Pharmacy teams should be integral to humanitarian organisations

Despite a rise in human-made and natural disasters, the humanitarian sector is the road less travelled for the pharmacy workforce^​1–4​. Humanitarian workers are exposed to multiple exceptional factors, such as unstable environments, neglected diseases and unfamiliar living conditions^​4​. It is a vastly different environment to hospital or community sectors in developed countries, yet a fundamental common aim links them — to provide the best possible quality of care to those in need^​1–4​.

Humanitarian pharmacy professionals are a vital link in the access and management of medicines and health technologies, and are drawn into the humanitarian sector by a passion to help the vulnerable in times of uncertainty^​5,6​. Their wide-ranging backgrounds and levels of practice influence medication management in diverse settings^​7​. Pharmacy professionals can be close to field operations — based within individual projects, such as hospital complexes or outreach clinics, in country-wide coordination positions streamlining medical orders, or in regional and global support roles framing and implementing medical policies. All the while ensuring that medical items ordered to the field reach their intended use. 

The International Pharmaceutical Federation’s ‘Global humanitarian competency framework’, published in 2021, outlines pharmacy expertise across patient, system and population-wide scopes of practice^​5​. Thus, where humanitarian aid is needed, pharmacy practice can include the more obvious activities of providing safe access to medication, monitoring therapy and counselling patients on their medicines, as well as allowing their expertise to permeate into wider public health efforts, such as supply chain management and liaising with governing bodies. 

There is a noted shortage of humanitarian pharmacists and pharmacy technicians, for reasons that include variable career pathways and opportunities between home and deployment countries and suboptimal recognition in drug supply cycle and clinical roles^​7–9​. A decade ago, “there [was] a crucial need to identify pharmacists with [humanitarian] experience, capture their expertise and formulate best practice”^​10​. Amid ongoing humanitarian disasters, improvements have been made in humanitarian pharmacy practice, including the creation of the competency framework, yet the ongoing need for workforce development stands^​5​. It is now for the pharmacy profession and its medical allies to promote pharmacy expertise, not only in hospital and community settings but also in the humanitarian sector. 

Monitoring and optimisation of medical stock

Humanitarian pharmacy teams are essential in medical stock management. Expertise needs to flourish into medical stock optimisation, unhindered by organisational understanding of the profession’s scope of practice, and into a humanitarian pharmacy workforce that is increasingly clinically relevant and positively impacting patient experience everywhere^​7​. 

In a medical humanitarian organisation, a pharmacist colleague noted that ‘[medical] stock cannot be managed without a clinical approach’. This voice is echoed across the sector^​2–4​. The optimisation of medical resources for clinical use relies on expertise in medical stock management^​6,11​. In humanitarian terms, medical stock includes all medical items needed for the running of a healthcare facility: medication, needles, biomedical equipment, hospital beds, masks, gloves and more; each item defined and quantities adjusted to the medical activities of a given project. Correct stock management and surveillance can ensure there is optimisation of the available medical resources.

The overall aim of stock surveillance is to review ‘ROSE’ — Ruptures (out of stock items), Overstock, Sleeping stock (unused items owing to e.g. change of medical activities) and Expired items. Stock surveillance and subsequent action to minimise ‘ROSE’ are essential pharmacy activities for the running of humanitarian projects and to allow accurate budget and stock forecasting. In the humanitarian sector, medical stock is planned and ordered far in advance of actual usage (sometimes six to nine months or more) owing to the issues of accessing quality controlled stock, transportation and importation realities. Any medical stock order omissions or miscalculations can cause detrimental effects to the project’s medical activities, such as insufficient supplies reaching surgical theatres or medications not being available for patients.

Currently, there is no consensus on who is responsible for medical stock and within different humanitarian organisations there are varying professional groups that oversee medical stock. Globally, medical stock management and distribution is better framed than within the humanitarian sector^​8​. From their training, pharmacists are vital in the process as they understand all aspects of the medication journey and, once in the humanitarian sector, become versatile to manage and strategically oversee the entirety of medical stock. Humanitarian pharmacy teams have the skills to monitor consumption patterns, advise on changing therapy options and propose alternatives when there are medication shortages, rationalising the distribution and optimising the use of medical resources to end-user units^​9​.

Good stock awareness links intrinsically to the quality of patient care. When there are limited resources, pharmacists assess cost-effectiveness through a clinical lens and can support medical teams in the prioritisation and implementation of new medical products. Pharmacy professionals are well placed to monitor and analyse consumption, identifying poor prescribing practices of clinical impact^​5,9,12​. This prescribing mapping allows for targeted training to streamline the use of healthcare resources and in turn impact patient outcomes.

Recognition by humanitarian organisations

Pharmacy teams are an integral part of delivering healthcare^​9​ and recognition by humanitarian organisations is crucial to maintaining pharmacy expertise within their healthcare structure. With a defined competency framework^​5​, humanitarian organisations can capitalise on their pharmacy workforce, allowing pharmacists to practice their core competencies from stock management and surveillance to stock optimisation and clinical service provision, without limiting them to one or the other. 

Removing pharmacists from monitoring stock — specifically from managing the teams that handle medical stock — can lead to a decrease in medical expertise, reducing resource optimisation and limiting access to that stock by the medical teams that need to use it. As part of the clinical group, pharmacy teams speak the same ‘language’ as medical stock users, such as doctors, nurses and allied healthcare professionals. This affords greater visibility for the medical team as to what products are available and when. It also creates an opportunity for the pharmacy team to propose alternatives and question overconsumption or underusage of items in view of forecasted amounts and ongoing medical activities^{​9,12,13​}.

The humanitarian sector adapts to often complex medical supply chains with long lead times. Pharmacy activities, including medical item substitution and optimisation to prevent stockouts of critical medicines, or unnecessary amounts of expired stock that then enter an equally complex destruction pathway, are continuous and pragmatic. Pharmacy teams handle medical stock with an attention to detail and a focus on patient care that can benefit any humanitarian project. Support for pharmacy teams and endorsement of capacity enhances their decision-making power, promoting their autonomy to optimise medical resources in line with humanitarian goals.

Pharmacy teams are mandated with their expertise to optimise medication and improve quality of care. Their role is crucial in the humanitarian sector, extending to optimisation of all medical resources where those resources are scarce and often difficult to access. It is imperative that pharmacy as a profession is involved in every aspect of overseeing the distribution of medications and other medical resources, through to their use by patients, such that at the end, ‘every pill reaches the patient’.