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The objective of this study was to determine gastrointestinal transit time in first-year health science students with a laboratory practical exercise conducted in two cohorts (classes of 2018 and 2019) of first-year health sciences students at the Health Science Campus in Windhoek, Namibia. All first-year health science students undertaking the Physiology course were invited to take part in the laboratory exercise. The primary outcome was the measurement of gastrointestinal transit time from the amount of time taken for ingested whole-kernel sweetcorn to be eliminated, which was calculated as the time period between ingestion of corn and the time of corn first seen in the stool and the time corn was last seen in the stool. The secondary outcome was an association between emotional irritability and/or anxiety and gastrointestinal transit time. The study analyzed responses of 175 students, who reported a median transit time of 29 (1–99) h. There was no difference in gastrointestinal transit time between male and female students. Likewise, there was no difference in the duration of the corn in the bowel between male and female students. Students who reported being worried and irritable during the exercise had more bowel movements before they saw corn in their stool and had slower transit times, respectively. A wider range of transit time was reported in a group of young, healthy students compared with previous studies in the literature. There were no differences between male and female student bowel activity. Anxiety did impact the bowel activity of the participants.

Background: COVID-19, a global pandemic, has disrupted pharmacy education in Africa, due to unpreparedness to migrate to online Learning. Aim: To assess outcomes and challenges facing migration to online pharmacy education. Methods: An evaluation of implementation of online learning in the Bachelor of Pharmacy programme in Namibia using key informant feedback. The outcomes were outputs and challenges facing migration to online learning, and its impact on pass rates and scores. Results: The pooled mean score was higher in 2020 (66.2%), compared to 2019 (63.4%) and 2018 (62.1%), (p=0.076). A variety of platforms were used as alternatives or supplements to Moodle. The main challenges included inequalities in internet connectivity, monitoring and quality assurance, implementation of experiential learning, and reliability of online assessment. Conclusions: Whilst migration to online learning did not impact on pass rates, there is need for policies and systems to address programmatic challenges to eliminate inequalities in online pharmacy education.

Objectives Standard treatment guidelines improve patient care outcomes. Few studies assess the impact of standard treatment guidelines on population-level medicine use indicators in resource limited settings in sub-Saharan Africa, where the burden of disease is greatest. The objective of this study was to determine the immediate and long-term impact of the national standard treatment guidelines on medicine use indicators at the population-level in Namibia. Methods An interrupted time-series modeling of the impact of national standard treatment guidelines implemented in Namibia in 2011, on population-level medicine use indicators. Antibiotic, generic and polypharmacy prescribing indicators were abstracted from the national Pharmaceutical Information System, over an eight-year period, 2007– 2015. This generated 15-quarterly time points. The impact was estimated by changes in trends of the indicators, immediately and after the intervention using R-software. The immediate impact was reflected by level change while long term impact was determined by trends/quarterly change after standard treatment guideline implementation. Key findings Data points from 522 Pharmaceutical Information System reports from 38 health facilities were included. The eight-year period estimates were, 2.9 ± 0.1 medicines prescribed per outpatient, 48.1 ± 2.5% of prescriptions had an antibiotic and 74.0 ± 4.2% of medicines were prescribed by generic name. Of the 13 regions, 61.3% and 53.8% had a decline in the average medicines per prescription and prescriptions with antibiotics respectively, as well as 53.8% of the regions had an increase in prescribing of generic medicines immediately after implementation of the standard treatment guidelines. Thereafter, quarterly trends in the three indicators did not significantly improve after the intervention at national and in all regions, except for generic prescribing in Oshikoto region, 4.5% (95% CI: 2.6 – 6.3%, P < 0.001). Conclusion Whilst national standard treatment guidelines immediately improved medicine use indicators, it is discouraging that the improvement over time was marginal across regions and was not sustained at the national level. Robust point of care interventions is needed for sustained and effective implementation of standard treatment guidelines.

Background: The COVID-19 pandemic has led to suspension of pharmacy education in resource-limited settings, negatively impacting pharmaceutical workforce outputs. Aims: To identify the elements of a COVID-19 resilient pharmacy education programme in Namibia and its grassroots impact on the pharmaceutical workforce and systems strengthening. Methods: An evaluation of COVID-19 resilience of the Diploma in Pharmacy programme in Namibia. Data on elements for resilience and outcomes were collected; qualitative and quantitative data were analysed descriptively. Results: The evaluation identified ten key elements for successful implementation of a COVID-19 resilient pharmacy education programme. The integration of quality improvement projects in the workplace strengthened pharmaceutical systems and workforce capacity in areas of rational medicine use and supply management of medicines. Conclusions: Whilst the COVID-19 pandemic has disrupted pharmacy education, this paper presents ten elements that, when implemented, may improve the resilience and minimise unforeseen academic interruptions during pandemics.

Introduction The prevalence of non-communicable diseases (NCDs) is rising in Namibia, and with it, the need for pharmacists to empower patients. This research aims to 1) identify patient-reported barriers and facilitators to managing chronic NCDs for Namibians, and 2) characterize common patient-reported medication and health-related needs of Namibians with chronic NCDs. Methods This qualitative study used semi-structured interviews to elicit participant perspectives regarding NCDs. The study used the conceptual frameworks of the Health Belief Model, the Theory of Planned Behavior, and the Explanatory Models of Illness to identify and understand key factors necessary to develop relevant patient-centered interventions. Participants were recruited from pharmacies throughout Namibia. Data were analyzed using thematic analysis from the transcribed interviews. Results A total of 23 interviews were conducted, with 20 being included in the final analysis. Themes identified included: 1) participants were motivated to seek care when they were symptomatic; 2) participants felt motivated to care for their condition to improve their own lives and their families for their family's sake; 3) participants integrated information from a variety of sources into their disease knowledge; 4) participants describe wanting to be more engaged in managing their health and wanting support to help manage their condition; 5) participants describe awareness of lifestyle changes necessary to improve health, but face many barriers to achieving them. Conclusion This study identified key factors that are essential for pharmacists and other health care professionals to be aware of in order to support patients who are diagnosed with an NCD. Health care providers should consider strategies to engage patients to harness their motivations, enhance health education, and create systems to reduce barriers to addressing lifestyle.

Namibia has previously relied on external training of pharmacists but began in-country training in 2011. In response to an identified need for postgraduate clinical pharmacy development and training in the country, a Master's degree was set up at the University of Namibia in 2016. The country has a considerable health burden of HIV and TB as well as a shortage of healthcare professionals. A UK clinical diploma model was adapted to meet the specific needs of the country and wider region, ensuring students could access the course over a sparsely populated, but large geographical spread, in addition to providing work-based learning, embedding research skills for future development, and focusing on the health needs of Namibia. The course uses online learning platforms and contact sessions to cover both knowledge and skill acquisition throughout the 3 years of the course. UK and US clinical pharmacists are utilised to provide specialist input, both remotely and within student workplaces, and further support has come from collaborations, including cross-site visits, with the UK-based pharmacy school whose diploma model was adapted. Challenges have included a shortage of clinical mentors, also compounding the students' difficulty in visualising their future roles, as well as lone practitioners finding it hard to attend all contact sessions. The initial dropout rates of earlier cohorts have since reduced with greater understanding of the programme, and enthusiasm for the course remains high. The aim for the Master's is to train students to become competent clinical pharmacists, thus having the knowledge and skills to mentor future cohorts of the course, as well as expanding the specialty within the country.

Background Pharmacovigilance systems increase access to safe medicines and healthcare, but their integration in public healthcare remains a challenge in many countries. The main barriers to pharmacovigilance integration are attributed to high patient load and limited capacities. Objective To explore the challenges associated with the effective integration of pharmacovigilance systems in public healthcare in a developing country such as Namibia. Methods A nationwide qualitative assessment of integration of pharmacovigilance systems particularly spontaneous adverse drug reaction (ADR) reporting at public health facility level was conducted. Key informant interviews were conducted among pivotal healthcare professionals involved in pharmacovigilance. The main outcomes were themes on challenges and strategies for effective integration of PV services at the facility level. Qualitative data were collected over a one-month period (i.e., March 2019), and thematically analysed. Results Eight (8) key informants were recruited; the majority were pharmacists (n = 7) and male (n = 5). The main challenges affecting the effective integration of pharmacovigilance systems reporting at public health facilities were “weak pharmacovigilance policies and structures”, “negative attitude of healthcare workers towards pharmacovigilance”, and “limited capacity and support for implementation of pharmacovigilance activities”. The main strategies for effective integration of PV systems at facilities included local capacity-building through continuing profession education and support, advocacy, stakeholder engagement, facility/region based pharmacovigilance champions, and facility-based policies for universal and inclusive reporting, (i.e. patients and health workers at all levels) as well as development of workable standard operational procedures. Conclusions The pharmacovigilance systems at healthcare facilities in Namibia were observed to have sub-optimal policies, structures and support systems, and lack health care worker buy-in. There is a need for a policy framework to ensure effective and sustainable integration of pharmacovigilance activities at public healthcare facilities.

Modern, quality education for health sciences is vital in developing and strengthening the health systems of countries in southern Africa. Medicine, pharmacy, and other disciplines in the region ty...

Introduction: The incidence and risk factors of tenofovir disoproxil fumarate (TDF)-related renal impairment (RI) in Namibia are unknown where TDF-containing ART regimens are used as the first line for HIV. Methodology: A retrospective cohort study among HIV-infected patients at two intermediate hospitals. A decline in estimated glomerular filtration rate (eGFR) was significant if it was ≥25% and included a change to a lower eGFR stage. New-onset RI was defined as an eGFR 2.0, for decline-in-eGFR were baseline eGFR >60 (aHR = 15.6); hyperfiltration (aHR = 5.0); and pregnancy (aHR = 2.4); while for RI, they were hyperfiltration (aHR = 4.1) and pregnancy (aHR = 29). Conclusion: The incidence of decline-in-eGFR was higher than in other sub-SSA countries, but not RI. A high baseline eGFR had the greatest risk for the decline, and hyperfiltration for the RI.

Background Globally, weak pharmaceutical information systems (PIS) negatively affect universal health coverage and outcomes. Few studies in sub-Saharan Africa qualitatively and quantitatively assess drivers and utility of data from PIS in public healthcare. Methods A nationwide cross-sectional descriptive study interviewed PIS focal persons in all 14 regions of Namibia. The primary outcome was extent and predictors of utility of PIS data. The extent of utility of PIS data was determined using descriptive statistics and predictors by logistic regression in SPSSv24 or thematic analysis for qualitative data. Results The study recruited 58 key informants at facility-based 56 (96.6%) and national 2 (3.4%) levels. Of the 56 facility-based respondents, 29 (51.8%) were female and 27 (48.2%) pharmacists. The mean age and PIS work experience were 33.5 ± 7.6years and 4.5 ± 3.3years respectively. The utility level of PIS data was 34 (60.7%) (target >80%). A total of 103 uses of PIS data were cited; of which 38 (36.9%) were informing decisions on rational medicine use, 27 (26.2%) on pharmaceutical stock management and 24 (23.3%) on strengthening pharmacy workforce. The utility of PIS data significantly decreased with lack of systems on routine reporting by health facility in-charge (cOR = 0.25, 95%CI: 0.06,0.90, p = 0.035). Longer work experience (cOR = 1.05, 95%CI: 0.88,1.25, p = 0.58), formal consultations (cOR = 1.29, 95%CI: 0.14,11.54, p = 0.82), and availability of feedback systems (cOR = 1.08, 95%CI: 0.33,3.56, p = 0.89) appeared to increase utility of PIS data. Two thematic drivers of utility of PIS data were programmatic “feedback and action on PIS; structures, technical support for PIS discussion”; technical “training/technical capacity of staff; tools and resources for data collection and utilization”; and human-resource “staff availability and workload; attitude and commitment”. Conclusion The nationwide study shows sub-optimal utility of PIS data in public healthcare in Namibia, which negatively affects delivery of pharmaceutical services. This calls for action to enhance capabilities for utilization of automated real-time pharmaceutical information decision support systems to enhance real-time analysis and feedback on medicines data in resource-limited settings.

Background In Namibia, one out of every 25 cases of tuberculosis (TB) is “lost to follow-up” (LTFU). This has impacted negatively on national efforts to end the disease by 2035. The aim of this study was to determine the trends and predictors of LTFU under the directly observed treatment short-course (DOTS) programme in Namibia. Methods The study involved a retrospective longitudinal analysis of a nationwide cohort of TB cases registered under the DOTS programme in Namibia from 2006 to 2015. The trends and predictors of LTFU among cases in the National Electronic TB Register of the National TB and Leprosy Program were respectively determined by interrupted time series and multivariate logistic regression analyses using R-Studio software. Results Out of 104 203 TB cases, 3775 (3.6%) were LTFU. A quarter (26%) of cases with poor outcomes were due to LTFU. The annual decline in cases of LTFU was significant between the first (2005–2010) and second (2010–2015) medium-term plan period for TB programme implementation (p=0.002). The independent predictors of LTFU were male sex (p=0.004), 15–24 years age group (p=0.03), provider of treatment (p, Loss to follow-up of tuberculosis patients is an important barrier to ending TB in high-TB-burden countries. The integration of social welfare among young and/or middle-aged men is critical in reducing loss to follow-up of TB patients. http://bit.ly/395WfBM

Background and aims: The advent of antiretroviral therapy (ART) and early diagnosis of the human immunodeficiency virus (HIV) has resulted in an appreciable reduction in morbidity and mortality among people infected with HIV. However, tenofovir disoproxil fumarate (TDF)-containing ART regimens are associated with a reduction in creatinine clearance (CrCl). No evaluation has been conducted in Namibia to date on the relationship between TDF-containing ART and CrCl among patients with moderate to severe reductions in CrCl to guide future practice. We aimed to address this.Methodology: Retrospective longitudinal study between January 2008 to December 2016 evaluating CrCl in patients with a baseline CrCl

Objectives: Optimal treatment success rates are critical to end tuberculosis in Namibia. Despite the scale-up of high quality directly observed therapy short-course strategy (DOTS) in Namibia, treatment success falls short of the global target of 90%. The objective of this study was to ascertain the predictors of treatment success rates under DOTS in Namibia to provide future direction. Methods: A nation-wide comparative analysis of predictors of treatment success was undertaken. Tuberculosis cases in the electronic tuberculosis register were retrospectively reviewed over a 10-year period, 2004–2016. The patient, programmatic, clinical, and treatment predictors of treatment success were determined by multivariate logistic regression modeling using R software. Results: 104,603 TB cases were registered at 300 DOTS sites in 37 districts. The 10-year period treatment success rate was 80%, and varied by region (77.2%–89.2%). The patient’s sex and age were not significant predictors. The independent predictors for treatment success as were: Region of DOTS implementation (p=0.001), type of directly observed treatment (DOT) supporter (pConclusion: Targeted programmatic, clinical and treatment interventions are required to enhance DOTS treatment success in Namibia. These are now ongoing.

Introduction: All antiretroviral therapies (ARTs) are potentially toxic to the liver. In sub-Saharan Africa, the rising incidence of ART induced adverse events has complicated treatment leading to recent revisions of Namibian ART guidelines. Unfortunately there have been limited studies to date evaluating ART induced liver injury in Namibia to guide further revisions if needed.Objective: Determine the current patterns and grades of ALT elevation in Namibia’s HIV/AIDS.Methods: Retrospective cohort analysis. Patterns of alanine amino transferase (ALT) liver enzyme elevation were determined in a cohort of ART naïve HIV patients on firstline ART regimen in a referral hospital in Namibia over a 1 year treatment period. Patterns of ALT changes at baseline, 3 months and 6 months were analyzed using ANOVA and Bonferroni test for pairwise comparisons.Results: Of 79 eligible patients, 72 developed significant ALT elevation within 3 months of ART initiation (F (3, 76) = 6.4, p = 0.002, ƞ2 = 0.193). Four 4 (5.6%) and 1 (1.38%) patient respectively developed grade 2 and grade 3 ALT elevation by month 3. There was no significant difference between mean ALT levels at baseline and month 6. A CD4 count of

Training health-care students in settings with high-prevalence HIV and tuberculosis (TB) presents a challenge to reduce the risk of infection during their clinical training while maintaining quality education. We sought to gauge the risk of exposure to HIV and TB and identify associated variables through two cross-sectional surveys of health students at the University of Namibia. In the HIV exposure survey, overall almost one-quarter of students (N = 367) reported exposure to HIV—most often needle-stick injury—with a much higher rate reported in senior years (73% in year 6). One in 10 students responding to the TB survey were found to have been exposed to TB (N = 290). Regression analyses suggested that time-related factors were a common predictor of risk of both HIV and TB in this setting. We consider that the overall exposure rate to HIV and TB was high, suggesting that training could be improved to reduce the risks of exposure.

Summary Background Snakebite envenoming is a frequently overlooked cause of mortality and morbidity. Data for snake ecology and existing snakebite interventions are scarce, limiting accurate burden estimation initiatives. Low global awareness stunts new interventions, adequate health resources, and available health care. Therefore, we aimed to synthesise currently available data to identify the most vulnerable populations at risk of snakebite, and where additional data to manage this global problem are needed. Methods We assembled a list of snake species using WHO guidelines. Where relevant, we obtained expert opinion range (EOR) maps from WHO or the Clinical Toxinology Resources. We also obtained occurrence data for each snake species from a variety of websites, such as VertNet and iNaturalist, using the spocc R package (version 0.7.0). We removed duplicate occurrence data and categorised snakes into three groups: group A (no available EOR map or species occurrence records), group B (EOR map but

The global workforce needs to be competent, flexible, adaptable, sustainable, and patient-focused. A competency approach towards education, development, and professional practice strengthens services and increases better health outcomes. This paper will provide a global perspective on competency approaches from different health care professions. It will focus on two case reports, describing the use of competency methodologies at an undergraduate and postgraduate level, as well as supporting the internship and/or pre-registration training. Challenges and opportunities will be highlighted by addressing some of the key questions posed for this special edition.

Alcohol is the most widely abused substance in Namibia and is associated with poor adherence and retention in care among people on antiretroviral therapy (ART). Electronic screening and brief interventions (eSBI) are effective in reducing alcohol consumption in various contexts. We used a mixed methods approach to develop, implement, and evaluate the introduction of an eSBI in two ART clinics in Namibia. Of the 787 participants, 45% reported some alcohol use in the past 12 months and 25% reported hazardous drinking levels. Hazardous drinkers were more likely to be male, separated/widowed/divorced, have a monthly household income > $1000 NAD, and report less than excellent ART adherence. Based on qualitative feedback from participants and providers, ART patients using the eSBI for the first time found it to be a positive and beneficial experience. However, we identified several programmatic considerations that could improve the experience and yield in future implementation studies.

Robust pharmaceutical management information systems (PMIS) strengthen healthcare planning and delivery. Few nationwide studies in resource limited settings in Africa validate the data quality of PMIS in public healthcare.To determine predictors and quality of data in a nationwide PMIS database in Namibia.A population-level analysis of the quality of data i.e. completeness, accuracy and consistency in a nationwide PMIS database, 2007-2015. Data quality of the PMIS was determined by three domains, completeness, accuracy and consistency. Data completeness was determined by level of missing data in SPSSv25, with acceptable level set at5%. Data accuracy was determined by proportion of PMIS indicators with extreme outliers. Data consistence was determined by patterns of missingness, i.e. random or systematic. Predictors of data quality were determined using logistic regression modelling.A total of 544 entries and 12 indicators were registered in the PMIS at 38 public health facilities. All the PMIS indicators had missing data and 50% (n = 6) had inaccurate data i.e. extreme values. The data for most PMIS indicators (75%, n = 12) were consistent with the pattern of missing completely at random (MCAR, i.e. missingness5%). Incompleteness of PMIS data was highest for average number of prescriptions 6%, annual expenditure per capita for pharmaceuticals 5% and population per pharmacist's assistant 5%. The main predictors of poor quality of PMIS data were year of reporting of PMIS data (p = 0.035), level of health facility (p 0.001), vital reference materials available at the pharmacy (p = 0.002), and pharmacists' posts filled (p = 0.013).The data quality of PMIS in public health care in Namibia is sub-optimal and widely varies by reporting period, level of health facility and region. The integration of data quality assurance systems is required to strengthen quality of PMIS data to optimize quality of PMIS data in public health care.

Background Namibia has recently introduced a number of health training programmes that expose students to infectious disease risks such as human immunodeficiency virus (HIV) and tuberculosis (TB). We explored the knowledge of students in relation to HIV and TB and whether or not there was evidence of exposure. Methods We conducted two cross-sectional surveys of Namibian health students (medicine and pharmacy) in 2018. Results There was a strong association between knowledge and exposure to HIV, but not TB (i.e. explicit exposure versus latent). Regression analysis suggested the time-related risk (age/year of study) to be predictive of knowledge in both studies. The training rotation in the respiratory unit predicted TB knowledge and post-exposure prophylaxis predicted HIV knowledge. Conclusions Knowledge of TB and HIV appears mostly related to the duration of study in health students. Exposure or specific experience may enhance knowledge. Future training in infection control may be better focussed on improving knowledge in earlier years.

Cobra snakes, including Naja mossambica and Naja nigricincta nigricincta, are one of the major groups of snakes responsible for snakebites in southern Africa, producing significant cytotoxicity and tissue damage. The venom of N. mossambica has been briefly characterised, but that of N. n. nigricincta is not reported. The current study identifies the venom proteins of N. mossambica and N. n. nigricincta. This is achieved using sodium dodecyl sulphate (SDS)-polyacrylamide gel eletrophroresis (PAGE), followed by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Most of the proteins were less than 17 kDa in both snakes. N. mossambica was found to have 75 proteins in total (from 16 protein families), whereas N.n. nigricincta had 73 (from 16 protein families). Of these identified proteins, 57 were common in both snakes. The proteins identified belonged to various families, including the three-finger toxins (3FTx), Cysteine-rich secretory proteins (CRiSP), Phospholipase A2 (PLA2) and Venom metalloproteinase M12B (SVMP). The current study contributes to the profile knowledge of snake venom compositions, which is of fundamental value in understanding the proteins that play a major role in envenomation.

Background: Limited utility of quality health data undermines efforts to strengthen healthcare delivery, particularly in resource-limited settings. Few studies model the effective utility of quality pharmaceutical information system (PIS) data in sub-Saharan Africa, typified with weak health systems. Aim: To develop a model and guidelines for strengthening utility of quality PIS data in public healthcare in Namibia, a resource-limited setting. Methods: A qualitative model based on Dickoff et al. practice-oriented theory, Chinn and Jacobs’ systematic approach to theory, and applied consensus techniques. Data from nationwide studies on quality and utility of PIS data in public healthcare conducted between 2018 and March 2020 informed the development of the model concepts. Pharmaceutical and public health systems experts validated the final model. Results: Overall, four preliminary national studies that recruited 58 PIS focal persons at 38 public health facilities and national level informed the development of four model concepts. The model describes concepts on access, management, dissemination, and utility of quality PIS data. Activities to implement the model in practice include grass-root integration of real-time automated pharmaceutical intelligence systems to collect, consolidate, monitor, and report PIS data. Strengthening coordination, human resources, and technical capacity through support supervisory systems at grass-root facilities are key activities. PIS focal persons at health facility and national level are agents to implement these activities among recipients, that is, healthcare professionals at points of care. Guidelines for implementation of the model at point of care are included. Experts described the model as clear, simple, comprehensive, and integration of pharmaceutical intelligence systems at point of care as novel and of importance to enhance utility of quality PIS data in resource-limited settings. Conclusion: While utility of quality PIS data is limited in Namibia, advantages of the model are encouraging, toward building resilient pharmaceutical intelligence systems at grass roots in resource-limited countries, where there are not only weak health systems, but high burden of misuse of medicines.

Shortages of medicines is a global problem that can have significant impact on health outcomes of patients and reduce the effectiveness of public health programmes. There are a multitude of reasons for medicines shortages occurring, however, and it is important for specific country settings to better understand the issues affecting medicines supply in order to effectively intervene. Namibia relies heavily on imports of medicines as it does not have an adequate pharmaceutical industry sector developed enough to produce sufficient medicines for the burden of disease arising. In addition, because there is no unifying system of medicines monitoring it is difficult to plan interventions to resolve common medicines shortages. This study reports the findings from a pilot survey that was undertaken to improve the information monitoring of medicines shortages in Namibia. The survey sought information from medicines suppliers from various pharmacy sectors who may provide a vital insight into how medicines shortages should be monitored and the causes of shortages observed in Namibia. A more robust survey as part of a broader system can be informed by this survey to address the shortage of medicines in Namibia and surrounding region.

Background and purpose Pharmacy and medical training were introduced for the first time in Namibia in 2011 and 2010 respectively. All students must complete a research project as part of their training, which is supported by various courses in the respective curricula including research methods. Following a revision of the medical curriculum, there was an opportunity to review the way research methods was taught for both degrees, piloting in pharmacy then expanding to other disciplines. An educational activity that was part of the research methods course for training pharmacy students in Namibia is described. Educational activity and setting The activity described related to a new approach in the running of the research methods course for pharmacy students and included, in a portfolio-based approach, a group project. Students were tasked to collect qualitative data from medical student colleagues that they then needed to codify and ultimately articulate into a survey questionnaire. The questionnaire was subsequently sent out to collect responses on medicines-related items that could be analyzed quantitatively in subsequent teaching sessions. Supportive lectures, tutorials and portfolio assignments were provided during the project. Data were collected the following year to create a more substantive dataset and a screencast video made to benefit future students in the course. Findings and discussion Through the course of this activity students developed a questionnaire survey tool based on qualitative responses to brief interviews with medical students and emergent themes based on qualitative analyses. A dataset was created that allowed demonstration of quantitative analyses and extraction of sub-scales from the questionnaire. Further educational resources were developed to ensure sustainability of this educational resource and retention in the taught curriculum. Summary The current article discusses the development, implementation and evaluation of this research methods course component. The application of data collected as part of the activity and its relevance to the educational activity is examined as well as lessons learned for the future running of the project and further evaluation.

Background Southern Africa lacks resources necessary to combat presenting health challenges. This crisis will likely be remedied through the in-country training of healthcare professionals, for example, in Namibia. Monitoring the workforce will be essential to inform planning in health services and training. A national pilot workforce survey in Namibia using a multi-modal sampling approach aimed to test methodology for describing the pharmacy workforce and quantifying preferences towards further training. Methods The survey tool included questions relating to socio-demographics, professional and practice aspects. A conjoint analysis approach was utilised to quantify preferences around study programme, modality of study and cost. Key findings Respondents (N = 135; ~20% response) represented a diverse range of individuals in various pharmacy sectors in Namibia. The majority of respondents reported female gender, private sector working, studying outside Namibia and societal group membership. Societal membership and pharmacy ownership – indicators of professional engagement – were associated with higher age; ownership was also associated with study outside Namibia and practice in community pharmacy. Regarding further study preferences, respondents placed more importance on study programme and modality over cost with the most preferred scenario being a 2-year full-time Masters programme in pharmaceutical industry/regulation by distance learning at the highest cost bracket. Conclusions This national survey sampled the population of pharmacists in Namibia exploring the composition of the profession and preferences towards training. Further work will validate the findings and provide ongoing monitoring of the pharmacy workforce that can be expanded to other professional groups over a larger geographical area.

Background: Routine monitoring of medicine use is costly. Medicine use monitoring in most low- and middle-income countries is heavily reliant on donor support, which is not sustainable. Innovative models to close gaps in monitoring of medicine use are critical towards strengthening pharmaceutical services.Objective: To pilot an inter-institutional collaborative model for monitoring medicine use in Namibia over a three-year period, 2013–2015.Methods: An interventional analytical design that piloted an inter-institutional collaborative model for monitoring medicine use in public health facilities in Namibia was followed. Three key stakeholders – the Ministry of Health and Social Services (MoHSS) division of pharmaceutical services, University of Namibia School of Pharmacy and United States Agency for International Development–funded Systems for Improved Access to Pharmaceutical Services (SIAPS) project – collaboratively designed and implemented a concept model, tools and guidelines for routine medicine use assessment. The model integrated medicine use monitoring as a component of the annual rural placements of Bachelor of Pharmacy students at public hospitals. The pharmacists at the hospitals and MoHSS provided support and supervised the students prior to, during and after the placement. Each student undertook a mini-project on medicine use at the facilities which included data collection, analysis as well as reporting using the World Health Organization or International Network of Rational Use of Drugs indicators. These were subsequently aggregated by the university with technical assistance from SIAPS and findings reported to the Ministry. Data collected by the students on hospital placements were entered in Microsoft Excel® template for descriptive analysis for patient care indicators. All students discussed their findings with health facility supervisors.Results: The collaborative efforts enhanced local institutional and students’ capacity on analysing, reporting and presentation of data on medicine use. A total of three medicine use surveys (MUS) involving over 1938 patients were conducted from 2013 to 2015. The local capacity to conduct medicine use evaluation (MUE) was increased among 74 pharmacy students. At least 15 public hospitals in 12–14 regions participated in the MUS. Findings reveal 83% of prescribed medicines were dispensed; 53%–57% patients were satisfied with medicine information; 50%–59% of patients felt they waited too long (consultation time of more than 3 h) before getting their medicines; over 80% patients did not know how to take their medicines correctly; 56%–80% of dispensed medicines were labelled correctly.Conclusions: A multisectoral collaborative model is cost-effective in medicine surveys, if there are mutual benefits. Student placements provide an opportunity to build local capacity for routine MUE. Ministries of Health should utilise this innovative approach to assess service delivery.

Background. Namibia regards hepatitis B virus (HBV) infection as a public health problem and introduced hepatitis B vaccinations for infants during 2009. However, information on HBV infection in the country remains limited, and effective public health interventions may be compromised in the absence of adequate evidence-based data. Available data from the World Health Organization (WHO) estimate that 15 - 60% of the normal population in many African countries may be positive for one or more of the HBV serological markers. Objective. To investigate the distribution of HBV infection in Namibia, using available laboratory data for 2013. Methods. A cross-sectional descriptive study was conducted using pre-existing electronic laboratory data on HBV infection. The data were retrieved from the central Namibia Institute of Pathology laboratory in Windhoek during January - December 2013. Tests were done on the following three main groups: (i) pregnant women during routine antenatal care (ANC) visits; (ii) patients with HIV/AIDS during antiretroviral therapy clinic visits; and (iii) any other individual suspected of having HBV infection. Results. Of a total of 77 238 hepatitis B surface antigen test results retrieved countrywide, 9 087 (11.8%) were positive. Of the positive results, 246/9 087 (2.7%) were in children aged 0 - 14 years, with the sexes equally affected. HBV infections increased markedly, particularly among females, in the age group 15 - 39 years, reaching a peak in the age group 30 - 34 years. Routine screening of pregnant women for HBV during ANC visits was found to be systematically conducted in only two regions, Ohangwena and Khomas. Conclusions. This study showed high proportions of positive results in pregnant women, patients with HIV/AIDS and individuals suspected of having HBV infection. The Ministry of Health and Social Services and stakeholders may wish to consider improving the routine and surveillance reporting systems for viral hepatitis and uptake of screening for pregnant women in all regions, and expanding HBV screening to other population groups. Population-based or similar studies are therefore required to determine the HBV prevalence and risk factors. This will assist Namibia in developing appropriate national viral hepatitis strategies as per WHO recommendations.S Afr Med J 2017;107(10):882-886

Objective In many low- and middle-income countries (LMICs), limited availability, substandard quality and high prices of pharmaceutical products lead to lack of access to essential medicines and poor health outcomes. Manufacturing pharmaceuticals in LMICs may improve access for patients while increasing the market size for manufacturers. Methods We present a tool for assessment of local manufacturing feasibility of pharmaceuticals, intended for use among key stakeholders during the business development process. The tool consists of five domains: product selection and capacity, market sizing, market entry, funding and quality assurance. Key findings The tool is intended to identify barriers and facilitators for local manufacturing and provide a roadmap for decision-making across multiple stakeholders. A case study in Namibia identified key barriers and facilitators to successful manufacturing in that county. Conclusions Careful consideration of feasibility and potential for success may lead to improved health for the populations of LMIC as well as significant market potential for pharmaceutical manufacturers.

Clinical pharmacy is currently not practised in Namibia. To introduce the concept and skills pertinent to this area of practice, pharmacy undergraduates at Namibia's new School of Pharmacy are introduced to clinical pharmacy from their second year, and progress from theory to practical application on the wards. This approach has led to students having a greater understanding of clinical pharmacy and how it can be applied in practice. Introducing clinical pharmacy progressively at an undergraduate level may help to stimulate interest in the speciality for future career progression.

Tuberculosis (TB) remains one of the world's deadliest communicable diseases. Although cure rates of the standard four-drug (rifampicin, isoniazid, pyrazinamide, ethambutol) treatment schedule can be as high as 95-98 % under clinical trial conditions, success rates may be much lower in less well resourced countries. Unsuccessful treatment with these first-line anti-TB drugs may lead to the development of multidrug resistant and extensively drug resistant TB. The intrinsic interindividual variability in the pharmacokinetics (PK) of the first-line anti-TB drugs is further exacerbated by co-morbidities such as HIV infection and diabetes.Therapeutic drug monitoring has been proposed in an attempt to optimize treatment outcome and reduce the development of drug resistance. Several studies have shown that maximum plasma concentrations (C max), especially of rifampicin and isoniazid, are well below the proposed target C max concentrations in a substantial fraction of patients being treated with the standard four-drug treatment schedule, even though treatment's success rate in these studies was typically at least 85 %.The proposed target C max concentrations are based on the concentrations of these agents achieved in healthy volunteers and patients receiving the standard doses. Estimation of C max based on one or two sampling times may not have the necessary accuracy since absorption rate, especially for rifampicin, may be highly variable. In addition, minimum inhibitory concentration (MIC) variability should be taken into account to set clinically meaningful susceptibility breakpoints. Clearly, there is a need to better define the key target PK and pharmacodynamic (PD) parameters for therapeutic drug monitoring (TDM) of the first-line anti-TB drugs to be efficacious, C max (or area under the curve (AUC)) and C max/MIC (or AUC/MIC).Although TDM of first-line anti-TB drugs has been successfully used in a limited number of specialized centers to improve treatment outcome in slow responders, a better characterization of the target PK and/or PK/PD parameters is in our opinion necessary to make it cost-effective.

SUMMARYThe aim of this study was to demonstrate the epidemiological use of multiple correspondence analysis (MCA), as applied to tuberculosis (TB) data from North East London. Data for TB notifications in North East London primary care trusts (PCTs) between the years 2002 and 2007 were used. TB notification data were entered for MCA allowing display of graphical data output (n=4947); MCA analyses were performed on the whole dataset, by PCT, and by year of notification. Graphical MCA output displayed variance of data categories; clustering of variable categories in MCA output signified association. Clustering patterns in MCA output demonstrated different associations by year of notification, within PCTs and between PCTs. MCA is a useful technique for displaying association of variable categories used in TB epidemiology. Results suggest that MCA could be a useful tool in informing commissioning of TB services.

The aim of the present study was to compare the effect of patient choice on completion rates and adverse drug reactions for patients treated for latent tuberculosis infection (LTBI) using 3-month rifampicin and isoniazid treatment (3RH) or 6-month isoniazid treatment (6H). Data for all patients treated using 3RH or 6H for LTBI between 1998 and 2004 were analysed. In total, 675 patients attended for chemoprophylaxis. Of these, 314 received 3RH and 277 received 6H. From April 1, 2000, patients were offered a choice of regimen; 53.5% completed the regimen successfully, a further 10.3% potentially completed it successfully and 36.2% failed to complete treatment. Logistic regression analysis suggested that successful completion was more likely in patients who were younger (an association that was lost after removing all patients aged

Barriers to delivering quality pharmacy education in developing countries have been identified as limited infrastructure, access to teaching resources, academic staff development, and research capacity.1 In 2010, the International Pharmaceutical Federation (FIP) and the United Nations Educational, Scientific and Cultural Organization (UNESCO) signed an agreement to develop a FIP UNESCO-UNITWIN Global Pharmacy Education Development (GPhED) program. The GPhED network strives to raise the standard of education globally and incorporate best practices through shared resources, expertise, and experience. UNESCO and FIP consider one of the essential factors favoring development in the field of professional competence the exchange of experience and knowledge between universities and other learning institutions. Additionally, collaborative practice by university teachers, researchers, and administrators from different regions across the world could benefit the entire professional community. The aims of the FIP UNESCO-UNITWIN program are global higher education and its development, with a special interest in African nations and low-income countries, empowerment of women as pharmaceutical scientists and academics, sustainable health workforce development, academic capacity building, quality assurance, and accreditation standards, which are all compatible with the overarching aims of UNESCO.2,3 Objectives of the program include promotion of an integrated system of research, training, information, and documentation in the field of pharmacy education through “Centres of Excellence,” which will facilitate intra-regional cooperation. Sharing in all areas is the key and to this end the GPhED program is currently developing three areas of activity that focus on sharing of teaching and learning resources, pharmaceutical education expertise and experience, and research capacity. Resource sharing within the program is being facilitated through SABER (Sharing and Building Educational Resources), an online platform (www.saber.monash.edu) from which resources can be downloaded, used, and shared internationally between academic institutions to improve teaching and learning. Enhanced pharmacy education creates better pharmacists, but creating high-quality student learning resources takes time and money. Sharing educational resources makes sense so students can benefit and learn more, especially in a global profession such as pharmacy where teaching needs are often similar. Sharing and collaborating creates and strengthens partnerships based on goodwill and a shared commitment to educational excellence. The SABER platform is a place to share, discover, acquire, and re-purpose resources for pharmacy education. It also encourages the collaborative creation of new content. SABER is available to educators in pharmacy schools around the world, hosting quality-assured educational resources and providing a trustworthy source of relevant and current material. Being multi-tiered, it allows various access levels for a broad range of users. SABER’s intuitive interface allows users to quickly find existing assets, and up-to-date social-networking tools let them build peer networks to adapt resources and create new material. The site is administered by Monash University on behalf of the GPHeED network and is accessible to all for free. Under a Creative Commons license, SABER enables academics anywhere in the world to share something as simple as an image or a PowerPoint presentation, to large purpose-designed teaching programs in areas relating to pharmacy and pharmaceutical science. The success of SABER depends on academics contributing resources they have developed to share via the database. Another important component in the GPhED program is the formation of the African Centre of Excellence in Pharmacy Education. Ideally, the Centre will facilitate the sharing of ideas, skills, resources, and good practice, including staff exchange for skills and capacity building. The Centre will provide a forum for discussion and debate on trends and developments in pharmacy education, facilitated by network partners, including NGOs and professional agencies, and coordinated by the founding partners. Africa was chosen to establish the first FIP UNESCO-UNITWIN Centre of Excellence because the region is in great need of a pharmacy workforce and lacks educational resources for universities.4 A recent meeting of the 5 founding partner countries – Ghana, Namibia, Nigeria, Uganda and Zambia – was held in Lusaka, Zambia to determine the future activities of the Centre. Five domains for the Centre of Excellence were determined (communication, capability, quality, innovation, and clinical). Each founding partner agreed to take the lead in one of these domains and coordinate projects or activities within them. The founding partners developed and agreed to a communications strategy and will contribute to advocacy, local network building, and communications to ensure the wider success of the Centre of Excellence. Proposed projects of the Centre include a survey of African colleges and schools of pharmacy to establish a database of academic capacity and expertise to facilitate intra-regional sharing of expertise through a visiting academic program. Another project is the development of a “Lab-box” of basic laboratory equipment to improve students’ ability to undertake laboratory experiments to support their learning of basic science concepts. The Centre of Excellence will invite additional countries to become part of the centre to expand its activities and provide a broader base of communication and support in the region. Centre of Excellence activities will also seek to promote gender equality and empowerment for women academics and scientists in collaborative research and policy development. The GPhED hopes to foster international collaborative research by having prospective research students complete a higher degree in their home university in Africa under the guidance of a local supervisor and an experienced international researcher with expertise in the chosen research area. The hope is that the arrangement of shared supervision will enable collaboration in policy synthesis and strategic development, with a focus on international development issues and sustainable practitioner development policies. Public health or service delivery projects are favored by the African universities due to the limited laboratory facilities available, but such projects will contribute relevant health data in the country and increase the capacity for improved health programs and delivery of pharmacy services. The FIP UNESCO-UNITWIN Global Pharmacy Education Development network is in the nascent stages of development, but through the goodwill, enthusiasm, and support of academics across the globe, sharing educational resources, expertise, and experience through such networks will facilitate the provision of quality pharmacy education in developing countries.

The International Pharmaceutical Federation Education Initiative (FIPEd) launched the 2013 FIPEd Global Education Report (available at: www.fip.org/educationreports) in September 2013. This is the first publication of its kind to provide a baseline on the current status and transformation of pharmacy and pharmaceutical science education worldwide. A foundation of scientific and professional education and training is a key factor for pharmacists to develop the capability to improve therapeutic outcomes, enhance patients’ safety and quality of life and help people to stay healthy, as well as advance science and practice. For pharmacy, contemporary forms of initial education and training are vital for the profession to meet the increasingly complex pharmaceutical and public health care demands of populations. The 2013 FIPEd Global Education Report was conducted using surveys in English, French, Portuguese, Arabic, Japanese, Chinese, and Spanish. This resulted in education and workforce data for 109 countries and territories representing around 175,000 pharmacy students and 2,500 education institutions worldwide. Data indicate that education, in both capacity and infrastructure, varies considerably between countries and World Health Organization (WHO) regions, and generally correlates with a country’s population size and economic development indicators. Those countries and territories with lower economic indicators tend to have relatively lower educational capacity and pharmacist production. African countries tend to have lower educational capacity and supply pipelines for pharmacists. This has implications for future parity for access to medicines and medicines expertise. There needs to be an ongoing effort to ensure capacity building linked with initial education and training to meet the health needs of populations. Initial education is key in the development of the health care workforce for the future; better science, better practice, and better health care are all linked to the responsible use of medicines. The proportion of the female undergraduate population is a majority globally, with some regions having an average female pharmacy student enrolment of more than 70%. The relative costs of pharmacy and pharmaceutical education also varies across countries and territories. Fourteen countries in this sample reported no direct student tuition fees (including Afghanistan, Austria, Czech Republic, Denmark, Estonia, Greece, Hungary, Malta, Poland, Serbia, Slovenia, Sweden, Turkey and Uruguay). For those countries in the sample that do charge a direct tuition fee (for domestic students in public universities) the correlation of direct tuition fee payments with gross national income (per capita) is significant. Similarly with the total student costs (ie, direct tuition fee plus public capitation contribution) there are strong positive correlations with gross national income. There is an associated variation in the relative contributions of direct (individual) and public contributions for initial undergraduate education in the higher education sectors. Respondents provided high-level information on quality assurance. Information was sought to characterize whether quality assurance and accreditation was in place within the country and the accrediting body responsible. Sixteen percent of respondents claimed to have no accreditation mechanisms. Of the 64 countries and territories who supplied data in this section, 38 (59%) indicated the existence of a national core curriculum or syllabus for initial education. Forty-seven countries and territories provided data on the proportion of time spent on science-based laboratory learning in the core curriculum, which ranged from 6% to 70%, with a sample mean of around 36% (one third) of curriculum time spent on laboratory-based learning. Degree titles and lengths vary, which suggests differences in content and education provision models between countries and regions. This variance suggests that additional research is needed to examine similarities and differences in the educational outcomes associated with differing degree titles and lengths. The 14 case studies included in the report provide an overview of the transformation that is occurring in pharmacy and pharmaceutical science education globally. Fourteen countries, Chile, Great Britain, Japan, Jordan, Malaysia, Namibia, Philippines, Portugal, Saudi Arabia, Switzerland, Thailand, UAE – Abu Dhabi, USA and Zimbabwe, were purposively sampled based on existing knowledge and asked a series of questions about pharmacy education, relating to current drivers, trends, innovations, transformation and links with national strategy for health care services. The case studies provide an overview of the transformation that is occurring in pharmacy and pharmaceutical science education globally. Notably, there is a shift to patient-centered, team-based practice and to clinically focused, integrated curricula with increasing opportunities for patient and practice-centered and interprofessional learning. Nonetheless, there is still a shortage of pharmacist academics and of clinical preceptors worldwide. The understanding of education and the factors that influence it are essential for human resource planning and for achieving universal access to medicines (Figure 1). We need to provide quality education that meets national and global standards and engage in a socially accountable manner to serve the needs of individual patients and society as a whole. Moreover, there needs to be a strong alignment between the outcomes of pharmacy education and the overall health needs of nations. Figure 1. Needs-based professional educational model.

Education at the University of Namibia, School of Medicine and School of Pharmacy relies on a community-centred curriculum. The aim is to nurture "7-star" doctors and pharmacists that will address the current social and health needs within the country. A sound understanding of the interplay between learning and the learning environment is said to improve interprofessional educational activities. This relationship is dependent on constrictive alignment of not only the aspects of pedagogy, but also that of educational leadership in context of the current and social health needs. In this report, we reflect on the interprofessional-learning environment that was created out of necessity within a Namibian context.

Background To research patient perceptions of medicines and illness in a multicultural setting, it is appropriate to translate research materials. However, the translation procedures should be valid and reliable to assure accuracy. Objectives To translate into 3 languages—Turkish, Urdu, and Bengali—a research questionnaire investigating illness and medicines perceptions of tuberculosis patients and to validate the translation. Methods A 4-stage protocol for the translation and validation of research questionnaires investigating illness and medicines perceptions was designed and implemented. This involved forward and back-translation, group-validation, and post hoc conceptual equivalence rating in 3 different languages. Results The translation protocol was found to be very useful in identifying discrepancies between original and translated versions; a total of 83 amendments were required. Post hoc evaluations also demonstrated improvements for 2 of the 3 language translations. Some redundancy was apparent and an improved protocol was suggested by the authors. Conclusions This study demonstrated that including a protocol for translation and validation of the translation is crucial to assure accuracy in multicultural research.

Aim: Attitudes and practice concerning complementary and alternative medicine (CAM) are currently an area of considerable importance. However, little is known about the overall importance of CAM in groups of health care professionals. Therefore, the primary objective was to analyse the knowledge about and use of CAM in an ethnically diverse student population at the London School of Pharmacy. Methods: A questionnaire was administered to students (264 completed questionnaires, response rate: 59.1%) and in-depth interviews were carried out with a sample of seven students. Results: Forty-three percent reported using at least one type of CAM during the last 12 months. The types of CAM used that were most frequently mentioned include aromatherapy, Traditional Chinese Medicine (TCM) and medicinal herbalism. TCM was reported by students of Chinese origin and by students from other ethnic backgrounds. However, Ayurvedic (Indian) medicine and medicine from Africa were only used in cultures from which the users originated. The study shows that a large number of herbal medical products were commonly reported by students of pharmacy. Conclusion The knowledge about and use of CAM is widespread among this group of future health care professionals and the students also expressed a strong interest in the topic. In-depth studies on the knowledge and use of CAM among other health care professionals and among ethnic minorities are urgently needed and may help to better manage the treatment of minor disorders as well as chronic diseases.

Forage sorghum has been identified as a potential source of biomass for heating by direct combustion. An important aspect of the production system is crop drying prior to storage or processing, such as pelletizing. In order to properly evaluate the effects of maceration or other similar treatments on the field drying of sorghum, a baseline of the drying characteristics of sorghum needs to be established. This was accomplished by drying samples of sorghum stalks in an Armfield UOP8 laboratory-scale tray dryer at an air temperature of 50°C and air velocity of 0.5 m/s. Stalks were cut into either 200 mm or 50 mm lengths. For some of the 200 mm lengths, the ends were sealed in paraffin wax to duplicate infinite cylinders so that the drying characteristics of the waxy skin could be determined separately from the cut ends. The data was fit to several standard exponential type models, including a two-term Newton model, and a separation of variables model based on Fick’s law. The length of the stalk and the sealing of the ends significantly affected the drying rate. Statistical indicators demonstrated that standard exponential models adequately capture the drying curves and are on par with the separation of variables model. The two-term Newton model and the separation of variables model provided a distinction between the axial and radial moisture migration. Using the separation of variables model, the effective diffusivity of sorghum stalks was determined to be 4.17 x 10-8 and 8.81 x 10-6 m2/hr in the radial and axial directions, respectively.

There are growing concerns over the oversupply of pharmacists amid continued growth in the pharmacy education sector in the United States.1 Brown predicts that 21 US states will increase the number of pharmacy graduates by 100% or more from 2001 to 2016, with no sign of a slowdown and a declining demand in the market.2 The author paints a bleak picture and argues that the profession should not simply allow market forces of survival of the fittest to correct the imbalance. However, there appear to be encouraging signs of expansion of the profession. For example, the broadened and well-defined role of the clinical pharmacist, not just in the hospital setting but in the community; the range of the profession in seeking traditionally hard-to-reach communities and less desired nightshift work; task-shifting from the medical profession; and a comeback of the compound pharmacist.3 The US situation does not appear to be unique, with a proliferation of both pharmacy schools and pharmacy graduates reported in other countries such as the United Kingdom and Canada. In response to this, the United Kingdom is examining a cap on student numbers.4 There are, however, vast differences in the pharmacy workforce globally. The International Pharmaceutical Federation Global Pharmacy Workforce Report (2009)5 identified sub-Saharan Africa as the area with the smallest proportion of pharmacists. Although the report did not include an analysis of schools of pharmacy or other pharmacy education programs, there appears to be a similar trend in the educational output. For example, the southern African countries Botswana, Namibia, and Swaziland are creating pharmacy programs for the first time.6 These countries share similarities besides their geography and disease profiles in that they are all low-population countries. They also all neighbor the Republic of South Africa where pharmacy education has long been established with a relatively healthy pharmaceutical industry sector. This might also explain why pharmacy education has been slow to take off given the huge investment required to initiate such programs when it may make more economical sense to train pharmacists in neighboring or wider countries. A report by Brock et al, 7 for example, suggested that an increase of 50% of pharmacists to steady state may be sufficient to meet the pharmaceutical care demand in Namibia. While this may seem a significant challenge, with the number of registered pharmacists in Namibia hovering at about 200 (a professional group less than the number of pharmacy graduates predicted for 2016 in 25 US States), an output of 20-30 pharmacy graduates per year over a decade may be all that is necessary. In this setting, there is little room for competition and little room for significant growth in the education sector except to consider international students, postgraduate programs, continuing professional development, and other educational programs such as technician training. This trend between oversupply in the “developed” setting and undersupply in continents such as Africa is not truly a dichotomy. In Ethiopia, for example, there were reported to be upwards of 12 pharmacy education programs, 8 some of which with support from US institutions.9 With a population of over 90 million people, this may not be surprising but could also result in government initiated rationalization to avoid oversupply and/or a loss of quality in the profession. While there are some stark differences between pharmaceutical care needs in different settings and the resultant educational strategies (for example, the clinical emphasis of North American education vs the emphasis on the pharmaceutical industry in some South African courses), there are also some lessons to be learned by policymakers and educationalists from the global trends observed in pharmacy education. Observing how educational output can change the profession might call some to question whether the tail wags the dog.