What future has Pharmacy in Nigeria?
Pharmacy is the science and technique of preparing and dispensing drugs. It is the health profession that links the health sciences with chemical sciences and aims to ensure the safe and effective use of pharmaceutical drugs (Wikipedia). From this definition, the importance of Pharmacy to health care delivery in any nation cannot be overemphasised. It occupies a central position now and will continue to be so for as long as there are diseases which require drug therapy. It is therefore necessary and very important for us to continue to talk about the future of the profession with a view to catching up with the rest of the world.
Pharmacy in Nigeria has gone through different stages of development. From mere government dispensers many years ago, pharmacists have moved on to become first class scientists with specialisation in different fields of Pharmacy. Today, there are about 17 schools of Pharmacy in Nigeria (accredited by the Pharmacists Council of Nigeria (PCN)) offering courses from Bachelor of Pharmacy degree to the Doctor of Philosophy (PhD) level. There are 19,559 pharmacists in the register of the PCN but only 11,336 of this number renewed their licences in 2014. With a population of more than 170 million, Nigeria has one of the lowest “pharmacist to 10,000” population figures (less than 1). This pharmacist to population ratio may not improve significantly very soon as our universities are only producing an average of 1,165 pharmacists per year (2012-2014 data). There about 6000 Nigerian pharmacists practising abroad, mostly in Europe and America, and there are so many others who have chosen other endeavours in Nigeria.
In terms of practice, it was estimated in 2013 that there are about 127,068 health care facilities in Nigeria, largely skewed in favour of urban settlements, leaving the rural setting with little or nothing. Most of the federal and state government owned facilities have pharmacists in their employment. There about 8,500 community pharmacy outlets and 52,000 patent medicine stores. This number refers to the registered outlets and I am sure that the number of unregistered outlets will be in multiples of the quoted figures. Nigeria has a potentially huge local demand for drugs but with pervasive poverty and extreme inequality, only a small percentage of the population can afford quality health care and quality drugs. The Nigerian pharmaceutical industry at an estimated size of $1 -1.6 billion is a negligible contributor (about 0.3%) to the country’s GDP and it is virtually non-existent in the world pharmaceutical map. Only 30 per cent of the drugs sold in Nigeria are manufactured locally. 70 per cent is imported, largely from China and India, and because of weak local control, the market is bedeviled with circulation of fake and adulterated drugs. There is practically no R&D activity as most of the research based companies only have scientific offices in Nigeria.
This profile of the profession and the practice should ordinarily suggest a future that should be exciting as much as it should be interesting. However, the peculiar nature of our society has practically removed the factor of excitement and reduces the work of the pharmacist to that of existence struggle. Despite their sound education, the environment of practice does not allow young graduates to give their best. They are practically released into a system that is completely strange and for which they are ill-prepared. They have to struggle in practically all areas of practice. In the hospital, the doctor is the ‘boss’. He has cornered everything and in fact, will prefer the pharmacist and other ‘irritating’ para-medicals (as he derisively calls the other health professionals) to be thrown out of the hospital. There can only be one head of department who will probably retire as an assistant director or at best a deputy director. Everyone one else must wait. The various leaders at the different federal and state health institutions have not helped matters. Their development agenda have not always have Pharmacy as a focal point of attention. The current and persistent but unnecessary leadership tussle in the health sector has done much damage than good and we can only hope that good reason will prevail very soon. The prejudice against pharmacists and other non-medical health care professionals should stop and the focus should be on the delivery of the best services possible to the patient. When are we going to have a minister of health who will set a developmental target of getting new molecules to treat diseases to come from Nigeria and set the necessary templates or create the enabling environment for this to happen? When are we going to have collaborative medication therapy management, involving doctors and pharmacists, for the benefit of the patients in our hospitals? There so many more questions which I believe, one day, the appropriate leadership will emerge and provide the answers to the satisfaction of all.
For now, the future of Pharmacy is in the hands of the pharmacists themselves. We must continually uphold the tenets of our profession with a firm resolve to protect the interest of the patients at all times. We must adhere strictly to the core values as enunciated by the Pharmaceutical Society of Nigeria. We must remember that the system will appreciate you more for who you are and not for whom you claim to be. It is therefore important for us to repeatedly ask ourselves what our contributions are to the wellbeing of the system that we are serving. We should quit complaining about the system and the environment. If the environment in which you find yourself is not conducive, then create your own environment. The hospital management led by the doctors may not allow you to enter the wards but they will not stop you from organizing educational seminars for patients on drug therapy, particularly for chronic diseases in your department. You will have to live above your environment to have a chance to influence your world.
The Pharmaceutical Society of Nigeria (PSN) and the various technical groups have a role to play in charting the future path for the profession. We need to get the young ones to appreciate the challenges ahead early in their professional lives. They need to decide quite early the area of practice where they want to specialise and this is where mentoring is important for the desired future. The benefits of professional community pharmacy practice must be expanded to the rural setting. We must devise a way to take the emphasis away from self to the society we claim to serve. We must try and replicate successes from one point to the other and spread the benefits of Pharmacy across the country. We must create, develop and sustain a distinct public identity and put a permanent stop to the mentality of comparing ourselves to any other person.
It is my hope that this future is not too far from us. A future where pharmacists will excel beyond the current limitations and expand the horizon of practice. A future where dispensing will be separated completely from prescribing. A future when Nigeria will become a manufacturing hub for pharmaceuticals in Africa and the world. A future when research and development activities will take top priorities in our universities. We really have cause to be proud of whom we are as past and recent histories have listed pharmacists among the world most famous in politics, inventions and management. The three most popular soft drinks in the world were invented or developed by pharmacists: Dr John Pemberton (Coca-Cola), Charles Alderton (Dr Pepper) and Caleb Bradham (Pepsi-Cola). Hubert Humphrey, a pharmacist, was the Vice-President of USA in the sixties. Back home, Prince Julius Adelusi- Adeluyi, at 47 years old, cleared all the top prizes at law school in 1987 and has remained till today a mentor to a vast number of people across the profession. If these people could succeed despite the hostility of their practice environment, then I am quite convinced that we can do better. Dr Hiroshi Nakajima, a Japanese doctor and one-time Director-General of WHO, was reported to have said that: “without drugs, a health care delivery system has no substance and no credibility”. This statement remains evergreen and confirms that the pharmacist’s work as custodian of drugs gives substance and credibility to the nation’s healthcare delivery system. Here lies the future and the hope that the land is green for Pharmacy and pharmacists.
Dr Lolu Ojo presented this keynote address (abridged here) at the Induction/Oath-taking ceremony of the Faculty of Pharmacy, Igbinedion University, Okada on Wednesday, 6 January 6, 2016