Pharmacy practice in Nigeria: Quo vadis?
I consider it a great honour to be invited to deliver the keynote address at the 2015 edition of the Induction/Oath-taking ceremony of the Faculty of Pharmacy, University of Benin. My association with Benin and the University of Benin started more than 30 years ago: first, visiting as a student (PANS) activist and later as an MBA and PharmD student of the University.
A keynote address delivered by Dr Lolu Ojo FPSN at the Induction/Oath-taking ceremony of the Faculty of Pharmacy, University of Benin, on Wednesday, 25 March, 2015.
My formal industrial Pharmacy practice career started (and was nurtured) in Benin. I will, forever, remain grateful to the city, the state (then known as Bendel) and the people for the tender care and overwhelming support received during these formative and difficult years. I made friends, who, even as at today, remain great influencers of my life. One of those friends, today, is my wife, Bridget, who has made life more meaningful and my association with Edo State permanent. I am grateful to the dean, Prof. J. E. Akerele (one of the great friends of those days) and the planning committee for giving me this unique opportunity to share my thoughts on Pharmacy and sundry issues using this very unique platform.
The choice of the topic, “Pharmacy in Nigeria: Quo vadis?” is apt and contemporary. There are, presently, a lot of activities being undertaken to redefine Pharmacy and its practice in Nigeria. We have just concluded a one-day retreat where various groups representing different areas of practice made presentations on the way forward. We are still working on the blueprint arising from the retreat. The Nigeria Academy of Pharmacy is also organising an education summit which will come up between 22 and 24 April, 2015. All these activities are meant to answer the same question that you have challenged me to provide answers to with this topic.
My first contact with the term “Quo vadis” was in the early eighties when we had the privilege to watch a film with the same title at the famous Oduduwa hall of the University of Ife. Quo vadis is a Latin word which translates to mean: “Where are you going?” It was recorded that, Peter, the great apostle of Jesus Christ, was running away from the prevailing persecution of Christians in Rome. On his way, he met the risen Christ carrying a cross and walking on the opposite side. Peter asked the famous question: Quo vadis, that is: Where are you going?
Our task today is to chart a new path for Pharmacy practice in Nigeria by examining the direction to which it is heading. We cannot possibly do a good job of fortune-telling without first examining where we are right now and how we got there.
The history of Pharmacy practice predates the formal establishment of Pharmacy in Nigeria. The healing of the sick was carried out by herbalists who prepared concoctions, balms and ointments from leaves, barks and roots of plants. The herbalist was the doctor and the pharmacist combined. He was very well respected in the community and was the consultant on all health matters. Then, there was peace in the “house of medicine”. Today, things have changed. The professions of Pharmacy and Medicine have been separated and have become more specialised.
It was in 1887 that the first Pharmacy ordinance was set up to control medicines. It was also in 1887 that the first Pharmacy shop was set up, owned and managed by ‘Dr’ Zaccheus Bailey. He was reputed to be kindhearted with a high standard of professional conduct. These attributes made people to call him doctor. Pharmacy then was treated almost like an appendage of Medicine and most of the dispensers were chosen and trained by the medical doctors.
The history of Pharmacy in Nigeria has been well documented and I will urge everyone to read the writings of Chief Andrew Egboh and Dr Fred Adenika (both late) on this subject. The early pharmacists were not accorded official recognition and most of them struggled throughout their careers. However, with perseverance and ardent struggle of our patriarchs, Pharmacy in Nigeria has advanced from the low level of the early beginning to the dynamic state that we have now. Pharmacists now have the opportunity of University education, including postgraduate studies and also with official recognition in the government, academia, hospitals and the community.
One of Dr Fred Adenika’s theses in his 1998 book: ‘Pharmacy in Nigeria’ was that ‘pharmacy development has suffered a remarkable downturn in the last decade’. The decade he was referring to was that preceding 1997 when he wrote the book, that is, 1980 to 1990. This was the period when some strange words crept into our lexicon: fake drugs, import licence, etc. It was also the period when some negative policies were introduced and the gains of previous years were practically eroded. Pharmacy suffered a decline in fortune in the hospital system. The ministry of health practically became the ministry of doctors. The regime of late Prof Olikoye Ransome-Kuti ensured that the relative parity between doctors and pharmacists were removed. The pharmacist became an orphan in the hospital system. It took years of struggle for some semblance of sanity to prevail but, even at that, the harm had been done. If Dr Adenika were to be alive, I wonder what description he would give the state of Pharmacy in Nigeria today.
My thesis for this address is that, in the past two decades, that is, 1995 to date, Pharmacy has had a challenged development in all fronts. While it is true that we have witnessed some individual and collective strides, the overall outlook still leaves much to be desired. From the individual pharmacist to the practice areas, there is no particular section that is spared of challenges:
– The crisis of professional identity persists. What exactly is my role as a pharmacist in the hospital system? What is the task being performed which is reserved for or can only be performed by a professional of my kind? These unanswered questions have taken so many young pharmacists looking elsewhere for satisfaction – acquisition of unrelated degrees, taking up roles completely out of sync with the profession, etc.
– While there are more schools of Pharmacy (about 17 now), the infrastructure and personnel needed to perform at the optimal level are lacking. I am not too sure if the necessary laboratory equipment and reagents are available in all the schools to guarantee adequate exposure for the students. The upheavals in the academic system have compounded the situation which has taken its toll on the quality of graduates produced. I am also not too sure of the adequacy of research grants available to make our teachers perform the research function. Where exactly are we in the struggle for development of new remedies for new and emerging diseases?
– The hospital space is closed. I have heard a lot of complaints on the differential treatment the doctors received in terms of remunerations and other perquisites. Pharmacists feel alienated and the discontent is high. To me, the crisis in the health sector is due to leadership failure. I have written about this before and my conviction remains very strong.
– The community pharmacy sector has not fared any better. There are about 10,000 registered premises known to and regulated by the Pharmacists Council of Nigeria. However, there are more than 50,000 illegal premises scattered all over the country. The open market is a tolerated illegality. They have almost assumed a position of immortality, desecrating everything that Pharmacy stands for.
– The global pharmaceutical industry is an oligopolistic US$ 900 billion market, consolidated mainly in the US, Europe and Japan – with the Asia-Pacific as the new frontiers, and dominated by 15 global conglomerates. It is an industry rapidly growing in countries like China, India, Malaysia, South Korea, Indonesia, South Africa, and Israel. India is the third largest pharmaceuticals producer in the world, while at over 20 per cent growth per annum, China has the fastest growing market. Nigeria, with one of the world’s fastest growing population (currently at 170 million), evidently has a potential huge domestic demand that can support a vibrant pharmaceutical industry. But the story is, lamentably, different:
o With pervasive poverty and extreme inequality, only a small percentage of the population can afford quality health care and quality drugs.
o With an estimated size of $1-1.6billion (PMG-MAN, Frost & Sullivan), the Nigerian pharmaceutical industry is less than 0.3 per cent of the national GDP and is practically non-existent in the world pharmaceutical map.
o Only 30 percent of the drug sold in Nigeria is manufactured locally. 70 percent is imported, largely from China and India.
* Frost & Sullivan estimates “nearly 17 percent of essential generic medicines and as high as 30 percent of anti-malarial are routinely faked in Nigeria”
* Current capacity utilisation rate in Nigeria is only 45 per cent.
* High cost of operation due to high interest rate, multiple taxation, lack of power, etc, making the locally manufactured products less competitive compared to the imported ones.
* Failure to address loopholes in the distribution system.
* There is practically no R&D activity as most of the research-based companies only have scientific offices in Nigeria.
* It is important to note that as at last year, we have about four companies that had been prequalified by WHO in Nigeria. This is a significant improvement in the global rating and has the potential of improved productivity and patronage by international organisations.
This is where we are today and the next question will be: How did we get here? As an emerging profession in Nigeria, we have tried and have been relatively successful in putting Pharmacy on a higher pedestal. There is so much to be done and some of the change factors are under our control as individuals and groups. The story of Pharmacy approximates that of Nigeria as a whole: potentials largely sub-optimised. As a result of mismanagement in the system, our profession has equally been misgoverned.
Now, to the last question: Quo vadis – Where are we going? I am not sure that I have a direct answer for you because it is a system thing. The trajectory should be defined by the policy makers and executors as it is done in other climes.
We are aware of the determination of the countries in Asia particularly India and China to develop the pharmaceutical sector. We expect the same situation here in Nigeria. We had a high hope about the implementation of the New Drug Distribution Guidelines but I am not too sure if this optimism is shared at the highest level of government.
The appropriate question which I can answer directly is: Where should we be going? I am convinced within me that we should be and we have the capacity to move towards professional excellence in all its ramifications. Our success will be determined and or guaranteed if we faithfully pay attention to and implement the following:
- Professionalism: By training, we are, first and foremost, pharmaceutical scientist. We must always carry this toga anywhere we found ourselves. The commercial aspect may be the second or parallel nature of our profession but it is certainly not the primary one. There is a question that we all need to provide answer to – Who is a successful pharmacist?
- Education:I think the time has come for us to speak with one voice on the training of Pharmacists in Nigeria. Apart from advocating for wholesale adoption of PharmD as the minimum qualification for registration and licensing to practise, I will also advocate for a practice-based exposure for all students in the last two years of their training. This aspect should be handled by real life practitioners in the relevant field. I am sure there will be many out there who will be ready to render services without much ado. The new graduates must be protected and guided to succeed right from time zero as pharmacist. Encouragement of personal development initiative is fundamental and I want to challenge all the technical groups to develop appropriate training courses in association with relevant organisations. I am happy that the Nigeria Academy of Pharmacy is working on this.
- Pharmacists in Academia:There must be something that makes us different from others around us. The emphasis on research must be given a new definition. We must find a way to make this work. There is an urgent need for collaboration with other technical groups. What constitutes a model community pharmacy or industrial or even hospital practice? I think it is the duty of our academicians to be pathfinders in this search.
- Community pharmacy:We are still grappling with the challenge of differentiation between a professional outlet and just a store. I think the time has come for us to have a common minimum standard of operation. It must be an enforceable rule for every practisingpharmacist to follow. I wish the ACPN can rise to this challenge and give every caller at a Pharmacy premise the chance to be able to recognise that this is a premise run by pharmacists. It is also time for us to intensify efforts on group practice. All the practitioners before us are all gone with few exceptions. If we do not wish to be like them, then this is the time to do something different.
- Drug distribution:Without solving the problem of drug distribution, it may be practically impossible to have the pharmacy practice of our dream in Nigeria. We should all support the implementation of the New Drug Distribution Guidelines (NDDG). It is a necessary first step towards sanity in the drug distribution in Nigeria. I have gone round the country trying to educate pharmacists on the provisions of these guidelines. We may not get the attention of the government until the election issues are settled. We are going ahead to set up a Mega Drug Distribution Centre which will protect the system and the public. This is the social enterprise advantage embedded in our plan.
- Hospital pharmacy: We must get this sector right. It is the window through which the public perceives the profession. There must be a directed effort to build capacity in this sector. As a group, we cannot afford to let it hang. I have told the last three presidents of the PSN on the need to adopt certain hospitals as models. We must make these model centres to do exactly what hospital pharmacists are doing in a chosen ideal setting abroad. The benefits of the practice from these centres will then be used to convince the government on the need to adopt the system created.
- The industrial sector: The industry must not be allowed to roll on its own. The society and the regulator must define a path for the sector. As it is now, it is highly fragmented, with virtually everybody coming in and out. Various attempts have been made to weld the industry together but differing interests have made the modest gains less impactful as it should be. We need an industry that will be ethical in its activities. We need an industry that will engage in research and support research activities in the universities. We need an industry that will put emphasis on local production not only of formulations but also of raw materials.
- Regulatory aspect: The pharmaceutical sector is a regulated industry. Much of the developmental challenges are from the regulators. It is known that only those who submitted themselves to rules and regulations get challenged every time. The Pharmaceutical space is dirty and is in need of urgent clean up. The PCN is statutorily empowered to regulate the practice of Pharmacy in all its ramifications. I think this is the time for the agency to live up to its name. Leaders should serve and not be waiting to be served. We have lost substantial time to undue emphasis on the ephemerals in the past and with the new lease of life, the expectations are quite high. It is important that the PCN pays attention to Pharmacy human resources. This will be a subject of another lecture in early May at the Obafemi Awolowo University. We must account for everyone.
- The Pharmaceutical Society of Nigeria(PSN):The PSN has been largely responsible for the progress made so far in the profession and that is a befitting tribute to our past and current leaders for their vision and commitment. The current leadership has been exceptionally dogged in the struggle to emancipate the pharmacy profession. However, the next leadership will need a new set of skills to navigate Pharmacy out of the turbulent waters. There is a need for creativity and a move away from problem fixation. New ideas will certainly be helpful. This applies to all the technical groups where action on the Pharmacy of tomorrow will be needed.
It is my hope and belief that the next and pleasant destination is assured if we follow some of these recommendations. Someone once said that “Well done is better than Well said”. How do we match our words with action? We cannot continue to have seminars ad-infinitum without a proper execution plan or capacity. The theme of the last PSN retreat was ‘Walk the talk’ and I want to persuade myself to look forward to a new dawn in the pharmacy profession.
To the graduating students and new pharmacists, my colleagues, I say a big congratulation. You have succeeded in joining a noble profession. Despite all the challenges, Pharmacy is a profession for the brightest and the best. I want to assure you, with all emphasis at my command, that Pharmacy, which you have embraced now, will provide a path for your self-actualisation. Please remember that your PharmD is not the end; rather it is the beginning of the end. You have to start learning how to practise. It is good for you to know that success in life is not always measured by fortune or acclaim. A venture tried, a challenge met, a future that you embrace is successful if only it makes the world a better place to live.
Once again, congratulations. Thank you and God bless.