In April 1994, South Africa underwent the most significant change in its recent history with the disbandment of the policy of apartheid and the attendant race-based politics, which affected most aspects of the country and, of relevance to this review, the education, health delivery, and career choices that race groups could pursue. In the past 28 years, the South African government has tried to implement policies in order to advance political and socioeconomic shifts toward a more equitable society. The healthcare sector was an early target for transformation that was aimed at increasing access to services and the expansion of primary healthcare and hospital facilities to previously underserved areas. This paper seeks to discuss these changes in broad terms, but with specific reference to general health care and pharmacy practice in particular. It will look at the changes in the legislative framework and pharmacy education and factors impacting the pharmacy practices in South Africa over the past 28 years. A discussion of the critical issues that have affected the profession in the last three decades will also be delineated, and future prospects for the profession as a whole, in terms of pharmacy practice and perspectives, will be discussed. We review the current aspects of the pharmacy profession in South Africa today and how the education of those future professionals is a major contribution to the pharmaceutical climate.

Background Medicines for non-communicable diseases (NCDs) are essential in the management of patients with NCDs therefore, it is important that they are readily available to patients at health facilities. Objective This study aimed to assess the availability of medicines used in the management of hypertension, diabetes mellitus, asthma and epilepsy in public outpatient departments (OPDs) and healthcare centres in Lesotho. Methods A cross-sectional study was conducted at public OPDs in district hospitals and healthcare centres in Lesotho using self-administered structured questionnaires targeting all health workers in managerial positions. Ethical approval was obtained from a licenced Health Research Ethics Committee (HREC) (Ethics number: 00048-18-A1) and the Ministry of Health Ethics Committee and Review Board of Lesotho (ID120-2018). Data were analysed descriptively. Results Ten of 16 respondents at OPDs perceived that medicines for diabetes mellitus were available and nine thought those for hypertension and asthma were available. Eight of 16 respondents perceived that medicines for epilepsy were available at OPDs. At healthcare centres, 73.3% (n = 63) of respondents perceived that medicines for diabetes mellitus were available, 62.8% (n = 54) thought hypertension medicines were available, 68.6% (n = 59) indicated that medicines for asthma were available, and 61.6% (n = 53) perceived that medicines for epilepsy were also available. Conclusion The majority of health workers at OPDs and healthcare centres perceived that medicines for hypertension, diabetes mellitus, asthma and epilepsy were available at health facilities. Thus, suggesting that the public health facilities in Lesotho seem to almost always have medicines for NCDs.

Background: Despite being in use for over 50 years, the physicochemical challenges posed by methyldopa remain ever present. Methyldopa is not only significantly hygroscopic, but also prone to oxidative and hydrolytic degradation that can be accelerated by moisture. Poor compression behaviour, another limitation of methyldopa, leaves the formulation scientist with a constellation of formulation hurdles that must be faced, understood, and overcome. This is a task that can be tackled using elements of the Quality by Design (QbD) approach. Objective: The study aimed at developing an optimal formulation of methyldopa into 250 mg immediate release tablets by direct compression using elements of QbD. Method: Excipients of pharmaceutical grade were selected for the candidate formulation, preliminary concentrations set for each and settings for mixing and compression variables established. The risk posed by all these factors was evaluated using Failure Modes and Effects Analysis (FMEA). The preliminary experiment was executed using a 12 run Plackett Burman design. A 16 run Box-Behnken experimental design successfully aided in the identification of excipient concentrations and manufacturing conditions that yield tablets of optimal quality. Results: FMEA revealed that magnesium stearate, colloidal silica, sodium starch glycolate (SSG), citric acid monohydrate, mixing speed, duration of pre-lubrication mixing, duration of lubrication and compression speed were critical risk factors. The optimal formulation was achieved at the following settings: 1 % m/m magnesium stearate, 1 % m/m colloidal silica, 3.9 % m/m sodium starch glycolate, 1.7 % m/m citric acid monohydrate, mixing speed of 101 rpm, 6 minutes of pre-lubrication mixing, 2 minutes of lubrication and compression speed of 20 rpm. Conclusion: The QbD tools used in this study enabled, not only achievement of optimal quality, but also a better understanding of the impact of critical formulation variables on tablet quality. Challenges to pharmaceutical development can be effectively overcome using the QbD approach.