Why I fought for change in Nigerian health sector – Akintayo
The quest to ensure that the Nigerian government accorded the health sector its appropriate status as a multidisciplinary sector where many scientists make huge contributions as team players in providing health care to Nigerians, prompted the decision of the outgoing President of the PSN, Pharm. Olumide Akintayo, to fight against what he described as fundamental distortion in the sector throughout his tenure as helmsman of PSN.
Speaking with Pharmanews in an exclusive interview at his office in Lagos on a number of issues affecting pharmacy in Nigeria, Pharm. Akintayo argued that the fundamental distortion in the health sector in Nigeria was built around the tendency of medical practitioners to always want to take all privileges and resources meant for the health sector in Nigeria.
Akintayo who spoke extensively on the up-coming 88th Annual National Conference of the PSN, noted that there was nowhere else in the world where such fundamental distortions were allowed in a multidisciplinary sector like the health sector.
Below are excerpts from the interview.
The 88th Annual National Conference of the PSN is here with us. What measures are you putting in place to make it a memorable one for participants?
One of the things I promised when I was campaigning to become PSN president was that we would tinker with the conference planning so that we could come up with a PSN conference with benefits that everyone would appreciate. Today, I believe we have been able to do that to a large extent.
Talking specifically about this 88th National Conference, as part of promoting a new culture of relationship management, we will take off with some new strategic interest groups. We are trying to generate the building blocks of a more virile profession. We now have forums like the Deans’ Forum, which encompasses all the deans of all pharmaceutical schools in Nigeria. We have also DPS’s Forum, which is a forum for all directors of pharmaceutical services in the country. We have Head of Pharmacy Departments of Federal Health Institutions Forum. We kick-started this actually in Uyo, last year, and we shall therefore continue this year. It is a continuation of that agenda.
The MCPD profile has also changed a little. We now run active MCPD sessions because the Pharmacists Council of Nigeria (PCN) has graciously approved that 10 credit points be earmarked for PSN and its affiliate programmes. So, we now have well-structured MCPD programmes free of charge.
Also, recently, we launched collaboration with GSK. This conference affords us the opportunity to showcase this. I believe you are aware that the partnership with GSK will afford participants the opportunity to get ACC certification. These are benefit packages we shall begin to enjoy as pharmacists.
One of the new and unique innovations we are also coming up with at the opening ceremony is the celebration of our talented colleagues. I have always said that pharmacists are clearly some of the best in any clime. And recently I was again proven right when it emerged that the best graduating student in one of our frontline universities, University of Nigeria, Nsukka, in the last academic session was actually a pharmacist. She graduated with a grade point average of 4.88 out of 5.0. That is the stuff pharmacists are made of. These types of people need to be celebrated and showcased. So, we are going to specially celebrate this pharmacist at our opening ceremony.
We have also come up with the Evergreen Award to celebrate legends of pharmacy. We are going to celebrate the inimitable Prince Julius Adelusi-Adeluyi, who turned 75 recently. He has received awards from so many institutions and organisations and it is only proper that at home we should celebrate him. He will be the very first recipient of our Evergreen Award of the PSN. This award is an innovation of this outgoing PSN NEC. It is an award for legends of the profession – people who have contributed significantly to the profession; and you cannot discount the contributions of Prince Adelusi-Adeluyi to this profession.
Also, our traditional VIP Forum which is one the innovations we brought to our conference is also holding this year. Our first VIP Forum was dedicated to our past presidents. Last year, we dedicated our VIP Forum to captains of industry. This year, we have decided to dedicate the VIP Forum to people who are not exactly members of our profession but who have been great blessings to us. I have a long list of such people who have assisted this outgoing administration in government in the private sector and I want to bring them together on this platform of VIP Forum to say a big “thank you” to them.
We are also bringing back the full dimensions of having a scientific conference by having abstract and postal presentations. We are intensifying on all those core values at the conference to improve our MCPD sessions.
Also, as the saying goes “All work and no play makes Jack a dull boy.” We are thus bringing back the social flair to our conference. There will be opportunity to dance and party for participants at the conference, especially the younger ones. We are dedicating an entire night for socials.
There will also be an election as you know. There will be change of guards and we are all set for that. We are going to have elections at our AGM and we have assured all players and contestants that we would guarantee a level playing field so that the very best in our profession can emerge for leadership assignments.
At the end of it all we should be able to come up with very strong resolutions that will help us take the profession forward.
You campaigned for the PSN presidency promising to deliver on a 13-point agenda. I have covered the PSN activities since then and quite a number of things have been achieved. How many of the objectives you set for yourself at the inception of your presidency have you achieved?
As you rightly stated, at the inception of this presidency, we had a 13-point agenda as a major plan of action. And as at last year, when I was giving an update at the PSN conference in Uyo, we had covered 12 of the 13 points. The only promise that we have not delivered on directly was our promise to establish a National Postgraduate College of Pharmacists that will promote a completely Nigerian agenda that is a little different in flair from what we have at the West African Postgraduate College of Pharmacists. Unfortunately, we could not do that because of the delays in getting the consultancy cadre circular approval. But, I want to thank God because I know that even before I bow out as president, the circular, I believe very strongly will be ready.
I have information that the residency training for pharmacists in Nigerian teaching hospitals has been approved. It is a prelude to the consultancy stuff. So we have made some progress. It is my conviction that once the consultancy circular is out, now that the residency training is ready, we can now go to the national assembly to formally seek for the establishment of the National Postgraduate College of Pharmacists. But, even when we don’t have that, we can start running our programmes under the framework of the West African Postgraduate College of Pharmacists. That was one direct promises we did not deliver on.
One other area that we pursued even when I did not directly promise was to have the Pharm.D degree formally instituted in Nigeria. That has not been achieved but it is one of the major areas we would recommend to our successors to pursue very vigorously.
A major issue you also pursued seriously as PSN president was trying to ensure all health care professionals were treated fairly as members of the health team. You had a running battle with medical doctors and the government over this issue. What prompted your position on this and what are the lessons to be learnt from that struggle?
I want to say that as pharmacy students in the university, we go through some of the most impossible conditions. Especially in the period of the 60s up to the 80s. I can say it anywhere that Pharmacy is one of the toughest courses to study in the university. I have told people of how we run courses everyday throughout our entire university days from 8am to 6pm, Mondays to Fridays. That was the schedule. We were in the laboratory, at least, every day for one laboratory session. We only had a break of one hour, between 2 and 3pm. That was how it was for those of us trained at the University of Ife (now Obafemi Awolowo University).
Now, when you run through such programme and then get out of the university to begin to hear some very disparaging talks and get shabby treatments, then it compulsorily calls for self-evaluation. That was what this was all about.
I have said before and I repeat it with all sense of responsibility that the fundamental distortion in the health sector in Nigeria was built around a certain “grab-grab syndrome” of medical doctors in Nigeria. They always want to grab all privileges and resources that are meant for the health sector in Nigeria. Some people have asked me what is grab-grab syndrome and I have made it very clear that if there is an opening for minister for health, commissioners of health, permanent secretary or heads in health institutions, a doctor believes it is his birth right.
Unfortunately, to compound the problem, we had a neo-colonialist dispensation of the late Prof. Olikoye Kuti as health minister, such that he influenced the military government of that time to put some things even in black and white. Assigning privileges like “for you to be this, you have to be a doctor.”
There is nowhere in the world that you have such things. For God’s sake, the health sector is a multidisciplinary sector comprising some of the finest assemblage of scientists. There are pharmacists, medical laboratory scientists, physiotherapists, nurses etc and of course, doctors.
The condition necessary to study any of these health science courses is exactly the same and I make bold to say that the cut-off mark, at least, when we got admission into the university at the Faculty of Pharmacy was higher than what they had in Medicine. That was at University of Ife. That was the tradition that time. The A-level cut-off for pharmacy was 12 points. That means you had to make an average of B’s in BSC. That was what pharmacy students went through.
So, I had a responsibility and I took it even personal and sometimes went too far. My due respect to those who feel we hurt their sensibilities in the course of this. Although today, we are not where we want to be, but a few things have been spelt out.
One of the things (with due modesty) that I succeeded in establishing firmly at the national assembly, especially to the senate leadership and the house committee on health, especially during the public hearing on the epic struggle for the National Health Bill was that there is a provision in section 42 A and B of the 1999 constitution. It states that there is equalisation philosophy and principle. That clause forbids and prohibits discrimination against the citizens of Nigeria on the basis of social, religions, cultural and affiliations and I dare add pro
You cannot come and tell me, for instance, that after 30 years post-qualification practice and having served as president of the PSN, Fellow of the prestigious NIM and Fellows of so many organisations outside the pharmaceutical sector, that I cannot be chairman of a committee on health issues or that I cannot be minister of health. That will be a climax of absurdity for any responsible or reasonable person to take such a position. I think it is beginning to sink that such a position is untenable and unacceptable.
I think our fight has helped to modulate those coming up with health statutes today. However, as I said, we are not yet where we want to be because we still have the extremely draconian and obnoxious decree of 1985 to deal with, but a few things are better now.
The illogicality of that 1985 decree 10 was that it was used as a tool to destroy the careers of so many health professionals in this country. This is because up till about three years ago, none of them could get to the apogee in the public service. They could not get to grade level 17, which is the peak in public service. The civil service norm is that once you are a university graduate, you can get to grade level 17; but that 1985 decree perpetrated an aberration in the health sector that made it impossible for many other health professionals other than doctors to get to that level 17.
Today, we have changed some of those things. Pharmacists and other health care professionals can now get to grade level 17. At the last count, about 15 of our members have today become directors. So, our struggle has yielded dividend in some areas.
I remember the former health minister, Prof Chukwu, declaring at a full forum for all health professionals that it is only medical doctors that can be called consultants. It was one of the greatest surprises or declaration I have ever heard in my life. This is because when it suit people, they mouth global best practice, international best practice, but when they come down home here in Nigeria, they will be doing all sorts of things.
I remember telling Professor Chukwu on that occasion that leadership ought to be respected not suspected but that because of his unfortunate declaration that day he left me with no other choice but to perpetually suspect all his motives because it was clear he could not protect my destiny.
Those were some of the things that triggered our resolve to take them on and have some things sorted out. I give God the glory that we got some result. Results have been trickling in. I have no doubt that we have been able to sensitise people that you have established chartered liberties to purse conventional rights. There are still so much more to be done and I believe our successors will consolidate on the foundations we have laid.
Another major issue that came up during your tenure was the new National Drug Distribution Guidelines (NDDG S). You were in support of this policy, but its implementation has not been smooth-sailing with amendments here and there based on industry reactions. What are your thoughts on the state of the NDDGS today?
Let me start by saying that too many things have gone wrong with drug distribution in Nigeria and you have also witnessed some of the developments. It was the various calls by the PSN that made president Obasanjo to come up with the Presidential Committee on the Pharmaceutical Sector which eventually generated the NDDG guidelines.
Let me put on record again that it was Olumide Akintayo as PSN president that wrote the immediate past minister for health, Dr Alhasan Khalilu on the need to ensure the implementation of the NDDGs from July 1, 2015 after the initial postponement. And we had assurances that this was going to happen. It did happen when the permanent secretary who was in charge came up with the ministerial press briefing to flag off the NDDGs. Of course, this created and generated some entropy especially from the pharmaceutical industry but I think the good news is that after interactions with various stakeholders, we have come to a point that all of us have agreed and government has approved that players at the level of wholesaling be expanded to give people a lot of options.
People still do not understand so many things about the NDDGs. So, one of the things we have done is to create a special forum that will be dedicated solely to the business of NDDGs in Nigeria at our conference. Today, we have a regulatory forum comprising PCN, NAFDAC and the Federal Ministry of Health, and they are driving this agenda. I can assure you that the PSN is working closely with them.
There are areas that are still work-in-progress. There is a newly approved drug distribution flowchart. One of the things that I ultimately believe we need to deal with is the menace of the open drug markets, and my appeal to colleagues, to stakeholders, is that this is an age-long problem. We must be grateful to the government because it appears it is willing to bring this problem to an end. However, we have to face the reality that you cannot run your race faster than the environment you find yourself. We have to things within the ambits of the law. I think that is where we are and I can tell you we have made some progress.
What is your advice to the incoming PSN leadership?
My advice to my successor is that when it comes to decision-making, you have to fair, bold and decisive. However, that feeling of compassion must be at the heart of it.