Pharmaceutical Subsector Labour Market Demands in the Pharmaceutical Subsector June, 2016 Research, Planning and Development Department
ACKNOWLEDGEMENT The Research, Planning and Development Department of the National Training Agency (NTA) would like to express sincere gratitude to all participating organizations for their contribution to this qualitative research. Through their cooperation and candor, a greater understanding of job vacancies, new and emerging skills/competencies and training needs within the Pharmaceutical subsector was established. 2
Table Of Contents 1 EXECUTIVE SUMMARY... 4 2 INTRODUCTION... 5 2.1 The Pharmaceuticals Industry... 5 2.2 Pharmaceutical Policies... 6 3 METHODOLOGY... 7 4 RESULTS... 8 4.1 Labour Market... 8 4.2 Vacancies... 9 4.3 New and Emerging Skill Sets/ Competencies... 9 4.4 Training... 10 4.5 Opportunities for Growth... 10 4.6 General Information... 10 5 ANALYSIS... 12 6 CONCLUSION... 14 7 REFERENCE LIST... 15 List Of Tables Table 1 - Public And Private Pharmaceutical Job Titles... 8 3
1 EXECUTIVE SUMMARY The National Training Agency (NTA), in keeping with its mandate to co-ordinate Technical, Vocational Education and Training in Trinidad and Tobago, has conducted several surveys on the labour market using a sectoral approach. Guided by the Government s emphasis on establishing national priorities for health, the Agency embarked on a qualitative study of the pharmaceutical subsector during the period December to February 2016. The main focus of this study was to ascertain the nature and scope of the demand side factors affecting the labour market of the Pharmaceutical subsector in Trinidad. The study sought to collect data on job vacancies, new and emerging skills/competencies and training needs within the subsector. In an effort to achieve this research, the limited literature in the field of pharmaceutical was reviewed and interviews were conducted to capture information from key industry captains. The respondents were very responsive and provided in-depth answers to the topics discussed. The interviewed industry captains provided similar information. The study revealed that the labour market was becoming, if not currently, saturated. This was as a result of the increasing number of persons graduating from pharmaceutical institutions. At present, there is little to no vacancies for pharmaceutical persons. In addition, an increase in the demand for jobs within the subsector is not anticipated but it was resoundingly iterated that there will always be a need for pharmacists. At present, the respondents do not foresee any new and emerging skills sets/ competencies within the next 12 months. The participants believe that there is a need for new specialty areas in pharmacology such as Intensive Care Unit Medicine, Diabetes Pharmaceutical Care, Cancer Chemotherapy Pharmaceutical Care, Mixing of Drugs, Pharmaeconomics, Pharmacy Administration, Pharmaceutical Care Planning and Clinical Pharmaceutical Care. Respondents indicated that their needs were being met by training providers/ institutions, however there is room for improvement. Respondents expressed a need for an expansion of the pharmaceutical curriculum to include in-depth training in Clinical Pharmaceutical Care, Oncology, Diabetes and Pharmaceutical Care Services which includes medication counselling, drug information services and therapeutic care. Respondents believe that as the subsector develops, there is a greater need for Government intervention. This is evidenced by the issues of drug shortage, unauthorized drug sellers, high-priced and low quality drugs. Moreso, pharmaceutical suppliers and doctors continue to overstep their boundaries in terms of the sale and dispensing of drugs. The stakeholders all recommended the setting of new policies and reviewing of existing laws, policies and regulations. Interviewees suggested a need for some level of policing in the industry and the implementation of penalties for persons breaking the law. As this critical subsector continues to strive, it is important that Government ensures that pharmaceutical institutions conform to the standards of safety and laws, thereby protecting the populations health. 4
2 INTRODUCTION The Government of Trinidad and Tobago has stated its full commitment to provide effective leadership for the health sector by focusing on evidence-based policy making; planning; monitoring; evaluation; collaboration and regulation (see www.health.gov.tt). According to the Budget Statement (2015), the Health Ministry was allocated $5.545 billion. The Ministry of Health, provides the financing for the procurement of medicine for the population. In Trinidad and Tobago, patients who access the public health sector are treated free of charge for all disease states. There are provisions for some patient groups (e.g. pregnant women, children under 5) to receive medicines free of charge. Patients attending private services are entitled to receive medicines for certain conditions, such as Chronic and Non- Communicable Disease at private pharmacies. Private health insurance schemes provide coverage for medicines (depending the plan subscribed to.) According to the Social Sector Investment Programme (2016), Trinidad and Tobago has one of the highest prevalence, morbidity and mortality rates for chronic non-communicable diseases (heart disease, stroke, diabetes, cancer) in the Caribbean, and these rates have been steadily increasing over time. With this in view, the Ministry of Health (MOH) is addressing the crucial health issue through the promotion and implementation of the Chronic Disease Assistance Programme (CDAP) which provides citizens with free prescription drugs and other pharmaceutical items to treat with health conditions as a consequence of Chronic Non-Communicable Diseases (SSIP, 2016). CDAP offers patients afflicted with a chronic disease, convenient, faster and improved access to medication. Furthermore, it reduces the burden on public dispensaries and patient waiting time by providing additional private dispensing facilities across the country. There are over 250 pharmacies throughout the country that provide medication through CDAP. For ease of access to these drugs, the Ministry of Health introduced the National Health Card. The card seeks to allow all citizens or legal residents to access State provided healthcare and prescription medication at a free or reduced cost. 2.1 The Pharmaceuticals Industry Pharmacy is about safe and effective use of pharmaceuticals, it provides a link between the health services and the chemical service and is the quality control between the patient and the physician (see www.health.gov.tt). Pharmacist s qualifications include a Bachelor degree in pharmacy and one must be registered with the Pharmacy Board of Trinidad and Tobago. Since its inception in 1999, to date, the School of Pharmacy at the University of the West Indies (UWI) graduated (first degree) approximately 614 pharmacists. The number of students per cohort has consistently increased over the years. In addition, the College Of Sciences, Technology and Applied Art of Trinidad and Tobago graduates a significant number of persons with Pharmacy Assistant certificates. 5
Branches of pharmacy consists of clinical pharmacy, pediatric, geriatric, wholesale, hospital, community, forensic, oncology, pharmaceutical manufacturing, law, academia, distribution pharmacy, national security pharmacy and retail. In 2012, four (4) licensed pharmaceutical manufacturers were recorded in Trinidad and Tobago and there were no multinational pharmaceutical companies manufacturing medicines locally in Trinidad and Tobago (T&T Pharmaceutical Profile, 2012). Presently, there are approximately 1150 registered pharmacists in Trinidad and Tobago and roughly 350 pharmacies that exists. The majority of pharmaceutical personnel work within the public health care system. The average salary of a pharmaceutical professional is $15,000 per month. According to the Ministry of Health, the health sector has been experiencing shortages and challenges with the supply medical and allied professionals. Therefore, the Ministry has adopted a comprehensive and strategic approach towards the development of human resources for the health sector, which involves attracting foreign based nationals who may be considering returning home. With respect to pharmaceutical human resource development, there is currently no strategic plan (T&T Pharmaceutical Profile, 2012). 2.2 Pharmaceutical Policies In Trinidad and Tobago a Strategic Plan involving the National Health Policy has been developed and is currently under internal review. According to the Trinidad and Tobago Pharmaceutical Profile (2012, p. 10), an official National Medicines Policy (NMP) document exists in the country but an implementation plan for the NMP is nonexistent. More so, policies on pharmaceuticals exist at present, and include the NMP and the Chronic Disease Assistance Program. However, the pharmaceutical policy implementation is not regularly monitored or assessed. In addition, there is a National Good Governance policy in Trinidad and Tobago. This Good Governance policy is multisectoral and is only for the public sector. It was developed in November 2010 and the Pharmacy/Drug Inspectorate is responsible for implementing this policy in the pharmaceutical subsector. Unfortunately, a policy is not in place to manage and sanction conflict of interest issues in pharmaceutical affairs. There is, however, a formal code of conduct for public officials. In addition, a whistle-blowing mechanism that allows individuals to raise concerns about wrongdoing occurring in the pharmaceutical subsector of Trinidad and Tobago is nonexistent. 6
3 METHODOLOGY This research exercise gathered information on the pharmaceutical subsector in order to provide information on the industry needs. The qualitative study captured information on job vacancies, new and emerging skills sets/ competencies and training needs within the subsector. The interviews were voluntary and anonymous. Interviews were used because the interviewer is able to gather complex, in-depth data that is not as easily obtained through questionnaires. The study succeeded in gathering data from key industry captains within the pharmaceutical subsector in Trinidad only. Each captain was contacted by telephone and a brief overview of the study was explained. All participants willingly accepted to be part of the study. Interview dates and times were set up and the interview was conducted on the days agreed upon. A discussion guide was utilized to gain a subject's unique perspective or experience as it related to the particular issue. The questions were open-ended and the discussion was conversational in nature. The guide mainly focused on four (4) areas: the labour market (in terms of job vacancies), new and emerging skill sets/ competencies, training needs and recommendations for the pharmaceutical subsector. It must be mentioned that time was a limitation during the study. Given the current affairs of the health sector, industry captains were very preoccupied with pharmaceutical business; thus making it difficult to set definite interview dates and times. Additionally, there is a clear lack of published studies of the pharmaceutical industry and almost no primary documents are freely accessible to give background information on the subsector. 7
4 RESULTS Interviewees presented their perspectives and experiences relating to the pharmaceutical subsector. Overall the participants shared similar views on the subsector. Presented below are the perspectives and views of the participants as it relates to the key questions posed. 4.1 Labour Market Respondents indicated that there will always be a need for pharmacists within the pharmaceutical subsector but they all believe that the subsector is becoming saturated with pharmacists. The labour market is reaching a point of saturation. The labour market is currently saturated. The industry is a bit saturated with infrastructure but there will always be a need for pharmacists. There is a consistent increase in enrollment and exponential growth from the School of Pharmacy. Respondents also divulged that the local pharmacists were coupled with the foreign pharmacists making the subsector even more saturated. The foreigners mainly filled pharmacist and academia positions (lecturers). Foreigners hailed from the Philippines, Cuba, India and the Caribbean region. The respondents stated key job titles that exists in the pharmaceutical subsector (both private and public). These are listed in the table below. TABLE 1 - PUBLIC AND PRIVATE PHARMACEUTICAL JOB TITLES Job Titles Within The Pharmaceutical Subsector Chief Pharmacist, Pharmacy Director Pharmacists (Pharmacist I, Pharmacist II, Senior Pharmacist, Clinical Pharmacist) Relief Pharmacist Pharmacy Technicians Pharmacy Assistants Inventory Clerk Customer Service Cashier Store Manager 8
It should be noted that the law only permits persons to be registered as Pharmacy Assistants even though some businesses refer to their assistant positions as Pharmacy Technicians. 4.2 Vacancies Participants indicated little to no vacancies within the pharmaceutical subsector. The existing positions within the subsector (public and private) are currently filled and should positions become vacant, the positions are easily filled. Pharmacies may say that pharmacists are scare because they don t want to pay the required salaries. In the private pharmacies, pharmacists shop around looking for better. It s a challenge to find employment. There are no vacancies and positions available are all filled. Pharmaceutical graduates who find difficulty in sourcing jobs, resort to sourcing jobs in manufacturing and distribution, hospital management, academia (as lecturers), the medical representative field, consultancy and some even chose to further their studies abroad (master s degree) or specializing in a new area. Many in the subsector had also opted to move from the public health system to private practices because of the less stress and financial reasons. Many even migrated to countries where it is much more feasible. Private practice makes the money. 4.3 New and Emerging Skill Sets/ Competencies Interviewees were asked if they thought there would be any new or emerging skill sets/ competencies in the subsector within the next twelve (12) months. All respondents gave a unanimous no. However, stakeholders hoped for the introduction of new job titles/ positions such as a Corporate Pharmacist, Pharmacist III and Clinical Pharmacist in the public health care system. They believe that these new positions will ultimately create a more efficient pharmaceutical subsector. Respondents indicated a need for specialized pharmacology which would require new skill sets in the future. These specialized areas included: ICU Medicine Pharma-economics Diabetes Pharmaceutical Care Clinical Pharmaceutical Care Cancer Chemotherapy Pharmaceutical Care Oncology Pharmaceutical Care Mixing of Drugs Therapeutic Care 9
4.4 Training Industry captains were very satisfied with the pharmaceutical training institutions. They stated that their needs were being met, however there is room for improvement. It was reported that pharmacists training was not entirely being utilized, more specifically, the clinical skill. Respondents identified areas where additional training could be expanded. There was also a need for additional services to be provided by pharmaceutical professionals. The majority of practical training is gained on the job (during internship) and the public health system plays a vital role in providing this on-thejob training. It is sometimes difficult for pharmacology students to find practical training (on the job training) in the industry. After their six (6) month pre-registration stint, the hospitals didn t usually keep students on full time because the hospital had its own staff. Train pharmacists to offer patient oriented services such as medication counselling, pharmaceutical care planning, drug information services and pharmacy administration. Trinidad and Tobago training is sufficient for what is expected but where the profession is going globally, it is not enough. The training is sufficient, there is room for improvement in specialty areas. 4.5 Opportunities for Growth Participants expressed that there were opportunities for growth within the subsector through new and innovative practices and services. Respondents stated that an introduction of more patient care practices will create employment and improve the quality of health care service. They expressed that there was a need for a reassessment of patient care services and the implementation of new ones based on the needs of the population and clientele. Participants conveyed that there will be a need for new structures (physical) to compliment these new services such as pharmaceutical care services and clinical pharmaceutical services. 4.6 General Information Respondents were asked what more could be done to develop the subsector. The interviewees responses were very similar. All the respondents stated an immediate need for legislation to regulate and monitor the pharmaceutical industry. This they felt will allow for greater compliance of the industry s safety laws and standards. Support the profession. Monitoring of pharmacist especially in the private sector. Government needs to stop the leakage of doctors dispensing drugs. 10
Stop the wholesalers and over the counter shops from selling more than they should. Need for policing and regularizing of the supply of drugs. Regular assessment for training programme every 4 years. Need for policy and legislation to change the registration of pharmacies to allow more opportunities e.g. distribution. Review the issues of drug shortages Proper procurement practices of pharmaceuticals Improvement in the role of the Chemistry Food and Drugs Department especially in areas of inspection and drug testing. 11
5 ANALYSIS The pharmaceutical subsector is a vibrant and somewhat stable one. As a subset of the health sector, the pharmaceutical subsector continues to strive despite its many challenges. From the non-communicable diseases to the current zika virus, the pharmaceutical subsector plays a vital role in providing the essential medicines to treat these illnesses. Despite its success, the research has indicated a dire need for the existing pharmaceutical policies and laws to be reviewed. The subsector is functioning and satisfying the needs of the population but there are aspects of the subsector that needs to be regularized and improved. The study supports the little literature that exists. Even though policies on pharmaceuticals exist at present; pharmaceutical policy implementation is not regularly monitored and assessed. As a result, doctors are overstepping their boundaries (in terms of the amount of drugs being dispensed), over-the-counter (OTC) shops are selling unauthorized drugs and suitcase traders continue to prosper. Besides these shortcomings, the pharmaceutical subsector continues to operate efficiently. The pharmaceutical subsector employs over 1000 persons (private and public), with the bulk of these persons employed within the public health system. Based on the findings, the number of persons working in the private pharmacies can vary according to size of the establishments. However, private pharmacies were generally found to have a small workforce. This was as a result of persons performing more than one function. For instance, a pharmacy assistant can also perform the tasks of a cashier. Currently, little to no vacancies exist within the subsector. However, if vacancies did exist, there is no difficulty in sourcing qualified, competent labour. The only issue mentioned in terms of recruiting pharmacists was the remuneration package. It was revealed that some local pharmacies may express a scarcity of pharmacists because of their refusal to pay the required salaries. Despite the saturated subsector, more and more persons are entering the subsector where the supply is significantly higher than the demand. At the same time, foreign persons are entering the workforce as well. In response to this situation, policy makers are now seeking talks with the Immigration Department, in an attempt to review the number of foreign pharmacists entering the workforce. Even though the expertise is welcomed, it should not be at the expense of the local pharmacists. One solution would be to continue the expansion of infrastructure and facilities to support the health sector such as the Children s Hospital. This could in turn bring some level of relief to the subsector by increasing the demand for pharmaceutical personnel. It is also critical that government begins to reassess the needs of the subsector and encourage specialization in other areas of pharmacology. This would break the monotony of the profession. The research highlighted a need for specialized areas of pharmacology. Specialized areas included ICU Medicine, Diabetes Pharmaceutical Care, Cancer Chemotherapy Pharmaceutical Care, Mixing of Drugs, Pharma-economics, 12
Oncology Pharmaceutical Care and Clinical Pharmacology. According to industry captains, there is a critical need for clinical pharmaceutical care. At present, these skills and competencies are not being fully utilized by the health care system. These specialized areas will require new skill sets and competencies. Despite this need for specialized areas, the health care bodies are not publicly seeking these specialized professions. This is further exacerbated by the provision of no formal training in these specialized fields by local training providers. This is evidenced by no strategic plan for pharmaceutical human resource development. With respect to training and development, stakeholders needs were being met by the training providers/ institutions of pharmacology. However, industry captains are of the belief that the pharmaceutical curriculum should focus more on the services side of the profession. These service areas include medication counselling, clinical pharmacy, pharmaceutical care planning, therapeutic care, pharmacy administration and drug information services. In an effort to ensure an efficient pharmaceutical subsector; robust patient care practices need to be implemented. Moreso, a reassessment of the services being provided and the implementation of new services based on the needs of the population and clientele. These services must be complemented by new physical structures. Conversely, training providers are providing a curriculum that is sufficient for what is expected and what the country needs. However, despite global trends, the training institutions have not sought to introduce any type of advanced formal training. Unfortunately, persons seeking advanced training have to seek it abroad. Presently, a master s programme does not exist in Trinidad and Tobago. Furthermore, even accessing the existing programme can be deemed tedious and difficult. In fact, many persons working in the industry, still possess diplomas in pharmacy but to convert to a degree requires four (4) years. Many of these persons are employed full time and many do not possess the time to complete the programme. According to the respondents, there is a need for a more friendly conversion/ transition to the degree programme. This will result in a much more qualified workforce. Notwithstanding, the success of the pharmaceutical subsector, there is still a public outcry for essential medication. Issues such the poor quality of drugs (causing adverse side effects), counterfeit drugs, illegal imports, and unauthorized sellers, shortage and highly priced drugs are always being brought to the forefront by the media. It is clear that in order to ensure that drugs are safe, effective and of good quality; the creation of a competent national drug regulatory authority, with the necessary human and other resources to control the manufacture, importation, distribution and sale of medicines is critical. Most importantly, the shortage of drugs continue to be a local and global issue. Participants indicated a need for Government to open discussions on the manufacturing of drugs locally. Ultimately the Government of Trinidad and Tobago needs to play a more forceful role in restricting the proliferation of counterfeit drugs; furthermore, the underpricing of these drugs negatively impacts local retailers of pharmaceutical drugs. Particularly, the Ministries of Health, along with Chemistry and Food and Drug Division and Customs and Excise Division, need to be held accountable for counterfeit drug trafficking in the country. 13
6 CONCLUSION Sound health is a pivotal contributor to human happiness and well-being. It also plays a critical role in economic progress, as healthy populations have longer life expectancies and are more productive members of the labour force and of society as a whole. Pharmaceutical professionals play a vital role in creating a healthy society by improving patient care through the medicine and information they provide. Therefore, it is crucial that the Ministry of Health provide the subsector with the resources and laws it requires to protect and improve the health status of the people of Trinidad and Tobago. 14
7 REFERENCE LIST Trinidad and Tobago Pharmaceutical Country Profile. May 2012. http://www.who.int/medicines/areas/coordination/pscp_trt_en.pdf Social Sector Investment Programme, 2016. http://finance.gov.tt/wp-content/uploads/2015/10/ssip-2016.pdf Review of the Economy. 2015. http://finance.gov.tt/wp-content/uploads/2015/10/roe-2015.pdf Ministry of Health. Website. http://www.health.gov.tt/sitepages/default.aspx?id=38 15