NN46, September 2011
Towards a New Global World of Skills Development? TVET's turn to Make its Mark
Specialised Skill Development in Resource-Poor Settings: the Case of Pharmacy in Malawi
By Zoe Lim, School of Pharmacy/Education, University of Nottingham
Email: paxzl1@nottingham.ac.uk
Keywords: Profession, task shifting, pharmacy, needs-based
Summary: This paper aims to fill the literature gap, which is dominated by Anglo-American model of professionalism, about the process of professionalisation in a postcolonial, aid-dependent context; and to demonstrate how the perceived superiority attached to the professions has inhibited innovative manpower strategy, such as professional-technician task shifting.
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Introduction: a pharmacy PhD that investigates ‘skills’ versus ‘needs’
To rapidly scale up human resource for health in resource-poor countries with a critical shortage of health professionals, ‘cadre substitution’ or ‘task shifting’ has been proposed as a cost-effective solution (Dovlo, 2004). Clinical tasks that are conventionally performed by health professionals are re-delegated to technicians, a manpower strategy which was supported by evidence of equivalent competency showed by technicians (Chilopora et al., 2007). This prompts the question ‘why do we need professionals?’ If technicians can perform an equally good job, why should we train the professional cadre? This forms one of the research questions in a PhD project which explored issues surrounding capacity building strategies in pharmacy education in resource-poor settings. This PhD project was mandated by an international pharmacy education coalition called the ‘WHO-UNESCO-FIP Pharmacy Education Taskforce’ (see http://www.fip.org/pharmacy_education), which aimed to advance pharmacy education worldwide, particularly in sub-Saharan African countries. An ethnographic study was carried out in Malawi, an under-resourced country which has traditionally relied on the technician cadres in public healthcare service provision.
Findings: it was not just about ‘skills’
It was found that there was a discrepancy shown between old-time and present-time pharmacy technicians’ job performance, which was explained by perceptual barriers stimulated by the present-day socio-political culture in Malawi. Within a political culture that misleadingly interpreted ‘democracy’ as freedom from accountability, civil servants conveniently surrendered responsibility for their work to their superiors. Pharmacy technicians therefore refused to assume the managerial responsibility that was felt should be borne by pharmacists, who received a much higher salary and enjoyed higher status in the occupational hierarchy. This was exacerbated by a rigid salary structure in the public sector that imposed a substantial income differential in the otherwise artificial professional-technician divide. Meanwhile, pharmacists were thought to possess professional ‘power’ and ‘ethics’ that could not be claimed by the technician cadre. When Malawi started to produce medical doctors, the pharmacy sector had to follow suit in order to maintain the status equality between the professions. Professional power was perceived to be needed for negotiation for public resources, or simply for effective inter-professional communication. On the other hand, a weak regulatory structure and enforcement in the public sector failed to govern health workers’ behaviour in the face of rampant drug pilferage. It was therefore perceived that professional ethics was urgently needed to restore public accountability.
Professionalisation in a post-colonial, aid-dependent setting
In other words, professionals are needed in Malawi not for their specialised technical skills but the traits attributed to professions such as power and ethics. This contradicts sociological theories about professionalism that proposes such traits must be earned by the profession proving its worth to its service users (Freidson, 2001). In fact, the embedded ideas about professionals’ moral and intellectual superiority in Malawi could be traced back to its colonial legacies and influence exerted by the international community. By ‘borrowing’ the Anglo-American model of professionalism, ideas about professional traits are also copied. Such implanted ideas about ‘only the professionals can do it’ formed perceptual barriers that inhibited implementation of innovative manpower strategies such as task shifting. Agency-driven professionalisation, as proposed by the orthodox model, did not take place in Malawi because of the extremely small number of pharmacists in the country. Even with the establishment of the first pharmacy school in Malawi, continual outflow of graduates to the private sector (or out of the country altogether) was most likely to happen, thus preventing a build up of a critical mass of public service pharmacists. ‘Local needs-based’ pharmacy services, without home grown ideas, therefore remain a globalised popular idea that is practically unviable in the nearest foreseeable future.
References
Chilopora, G., Pereira, C., Kamwendo, F., Chimbiri, A., Malunga, E. & Bergström, S. 2007. Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi. Human Resources for Health, 5, 17.
Dovlo, D. 2004. Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A desk review. Human Resources for Health, 2, 7.
Freidson, E. 2001. Professionalism: the third logic, Chicago, The University of Chicago Press.
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Cite article as: Lim, Z., (2011) ‘Specialised Skill Development in Resource-Poor Settings: the Case of Pharmacy in Malawi’, in NORRAG NEWS, Towards a New Global World of Skills Development? TVET's turn to Make its Mark, No.46, September 2011, pp. 64-66, available: http://www.norrag.org
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