Closing the Cancer Divide in Tanzania:
The Role of Global Oncology Pharmacy
Randy Hurley MD, cTrop Med, BS Pharmacy
HealthPartners and Regions Cancer Care Centers
Foundation for Cancer Care in Tanzania
Acknowledgements:
Mary Cooke Pharm D
Jill Strykowski MS, RPh, BCPS
Monique Giordana Pharm D, BCOP
I have no conflicts of interest
Global Oncology Pharmacy
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The evolving role of Oncology Pharmacy professionals
Role of Oncology Pharmacy in resource-constrained settings
Pharmacy practice in Tanzania
Visions for the future
Inpatient Oncology Pharmacy,
University of Wisconsin Hospital, 1982
• Technician med administration
• Drug order MAR transcription
• Admission & discharge
counseling
• Care team rounding
• TPN monitoring
• Pharmacokinetics
• Chemotherapy administration
Scope of Oncology Pharmacy Practice
• Clinical skills and
therapeutic management
• Generation, interpretation
and dissemination of
information
• Guidelines, policies and
standards
• Public health and advocacy
HOPA Scope of Hematology/Oncology
Pharmacy Practice 2013
Mary Cooke Pharm D,
Pathways to advance oncology
pharmacy practice globally.
13th annual HOPA meeting
April 2017
HealthPartners Cancer Care Centers Scope of
Oncology Pharmacy Practice
• Supervise all aspects of
chemotherapy
• EHR order sets
• Double checks
• Policy/procedures
• Quality assurance
• Patient counseling
• MTM
• Inpatient rounding
Monique Giordana Pharm D, BCOP
Regions Cancer Care Center
International Society of
Oncology Pharmacy Practitioners
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Education
Advocacy
Annual meeting
Journal of Oncology
Pharmacy Practice
Recommendations for oncology pharmacy in
resource-constrained settings
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Procurement
Storage
Preparation and dispensing
Disposal
Training
Cost containment
Stother M. JOPP 2012
Drug procurement in
resource-constrained settings
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Essential medicines list
Bulk purchasing
Reputable suppliers
Personnel on procurement
board of hospitals
• SOP for drug purchasing
Drug storage in resource constrained settings
• Physical security of storage
location
• Refrigerator hooked to
back up generator
• SOP for drug inventories
and management of
discrepancies
Preparation and dispensing in
resource-constrained settings
• Physical infrastructure to
limit exposure
• Sterile products hood
• PPE and changing room
• Fixed dose rounding
• Pre-printed order sets
GHM shipping container
Safe drug disposal in resource-limited settings
• SOPs for chemotherapy
waste
• Disposal collection
containers
• Functional incinerator
Personnel training for resource-constrained
cancer centers
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Safe handling
Safe disposal
Chemotherapy spills
Administration
Extravasation
Infusion reaction kits
Cost containment
• Bulk purchasing
• Dose rounding and fixeddosing
• Defined cost-effective
treatment protocols: an
“NCCN” for resourceconstrained areas
• Disease guidelines and
priorities
Health economics, Pharmacology,
Pharmacogenetics, Acceptable toxicity
Nutritional status, Intercurrent illness
Tanzania Pharmacy Workforce:
Education
Pharmaceutical Assistant:
• 2 year certificate
Pharmaceutical Technician:
• 3 year diploma
• Education focuses on
supply chain, calculations,
and some clinical
Pharmacist:
• 4 year bachelor degree
• Clinical pharmacy training
Source:, 2009. Ministry of Health of Social Welfare.
Industry & Labor Force Statistics
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Pharmacies/Dukas in Tanzania: 5241
Pharmacists in Tanzania: 704
Pharmacies per 10,000 population: 1.08-2.61
Pharmacists per10,000 population: 0.01- 1.37
Pharmacist Salaries
Source: Assessment of the Pharmaceutical
Human Resources in Tanzania, 2009.
Ministry of Health of Social Welfare.
Industry & Labor Force Statistics
Source: Assessment of the Pharmaceutical Human Resources in Tanzania, 2009. Ministry of Health of Social Welfare.
Ilula District Hospital
Pharmacy Services
• 15 year commitment form
Minnesota-based NGO
• Frank Sanga, Pharmacy
technician
• Annual inter-professional
global health elective,
UofM College of Pharmacy
Ilula District Hospital
Pharmacy Services
• Frank Sanga, pharmacy
technician
• Procurement officer
• Dispensing by nurses and
midwives
• Hospital management
team
• QI team
Ilula District Hospital
Pharmacy Services
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Increasing clinical role
Retrospective QA
“Out of stock” shortages
HIV Clinic
Oncology Pharmacy
KCMC, Moshi Tanzania
•Dedicated pharmacist
•SOPs
•Secure storage room in clinic
•Mixing hood
•Training
•Fundraising for chemo
Rahim Senkondo, Pharmacist
Oncology Pharmacy
KCMC, Moshi Tanzania
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Additional staff
Drug shortages
PPE shortages
Changing room
Additional training
Rahim Senkondo, Pharmacist
The future of oncology pharmacy
at KCMC
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Education
Academic affiliations
Society affiliations
Expanding clinical role
Simulation-based learning chemo administration
Conclusions
• Oncology pharmacy is a key component of closing the global
cancer divide
• Oncology pharmacy professional societies are beginning to
expand their global connections
• Although professional pharmacy in Tanzania is still evolving,
the Cancer Center at KCMC has developed a strong oncology
pharmacy program
• There are exciting opportunities to partner with oncology
pharmacy at KCMC