Here, at least 90% of the drugs we take are not manufactured in the country, whereas Morocco produces at least 70% of the drugs consumed locally. In this country, a political will has facilitated the regulation of this sector and the settlement of donors and investors.
- Does the State have enough power to initiate reforms in the face of lobbying by the international pharmaceutical industry?
Well, I think the State is strong enough. You know why? Because I work for a foreign laboratory with a large international scope but, paradoxically, Africa is not such an important market for them. The African market is not yet in their mind precisely because we do not have the means yet. Our insurance systems do not provide good coverage, not everyone gets treatment on time, not everyone can afford treatment. Despite all those drugs circulating in pharmacies, in comparison to what happens elsewhere in the world, this is very minimal. It is our responsibility to develop our market.
- Does this mean that the current context is rather favorable to the development of the local pharmaceutical industry?
Exactly. If there is a firm political will, we can have our own industrial units. Pharmaceutical companies are so powerful that some of them have budgets exceeding those of our countries. Now, because they are looking the other way, they are not going to put a lot of money into our countries. One example is the laboratory where I work, which I know very well. There are two countries, Turkey and Saudi Arabia, where the sales figures made by laboratories are forty times higher than those generated in the whole of Africa.
The African market is not so important for these companies, hence the fact that there are sometimes stock-outs. This is the case for example of “Celestène”. What happens with the laboratory that produces this drug is that they have reached their maximum level of production of the active ingredient and therefore cannot exceed their current level of production. Yet the demand is greater than the level of production. Consequently, they decide to supply specific countries to the detriment of others, i.e. the low-income countries. This is why this drug is often out of stock in Senegalese pharmacies.
- How do you see pharmacists’ place in the health system?
Pharmacists are poorly valued and not considered in the Senegalese health system. Two years ago, we went to see the Human Resources Director of the Ministry of Health to share our concerns with him about the fact that most of the country’s health districts were lacking a pharmacist. What he told us was that until recently, pharmacists were not interested in the public service at all, preferring the private sector.
That is why, at a certain point, in their recruitment policy, pharmacists were not given much consideration anymore. But the problem is that for any skilled professional, be they doctors, pharmacists, nurses or midwives, if they are not given the optimal conditions to make a career in their field, they will not stay. Therefore, if the State wants pharmacists to join the Senegalese health system, they must be taken into account and supported in an efficient manner.
- You just said you made proposals to improve the situation. What are they?
We made fifty recommendations in a memorandum on the pharmaceutical profession. Regarding training and skills, we pointed out that the lack of practical skills of young pharmacists is blamed by many employers. But we believe that a pharmacist with a degree has been positively sanctioned by his masters with a PhD and therefore cannot be held responsible for a lack of skills. If there is a perceived lack of skills, then the training received by the graduate must be reinforced.
We must require greater rigor in the supervision of student trainees, institutionalize thesis supervision beyond the specific objective of research and broaden the internship to other fields than biology
On this basis, we recommended that the training offer should be matched to the requirements of the labor market for the classical pharmaceutical sectors. This suggests that a skill inventory should be established for each sector and that the practical training in other sectors, such as wholesale distribution, should be expanded. We must require greater rigor in the supervision of student trainees, institutionalize thesis supervision beyond the specific objective of research and broaden the internship to other fields than biology, since internal pharmacists are the ones who will be most likely to choose the biology sector. A fund should also be created to support training for pharmacists, enabling young graduates to acquire other specific skills after their PhD so that they can be efficient in a given sector.
Another problem is the fact that young graduates may sometimes be refused registration with the Pharmacists’ Association, which is not the case in any other profession. We suggest two major principles to be implemented: recognition of the title of any pharmacist holding a degree and registration with the Association of Pharmacists of any pharmacist exercising solely by virtue of obtaining a degree. However, the members of the Association stipulate that they only consider a pharmacist when they practice in a purely pharmaceutical sector. But when a graduate pharmacist exercises in other sectors, they say that this is not a pharmaceutical act and will not accept the registration unless the pharmacist is the head pharmacist of their company. This is very problematic!
We also made recommendations regarding the low job offer, challenges in opening a drugstore, and the viability of drugstores, with an outlook at the end of the document. We have been working on this document for almost a month and a half despite our limited resources. Unfortunately, in our countries, people think and make proposals, but it is hard to get them implemented.
- Apart from the problems facing pharmacists, what do you think about the weaknesses of the Senegalese health system?
Health care accessibility is the first issue everyone has to work on. And when a Senegalese is sick, they must be able to receive treatment where they live. I am talking first and foremost about geographical accessibility, it is important. After that, comes financial accessibility. Senegalese people do not have a culture of insurance; not everyone is considered to be covered. The State should create an environment in which every sick Senegalese can receive care. This includes making drugs financially accessible, as well as health facilities that offer quality care and specialized care. This is something missing in Senegal because there are not enough specialists in the country due to a lack of training.
More recently, efforts are being made by the Ministry of Health to grant more scholarships to physicians who want to receive specialized training. But these training courses must be open and accessible to young Senegalese.
When a Senegalese is sick, they must be able to receive treatment where they live
As a former president of the students at the Faculty of Medicine of Dakar, the observation we made was that some specialization courses are attended by more foreigners than Senegalese. This situation is a real problem. That is because Senegalese students do not pay as much for enrollment as foreigners, and therefore bringing in foreigners actually helps the institution to fill up its coffers. Nevertheless, from a public health point of view, our population still has real needs, in terms of nephrologists, cardiologists, orthopedic specialists, surgeons and diabetologists. State investment is needed in these specializations so that young graduates can be oriented in these sectors.
Our health system is sick. The biggest work in hospital today is being done by those in training, such as seventh-grade students. The average Senegalese visiting the hospital has no idea that those consulting them are young trainees. Their skills cannot be doubted simply because they have a high level of education or perhaps they are even attending a specialization course, since they are already doctors. However, the fact is that they are not properly supported.
During my time at the Faculty and when I was involved in the decision-making process, I advocated that students be reimbursed for their internship costs. I am telling you that some students who attend to patients in hospitals do not even have the money to go home! In their training, they are obliged to work hard, and patients are entrusted to them. They are not well-supported, and no one knows if they eat properly.
The problem is that when you’re not well supported, you do not do the job as you should. Perhaps this is one of the reasons why there are certain abuses in our health structures. The State should pay a little more attention to these problems and make sure that every medical student, from the seventh year onwards, can benefit from a support grant in addition to the university grant.
Crédit photo : sudonline.sn