title: Emerging roles and competencies of district and sub-district pharmacists: a case study from Cape Town.
abstract: BACKGROUND
  District and sub-district pharmacist positions were created during health sector reform in South Africa. High prevalence of HIV/AIDS, tuberculosis and increasing chronic non-communicable diseases have drawn attention to their pivotal roles in improving accessibility and appropriate use of medicines at the primary level. This research describes new roles and related competencies of district and sub-district pharmacists in Cape Town.
  
  
  METHODS
  Between 2008 and 2011, the author (HB) conducted participatory action research in Cape Town Metro District, an urban district in the Western Cape Province of South Africa, partnering with pharmacists and managers of the two government primary health care (PHC) providers. The two providers function independently delivering complementary PHC services across the entire geographic area, with one provider employing district pharmacists and the other sub-district pharmacists. After an initiation phase, the research evolved into a series of iterative cycles of action and reflection, each providing increasing understanding of district and sub-district pharmacists' roles and competencies. Data was generated through workshops, semi-structured interviews and focus groups with pharmacists and managers which were recorded and transcribed. Thematic analysis was carried out iteratively during the 4-year engagement and triangulated with document reviews and published literature.
  
  
  RESULTS
  Five main roles for district and sub-district pharmacists were identified: district/sub-district management; planning, co-ordination and monitoring of pharmaceuticals; information and advice; quality assurance and clinical governance; and research (district pharmacists)/dispensing at clinics (sub-district pharmacists). Although the roles looked similar, there were important differences, reflecting the differing governance and leadership models and services of each provider. Five competency clusters were identified: professional pharmacy practice; health system and public health; management; leadership; and personal, interpersonal and cognitive competencies. Whilst professional pharmacy competencies were important, generic management and leadership competencies were considered critical for pharmacists working in these positions.
  
  
  CONCLUSIONS
  Similar roles and competencies for district and sub-district pharmacists were identified in the two PHC providers in Cape Town, although contextual factors influenced precise specifications. These insights are important for pharmacists and managers from other districts and sub-districts in South Africa and inform health workforce planning and capacity development initiatives in countries with similar health systems.
authors.affiliation: School of Public Health, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa. hbradley@uwc.ac.za.
authors.forename: Hazel
authors.initials: H
authors.lastname: Bradley
authors.affiliation: School of Public Health, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa. ulehmann@uwc.ac.za.
authors.forename: Uta
authors.initials: U
authors.lastname: Lehmann
authors.affiliation: School of Public Health, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa. nbutler@uwc.ac.za.
authors.forename: Nadine
authors.initials: N
authors.lastname: Butler
mesh_terms: D002947:Cities; D002983:Clinical Competence; D003157:Community Pharmacy Services; D003695:Delivery of Health Care; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D007857:Leadership; D010594:Pharmacies; D010595:Pharmacists; D011320:Primary Health Care / Q000379:methods*; D024382:Professional Role; D011634:Public Health; D013019:South Africa; D014505:Urban Population; D000078329:Workforce