[Pharmaceutical regulations in Chad: assessment of drug dispensing practices in private pharmacies in N'Djamena]. / Règlementation pharmaceutique au Tchad: état de lieux des pratiques de délivrance des médicaments dans les officines privées de N'Djaména.

Introduction: the purpose of this study was to evaluate drug dispensing practices in private pharmacies in the city of N'Djamena and, specifically, (I) to describe the characteristics of dispensaries, (ii) describe dispensing practices and (iii) assess regulatory compliance when dispensing on the basis of a prescription and an advice. Methods: we conducted a cross-sectional survey from June to December 2020. Data were collected in two stages, through interviews with pharmacists and participant observation in drug delivery practices in pharmacies. Results: in total, 26 pharmacies, or 50% of pharmacies in N'Djamena, were surveyed. The main survey findings were: private pharmacies in the city of N'Djamena employed two categories of staff, namely pharmacists and auxiliary staff (pharmacy technicians, nurses and salespeople or staff with "no health qualifications". These had not been trained in a health school recognised by the Ministry of Health) to dispense medicines. Very few pharmacies (8%) had a customer confidentiality area and a order book. The three modes of delivery were observed in more or less equal proportions (30 to 40% of dispensations). Dispensing at the patient's request was slightly predominant (40%) and the majority of medicines dispensed at the patient's request and based on dispenser's advice belonged to the different tables of toxic substances (over 70%). The noted absence of the pharmacist from the pharmacy justified why 84% of patients' requests were addressed to the pharmacy assistants. Conclusion: this study shows low compliance of pharmacies with pharmaceutical regulations for proper dispensing of medicines in the city of N'Djamena. Factors related to pharmaceutical sector governance and human resources management as well as therapeutic patient education could explain this gap.

A public health e-learning master's programme with a focus on health workforce development targeting francophone Africa: the University of Geneva experience.

BACKGROUND: Shortage of a competent public health workforce is as a worldwide problem. The situation is especially bad in sub-Saharan Africa. In 2008, the World Health Organization and the Global Health Workforce Alliance launched a call for proposals for a public health training programme with an emphasis on health workforce development specifically targeting Africa. Our article presents the development, implementation and evaluation of an e-learning Master of Advanced Studies in Public Health on Workforce Development. The project was developed in collaboration with academic partner institutions of 10 French-speaking African countries and local/regional/HQ WHO offices. METHODS: A five-step approach was adopted. First, a needs assessment study was done in the target countries, with identification of priority health issues. Second, student and tutor selection was done in collaboration with local WHO offices, health authorities and partner universities. Third, the e-platform was developed and a training workshop for tutors was organized. Fourth, the learning objectives were derived from the needs assessment study and an interactive educational approach was adopted. Fifth, the participation of students, their perception of the programme, their performance on assignments and community outcomes were monitored. RESULTS: The needs assessment allowed the identification of 12 priority health issues (trauma related to road accidents, maternal and child health, HIV/AIDS, mental heath, food and malnutrition, health resource management, infectious diseases, access to essential drugs, chronic diseases, health promotion, ageing and violence/conflicts) of which 10 were studied through the lens of the key public health disciplines (epidemiology, human resources, health project/service planning, health policy, communication, health economics/management, informatics and ethics/human rights), each validated through a certifying examination. Student participation, measured through connection hits (total: 58 256; mean: 168/student/module) and posted messages (total: 5994; mean: 18/student/module), was good, and global satisfaction was high (7.7/10). Twenty-nine students out of 37 obtained their master's degree from the University of Geneva. Outcomes reported include career development, strengthening of inter-country networks and common projects. CONCLUSIONS: Keys to the success of the programme were the enthusiasm and commitment of students, the availability of the coordination team, the simplicity of the electronic platform and the support of local/regional/WHO offices. Yet, the sustainability of the programme is not assured.

Road Map for Scaling up for Human Health for Improved Health Service Delivery in the African Region 2012-2025

Ensuring the availability of sufficient numbers of qualified health workers in the right place is essential for delivering quality health services to the population. Existing weaknesses in health systems including shortage of skilled human resources for health (HRH) 1 in most African countries is recognized as a major impediment to delivery of essential interventions and progress towards achieving health objectives. Of the 46 countries in the Region; 36 have critical shortage of HRH with only about 0.8 physicians; nurses and midwives per 1000 of the population while the minimum acceptable density threshold is 2.3 per 1 000 population. The estimated shortage of doctors; nurses and midwives in the Region was 820 000 in 2006. When all categories of health workers are included; the shortfall is estimated at 1.4 million. Migration of qualified health workers; inadequate remuneration and incentives; poor distribution of the available health workers; under investment in the production of sufficient health workers; inadequate capacity of HRH departments to carry out the main HRH functions and; low implementation of most of the existing plans are identified as the main causes of the present situation that constitutes a key impediment to meeting the needs for health care delivery for all. There are significant disparities between rural areas and urban areas; with shortages in the rural areas. Over 90 of pharmacists and dentists practise in urban areas. The situation is the same for other cadres; as medical specialists (86 ); general physicians (63 ) and nurses and midwives (51) serve mainly urban areas. The challenges facing the countries are uneven and pose a strategic threat to national and regional health systems development and the overall well- being of populations in the Region. A number of major and pressing HRH challenges are identified The road map recognizes that sustained political; institutional and financial commitment with the involvement of different critical stakeholders and partners that influence HRH production; availability and performance is critical to improving HRH development at country level. The road map builds on a number of national; subregional; regional and global efforts and has six strategic areas for achieving the objectives: strengthening health workforce leadership and governance capacity; strengthening HRH regulatory capacity; scaling up education and training of health workers; optimizing the utilization; retention and performance of the active health workforce; improving health workforce information and generation of evidence for decision-making; and strengthening health workforce dialogue and partnership. Each of these strategic areas has a set of identified priority interventions for achieving the objectives. It is recognized that implementation of the road map will require the commitment and collaboration of all stakeholders and partners under the leadership of national governments