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Graduates' employability has emerged as a measure of institutions' success since recent higher education (HE) reforms and massification. A variety of strategies have been designed and implemented to ensure the smooth transition of graduates into the labour market. Our research compares the actions taken by two local higher education institutions (HEIs) to address the employability agenda in Portugal. The goal is to discuss whether these institutions have implemented a fully integrated employability strategy. Additionally, it explores the perceptions of local employers regarding the role of HEIs in mitigating their skill needs. The empirical analysis draws on qualitative data gathered through interviews with the academics responsible for employability actions and a sample of local employers in this specific regional setting. The findings suggest that HEIs have designed and implemented a varying set of employability actions and practices and are facing important challenges. The employers recognise HEIs' endeavours, but still refer to barriers for further collaboration. Academics face challenges to implement a mostly externally driven employability agenda, even in those that essentially cater to the local labour market.

New methodologies, contexts, and technologies are generating a lot of interest in the field of higher education, and this Special Issue intends to address the current research and trends in all dimensions of higher education [...]

This research examines the barriers and facilitators to employers’ engagement with higher education institutions. The data were collected through interviews with a set of employers (n = 19) in the Northern region of Portugal, V.N.de Famalicão, in 2019. We begin by exploring employers’ engagement activities as a potential solution to address local-level skill problems. Empirical evidence suggests that the engagement activities are mostly passive as firms use higher education largely as a recruitment channel. The differences in organizational goals and culture are the most cited barriers to the lack of more active engagement. Some efforts have recently been made to strengthen the ties between higher education and employers, notably through a local multi-stakeholder partnership as a potential broker. However, it will take time for this to bear fruit and contribute to reducing skill gaps and shortages. The data show that despite employers’ apparent willingness, more effort must be made to encourage active engagement.

Measures of stock of skills alternative to human capital have raised fresh difficulties, especially in data managing. We propose to empirically compare the efficiency of a hierarchical cluster analysis and a fuzzy clustering in reducing discrete skill data. The outcomes of both methods are subsequently used to measure the impact of skills on earnings in addition to human capital. The proposed methodological comparison was made using an original dataset of retail bankers’ skills assessed by supervisors. Empirical evidence shows that the fuzzy approach is more efficient than the hierarchical clustering: the resulting clusters are fewer and easier to interpret. Furthermore, the earnings equation enriched with skill variables allowed us to correct the education premium, and provides information on monetary incentives related to individual skills. Our paper attempts to raise researchers’ and practitioners’ awareness of data reducing methods, and their implications for wage determinants. First published online: 29 May 2015

Abstract Background South Africa is composed of a two-tier healthcare system. One tier is a private healthcare system that is funded through medical insurance, and comprised of people who can afford to make monthly payments towards their medical insurance. Second tier is a government-funded public healthcare system, which covers the majority of the population. This study explored the perceived barriers and current strategies being utilised by the pharmaceutical industry to increase access to innovator medicines. Objectives The objectives of the study were to: (1) quantify and classify innovator medicines registered between 2010 and 2020 by the South African Health Products Regulatory Authority (SAHPRA); (2) identify barriers to accessing innovator medicines in South Africa through interviews with market access managers from innovator companies; and (3) explore the current market access strategies used by the pharmaceutical industry. Design This study employed a quantitative and qualitative methodology. Whereby the former involved the extraction of a list of innovator medicines from the regulator database, and the latter involved 9 semi structured interviews. Purposive sampling was conducted through pharmaceutical association member companies. The interviews included seven market access managers and two medicine managers from one of the payers in South Africa. Thematic analysis was used to interpret the data collected from the study. Results According to the regulator database during the review period, 238 innovator medicines were registered. Only 14.77% were available in the public sector in the form of tenders, whereas in the private sector (based on the products having a SEP), 76.92% were available. From the interviews six themes emerged: reimbursement of medicines, types of reimbursement, partnerships, technology, legislative challenges, and other factors (e.g., real-world evidence). Conclusion Access to innovator medicines in South Africa is a challenge, as the price of these therapies is high. Therefore, various stakeholders in the health sector must collaborate to identify and implement solutions that are locally relevant. The government needs to proactively update policies that would allow for alternative reimbursement methods to be explored.

On 25–26 April 2024, the 5th PPRI (Pharmaceutical Pricing and Reimbursement Information) Conference on ensuring equitable access to affordable medicines took place in Vienna (Austria). Twenty-four accepted contributions were presented either as oral presentations or posters, adding to invited keynote lectures, stakeholder debates and workshops. The global multi-stakeholder audience discussed a range of approaches in pharmaceutical policies, which have the potential to successfully and sustainably address current and future challenges in ensuring patient access to affordable medicines globally. These discussions benefited from the interaction between policy-makers, stakeholders in the private sector and researchers who provided evidence on implemented and piloted policies. Among the policy options that drew the most attention during the PPRI Conference were procurement with targeted instruments to achieve strategic objectives, innovative payment models such as different variants of managed-entry agreements, and new models to fund pharmaceutical research and development. Experiences on established policy options that are being newly introduced in several countries, such as price regulation, health technology assessment, evidence-based selection for reimbursement decisions and measures to enhance the uptake of biosimilar medicines were also shared. The PPRI Conference reaffirmed the relevance of pharmaceutical pricing, procurement and reimbursement policies aligned with policy actions in other areas and along the pharmaceutical life-cycle and emphasised the importance of developing needs-driven health systems. Innovation in policy-making is needed to work towards equitable patient access to affordable medicines. This requires transparency, alignment on evidence requirements, communication, coordination, intra-country and international collaboration, solidarity and trust.

Sustainable access to affordable medicines remains a public health issue globally, including for high-income countries. To foster the debate on avenues for the future, the fifth PPRI Conference held in Vienna on 25 and 26 April 2024 will offer a forum for the debate on innovating pharmaceutical policymaking to develop and implement futureproof policy options, which are able to address current and future challenges. The Conference invites a broad audience of stakeholders, including researchers, policymakers, payers, patients, industry and health professionals. The conference topics are organised in three strands: Strand 1 on ‘Local challenges, global learnings’ aims to contribute to lively discussions on the implementation of pharmaceutical policies across the globe. Best-practice examples will be presented, supplemented by case studies of less effective policies which can offer rich learnings. Strand 2 on ‘Strengthening the evidence base’ is the place for presentations and discussions on topics such as health technology assessments, managed entry agreements and real-world data. Strand 3 ‘Futureproofing pharmaceutical policies’ is particularly dedicated to explore innovation in policymaking to achieve sustainable access to affordable medicines.

Background We sought to identify what barriers and facilitators determine current perceived access to childhood cancer care in South Africa through in-depth interviews with stakeholders in South Africa’s public and private sectors.Methods Qualitative semi-structured interviews were conducted with 29 key health system stakeholders, including policy-makers and regulators, medical insurance scheme informants, medicine suppliers, healthcare providers and civil society stakeholders. Identified barriers and facilitators in access to medicines and broader care were structured according to the pharmaceutical value chain (PVC).Results Barriers and facilitators were identified across all components of the PVC. Key barriers included (1) a lack of political commitment to childhood cancers, (2) discontinuation of essential chemotherapeutics, (3) incomplete insurance coverage for childhood cancers, (4) stock-outs of essential medicines, (5) the inability to access care, including travel to healthcare facilities and (6) low awareness on childhood cancers among primary healthcare (PHC) workers. Proposed priority interventions included pricing flexibilities, increased transparency and consistency in decision-making and healthcare spending, and improved training of PHC staff, nurses and pharmacists on childhood cancers.Conclusion This first comprehensive study of determinants of access to medicines used in childhood cancer in South Africa provides context-specific evidence for targeted policy development.

Background In South Africa (SA), most patients rely on the government for free healthcare. Some choose to subscribe to a medical insurance scheme. If insulin is unavailable in government or otherwise unaffordable, non-adherence may occur, which can increase complications of the disease.Methods Data on availability and pricing of insulin and related diagnostics was collected from SA pharmacies via an online survey. Co-payments levied on insulin by the biggest medical aids were extracted from formularies. Affordability of these items was then assessed. An adapted methodology from the World Health Organization/Health Action International tool was used.Results There was fairly high availability of insulin in the public sector, with the exception of long-acting insulin which respondents claimed was difficult to find; however, long-acting insulin glargine was available in most private sector pharmacies. Point-of-care (POC) blood glucose testing was free in the public sector but offered in only 31.25% of pharmacies. Patients pay a minimum of USD 40.4 (over 3 days’ wages for the lowest paid government worker (LPGW)) for a months’ supply of the cheapest insulin, needles and test strips. Insulin in SA was cheaper than 5 other countries, except Australia.Conclusion Overall, there is a good availability of insulin and related diagnostics in SA. Even though insulin is cheaper than other countries, it is unaffordable to the LPGW. This highlights the importance of ensuring a constant availability of insulin in the free public sector. Whilst human insulins are cheaper than newer analogue insulins and SA faces cost constraints, important variables in favour of newer insulins, such as ease-of-use, long term outcomes and value should be considered when treatment guidelines are updated. Annual POC testing should be available and offered free to all patients to detect diabetes early.

Background South Africa’s National Drug Policy (NDP) was first issued in 1996, at a time of considerable political change.Objectives To revisit the lessons learned from the process of development and initial implementation of the NDP.Methods Six in-depth face-to-face interviews were held with purposively-selected key actors. Interviews, which followed pre-determined semi-structured questions, but were allowed to explore additional areas, were recorded and transcribed, and then subjected to abductive thematic analysis, informed by the Walt and Gilson model.Results Three key themes emerged, described as ‘evidence', ‘trust' and ‘looking forward'. A paucity of evidence backed some of the key concepts in the NDP, and these have not been addressed as evidence has matured. The lack of trust which characterised the policy process impacted on the ways in which actors were able to or not able to engage, and therefore on the resultant content and the choices exercised. The coherence of the policy, its articulation with other health reforms, and its contribution to subsequent efforts to ensure universal health coverage in South Africa have all been weakened by the failure to revise the document over time.Conclusion As South Africa advances its plans for universal health coverage, there is an urgent need to revisit key components of the NDP which are no longer fit for purpose.

Abstract Background In the dynamic field of pharmacy amongst a diverse array of countries with disparate income levels, pharmacists play a pivotal role in integrating emerging scientific knowledge into their practice while adapting to evolving therapeutic interventions and expanding service delivery responsibilities. Lifelong Learning (LLL) is cultivated through continuing professional education (CPE) and continuing professional development (CPD), indispensable components ensuring sustained professional competence and heightened patient care quality. The global landscape witnesses diverse LLL activities tailored to pharmacists’ learning needs and preferences. This scoping review maps and synthesises a comprehensive global perspective on the existing knowledge regarding CPE/CPD models, statutory requirements, and pharmacists’ preferences for LLL activities. Objective To comprehensively investigate global models of CPE/CPD for pharmacists’ and examine the statutory requirements governing pharmacists’ registration and licensure. Method A literature search of PubMed, Google Scholar, Web of Science, and the University of KwaZulu-Natal library search engine was undertaken for studies between January 2012 and February 2023. The article selection and reporting followed the recommendations made by PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-Analyses) guidelines. The articles were tabulated based on their respective country’s income level, continuing education models employed, country-specific statutory requirements, and pharmacists’ preferences for LLL activities. Results Of the initial 3974 publications identified through the database search, 24 studies met the review criteria. The majority of the articles originated from high-income countries (HICs) (14/24, 58.3%), and most employed the mandatory CPD points system (21/24, 87.5%). However, in some HICs and upper-middle income countries (UMICs), the CPE/CPD is non-mandatory. While most countries (19/24, 79.2%) offer various LLL formats, the preference of pharmacists remains primarily face-to-face learning (13/24, 54.2%). However, workplace learning (3/24, 12.5%) and blended learning (7/24, 29.1%) are mentioned in some studies. Conclusion Diverse models of CPE/CPD alongside statutory requirements persist globally and evolve, shaped by varied implementation experiences. HICs lead in CPD models, while the implementation in low- and middle-income countries (LMICs) and low-income countries (LICs) requires further exploration for inclusivity and effectiveness. A few UMICs are either initiating or in early stages of implementing the CPD models. Structured planning for LLL activities is increasingly a global requirement for pharmacists’ licensure. The essential progression of pharmacy practice in developing healthcare systems necessitates a mandatory CPD model. Ongoing research is crucial to fortify the implementation, align and unify the CPD model with evolving pharmacy profession needs.

Background: Medicines are intended to cure, prevent, or diagnose diseases, alleviate signs, or symptoms, but improper use can cause patient morbidity and even mortality. Pharmacists assume direct responsibility for all the patient’s drug-related needs. Hence, pharmacists’ knowledge and attitudes regarding pharmaceutical care (PC) and their perceived barriers to PC provision are imperative to treatment success. The aim of the study was to explore community pharmacists’ knowledge and perception towards pharmaceutical care and identifying perceived barriers towards its implementation in South Africa. Methods: A quantitative study was undertaken, using a descriptive cross-sectional design. The data were collected by means of an online questionnaire completed by community pharmacists across South Africa. The data were analyzed using descriptive statistics, through Microsoft Excel and the Statistical Package for the Social Sciences (SPSS). Results: Out of 250 online questionnaires sent, a total of 181 responded, which delivered an 72.4% response rate. The vast majority (n=166; 91.7%) of the respondents were knowledgeable about PC though a few (n=15; 8.3%) of the respondents had a poor understanding of PC. A high number of respondents (n=173;95.5%) agreed that providing PC would increase the patients’ confidence in the pharmacy profession (n=173; 95.5%); and about 87.2% responded that all pharmacists should provide PC services. Lack of compensation for PC provision was perceived as the main barrier (83.9%). Conclusion: South African community pharmacists have good knowledge of PC, but a lack of remuneration and time were perceived as the main barriers to PC provision. Relevant stake holders like policymakers in pharmaceutical service, health care financial managers, and pharmacy managers should intervene to overcome these barriers.

Abstract Background South Africa faces numerous sexual and reproductive health challenges that can be mitigated with contraceptive use. Contraceptive use is defined and measured as use, non-use, or discontinued use. Research has shown that there are expanded definitions of use beyond these categories. Identifying such categories may assist in a better understanding of factors that influence contraceptive use. Setting and methodology This qualitative study was conducted in the eThekwini Municipality in KwaZulu-Natal, South Africa. The aim was to explore the factors influencing the uptake and use of modern contraception. One hundred and twenty-seven participants were enrolled in this study. One hundred and three of those were community members, and twenty-five were healthcare providers. Focus group discussions and in-depth interviews were conducted to gather the data. Data analysis was facilitated using NVivo 10 software. Results The data show that numerous factors influence contraceptive uptake and use. From these factors, a continuum of use that captures a variety of states of use emerged. Five different states of use were uncovered: no-use, vulnerable use, compelled use, conditional use, and autonomous use. The development of the model illustrates the complexity of contraceptive needs and that it extends beyond definitions found in policies and large-scale surveys. Expanding conceptions of use can aid in developing counselling and information support tools that can improve the uptake and continued use of modern contraception.

The South African government is moving toward universal health coverage (UHC) with the passing of the National Health Insurance (NHI) Bill. Access to quality primary healthcare (PHC) is the cornerstone of UHC principles. The South African governmental health department have begun focusing efforts on improving the efficiency and functionality of this system; that includes the involvement of private healthcare professionals and medical insurance companies. This study sought to explore perceptions of medical insurance company personnel on PHC re-engineering as part of NHI restructuring. A qualitative research design was adopted in this study. Semi-structured interviewed were conducted on 10 participants. Their responses were audio recorded and transcribed utilizing Microsoft Word ® documents. Nvivo ® was used to facilitate the analysis of data. A thematical approach was used to categories codes into themes. Although participants were in agreement with the current healthcare reform in South Africa. The findings of this study have highlighted several gaps in the NHI Bill at the current point in time. In order to achieve standardized quality of care at a primary level; it is imperative that reimbursement frameworks with clearly detailed service provision and accountability guidelines are developed.

Abstract Background Universal health coverage has gained significant momentum internationally as the policy solution to address healthcare system deficiencies and promote equitable distribution of quality healthcare. The South African government has adopted this option and developed policy papers for discussion on a National Health Insurance (NHI) system for South Africa. A large part of the policy has been focused on promoting functionality of the primary healthcare system (PHC); to promote an efficient referral pathway. This study sought to explore potential barriers perceived by policy developers that could hinder achieving the NHI goal. Furthermore, given that a large focus is centred on PHC re-engineering, it was imperative to understand participant’s opinions and perspectives on the role of a pharmacist at this level. Methods A qualitative research design was adopted in this study. Semi-structured interviews were conducted with ten policy developers that were selected via a referral technique. These were audio recorded using a digital voice recorder on an online platform, transcribed verbatim and saved on Microsoft Word® documents. NVivo®, was utilized to facilitate the analysis of data. A thematic analytical approach was used to categorize codes into themes. Results The findings revealed that participants were in agreement that healthcare system reform is crucial in promoting equitable distribution of healthcare services in South Africa. However, the reality of this is dependent on addressing key concerns perceived by participants that have been reported as three major themes: (1) the benefit of NHI implementation; (2) concerns about NHI implementation; (3) implications for pharmacy. Conclusions South Africa is in the second phase of NHI implementation. This phase is focused on the development of sound NHI legislation and structures. This study identified a number of concerns regarding legislative anomalies and role-player involvement that could compromise the efficient implementation of NHI.

Introduction The effectiveness of a health system in providing access to medicines is in part determined by the alignment of several core pharmaceutical processes. For South Africa’s public health sector, these include the registration of medicines, selection and subsequent procurement through national tenders. Registration, selection and reimbursement are key processes in the private sector. This study assessed the alignment of forementioned processes for essential paediatric oncology medicines in South Africa.Methods A selection of priority chemotherapeutics, antiemetics and analgesics in the treatment of five prevalent childhood cancers in South Africa was compared with those listed in 1) the WHO Essential Medicines List for Children (WHO EMLc) 2021, 2) the registered health products database of South Africa, 3) the relevant South African National Essential Medicines Lists (NEML), 4) bid packs and awarded tenders for oncology medicines for 2020 and 2022 and 5) oncology formularies from the leading Independent Clinical Oncology Network (ICON) and two private sector medical aid schemes. Consistency between these sources was assessed descriptively.Results There was full alignment for 25 priority chemotherapeutics for children between the NEML, the products registered in South Africa and those included on tender. Due to unsuccessful procurement, access to seven chemotherapeutics was potentially constrained. For antiemetics and analgesics, eight of nine active ingredients included on the WHO EMLc were also registered in South Africa and on its NEML. An exploratory assessment of private sector formularies showed many gaps in ICON’s formulary and two medical scheme formularies (listing 33% and 24% of the chemotherapeutics, respectively).Conclusion Despite good alignment in public sector pharmaceutical processes, access constraints to essential chemotherapeutics for children may stem from unsuccessful tenders. Private sector formularies show major gaps; however, it is unclear how this translates to access in clinical practice.

A 56-year-old man presented at the emergency department with bilateral eye pain, itching and watery discharge for 10 days, fever for seven days, and cough for one day. He had been vaccinated against COVID-19 and had developed ocular symptoms two days after receiving the second dose of the vaccine Sinopharm. Investigations revealed that the nasal PCR was positive for COVID-19. We managed him on the lines of episcleritis and critical COVID-19 pneumonia. The patient later deteriorated and was intubated. He died on the sixth day of his hospitalization as a result of a protracted disease course and ST-segment elevation myocardial infarction (STEMI). We report the development of episcleritis and critical COVID-19 infection after COVID-19 vaccination to emphasize the consideration of antibody-dependent enhancement after vaccination.

Monitoring access to pediatric medicines as part of the Sustainable Development Goal (SDG) agenda for 2030 requires surveying age-appropriate medicines. This study aimed to develop tracer sets of essential age-appropriate medicines for use in SDG indicator 3.b.3 or in conjunction with other methodologies for monitoring access to medicines. Two sets of medicines were developed, one for young children (1 month to 5 years) and one for school-aged children (5–12 years). Priority diseases were selected based on the global burden of disease and linked to active ingredients of first choice according to treatment guidelines and the World Health Organization (WHO) Model List of Essential Medicines for Children (EMLc). To ensure clinical relevance, the Delphi technique was employed to identify areas of (dis)agreement among clinical pediatric experts. During two consultation rounds, experts were invited to indicate (dis)agreement. Five experts per age group were largely in agreement with the initial selections, but various therapeutic alternatives were suggested for addition. A second consultation round with five experts did not lead to major adjustments. The final sets included 26 treatment options for both groups. Specific age-appropriate formulations were selected from the WHO EMLc 2023. These two globally representative tracer sets of medicines consider the particular needs of children and could aid countries in the critical monitoring of accessibility to pediatric medicines.