Emerging roles and competencies of district and sub-district pharmacists: a case study from Cape Town

District and sub-district pharmacist positions were created during health sector reform in South Africa. High prevalence of HIV/AIDS, tuberculosis and increasing chronic non-communicable diseases have drawn attention to their pivotal roles in improving accessibility and appropriate use of medicines at the primary level. This research describes new roles and related competencies of district and sub-district pharmacists in Cape Town. Between 2008 and 2011, the author (HB) conducted participatory action research in Cape Town Metro District, an urban district in the Western Cape Province of South Africa, partnering with pharmacists and managers of the two government primary health care (PHC) providers. The two providers function independently delivering complementary PHC services across the entire geographic area, with one provider employing district pharmacists and the other sub-district pharmacists. After an initiation phase, the research evolved into a series of iterative cycles of action and reflection, each providing increasing understanding of district and sub-district pharmacists’ roles and competencies. Data was generated through workshops, semi-structured interviews and focus groups with pharmacists and managers which were recorded and transcribed. Thematic analysis was carried out iteratively during the 4-year engagement and triangulated with document reviews and published literature. Five main roles for district and sub-district pharmacists were identified: district/sub-district management; planning, co-ordination and monitoring of pharmaceuticals; information and advice; quality assurance and clinical governance; and research (district pharmacists)/dispensing at clinics (sub-district pharmacists). Although the roles looked similar, there were important differences, reflecting the differing governance and leadership models and services of each provider. Five competency clusters were identified: professional pharmacy practice; health system and public health; management; leadership; and personal, interpersonal and cognitive competencies. Whilst professional pharmacy competencies were important, generic management and leadership competencies were considered critical for pharmacists working in these positions. Similar roles and competencies for district and sub-district pharmacists were identified in the two PHC providers in Cape Town, although contextual factors influenced precise specifications. These insights are important for pharmacists and managers from other districts and sub-districts in South Africa and inform health workforce planning and capacity development initiatives in countries with similar health systems.Web of Scienc

Giant colonic pseudo-diverticula importance of, and aids to radiological diagnosis: a case series

INTRODUCTION: This case series illustrates the clinical presentation and radiological findings of two patients in whom the diagnosis of a Giant Colonic Diverticulum (GCD) was histologically confirmed. We also discuss the pathogenesis and differential diagnosis. CASE PRESENTATION: In one case, the patient had no previous large bowel symptoms and intra operatively no other colonic diverticula were found. Both were treated with surgical resection. CONCLUSION: The preoperative diagnosis of GCD is made radiographically, and the importance of the early recognition of radiological findings, especially in asymptomatic disease, is emphasised

Regionalização dos serviços de saúde: desafios para o caso de Angola

Este artigo apresenta a situação da saúde de Angola no período 2000-2007, discute a regionalização do sistema de saúde como importante instrumento para a melhoria tanto do acesso aos serviços de saúde daquele país, quanto da utilização destes, e aponta condições e desafios para a sua implementação. O artigo se apóia numa revisão bibliográfica de: (a) autores brasileiros, considerando-se que, no Brasil, ainda decorre a reforma sanitária com vasta produção bibliográfica sobre a temática; (b) autores africanos, ou com estudos sobre a África, e internacionais, em vista da necessidade de se analisarem experiências regionais e mundiais relativas ao assunto e (c) estudos e recomendações da Organização Mundial da Saúde sobre a descentralização/regionalização em saúde. Ficou demonstrada a necessidade de reformas no sistema de saúde de Angola, o qual apresenta enormes deficiências de estruturação e funcionamento, o que leva à baixa resolubilidade dos seus serviços. A regionalização foi considerada como uma importante estratégia para reestruturação do sistema de saúde, ao lado de outras que não são foco principal deste estudo. A avaliação do seu impacto só poderá ser feita a longo prazo