Why I’m dissatisfied with pharmacy practice in Nigeria – Pharm. Bisi Bright
It was Martin Luther King Jr who once said, “Occasionally in life, there are those moments of unutterable fulfillment which cannot be completely explained by those symbols called words. Their meanings can only be articulated by the inaudible language of the heart.” This perhaps explains the unmistakable joy of fulfillment often reflected on the face of Pharm. (Mrs) Bisi Bright, the executive director, Livewell Initiative, a leading non-governmental organisation committed to delivering health quality care services, especially to the underprivileged.
In this exclusive interview with Pharmanews at her office in Lagos, Pharm. Bright, a Fellow of both the Pharmaceutical Society of Nigeria (PSN), and the West African Postgraduate College of Pharmacists (WAPCP), went down memory lane on the activities of LWI, revealing significant milestones. She also spoke on some general issues affecting pharmacy practice in Nigeria.
Tell us a little about yourself
My name is Pharm. Bisi Bright, I am the chief executive officer, Livewell Initiative, a self-sustaining non-profit organisation that is into public health and education. I am by background a clinical pharmacist and a public health practitioner. I got my first degree in Pharmacy from the then University of Ife (now Obafemi Awolowo University), Ile-Ife, Osun State, after which I worked for many years before going for my first postgraduate programe in Clinical Pharmacy at the West African Postgraduate College of Pharmacists (WAPCP), where I got my Fellowship as far back as 1997. Later on, I did my Masters in Public Health. I also have a diploma in Psychology, Family Planning, and many others.
Tell us about Livewell Initiative
Livewell Initiative is a self-sustaining and very innovative non-governmental organisation that is not donor-funded. Even though most NGOs are donor-funded, LWI is not and has never been. By the time we were founded, it was based on the principle of ethics, accountability and transparency. Those are the core values of the organisation and those core values have really helped to drive innovation within the organisation; and because we are innovation driven, we have been able to attain sustainability and have won several awards.
The organisation was inaugurated officially on 20 September, 2007 at the Muson Centre, Onikan, Lagos, under the auspices of His Excellency, Governor Babatunde Raji Fashola, the Lagos State Governor, who was ably represented.At the time we were inaugurated, we had started running some of our programmes. We wanted toto find out if our policy of not being donor-funded would work.
Why did you decide not to be donor-funded, knowing full well that running an NGO requires lots of money?
At the time we started off, while we were trying to register the organisation and also get people on board, one of our directors, who was a Swiss and who had worked with the World Health Organisation for about 30 years, advised us not to go for donor-funding. She said most donor-funded NGOs don’t usually survive the “weaning” period – a period when an NGO is not big enough to stand on its own. Should majority of the donors decide to withdraw from further sponsorship, the NGO would not survive the stage and usually becomes underfunded. That was what really informed our policy from the beginning. Expectedly, it was a bit tough at the beginning as we had to use personal funds to start off the organisation. We however ensured that our programmes were very appealing to would-be clients so that they would want to work with us and that was how we started.
What kept you going during those trying moments?
When you run a non-profit organisation, you only measure success by sustainability. So we knew from the beginning that finance would be a challenge but we consoled ourselves by accepting the fact that even profit-making organisations do have financial challenges. Therefore, our major inspiration was the fact that, firstly, we realised that our programmes were in high demand. We also found out that we were making an impact, and that we were able to implement cases in which we had deficiency in cash, by barter arrangement, which we found out that most company really liked. That’s what kept us going and encouraged us.
Also, the fact that we could see people getting well; that we could see communties enjoying better health after our organisation’s intervention, kept us going from strength to strength as well.
Comparing your aspirations in the university with what you are doing presently, would you say studying Pharmacy was a good decision for you?
When I tell people about Pharmacy, I always tell them that I had always wanted to read Pharmacy, although I don’t like the way it is being practised here in Nigeria. I have never had any regrets studying Pharmacy because it has really helped me a lot in life.
When you read Pharmacy, you learn to have an eye for detail; you learn to be meticulous and you also learn to be resilient. For you to go through the pharmacy curriculum, you must learn to work lengthy hours and work within a very hectic schedule, involving lots of strenuous activities, while others around you are enjoying and relaxing. So, that has prepared me to go through what I am doing presently and it was like going through pharmacy again and I love it.
What do you think is wrong with the way pharmacy is being practised in Nigeria?
I will speak within two contexts – Pharmacy as a practice and profession, and secondly, Pharmacy as a practice within the health system. For the first one, I really think we could do a bit more in the sense that while Pharmacy is a versatile profession, I have come to discover that most pharmacists tend to toe a particular line.They either go into hospital, community, industry or the academia – those were the areas we focused majorly on, whereas in other countries of the world, pharmacy is so versatile that you can find 20 pharmacists doing absolutely different things and they all arrive at pharmacy practice.
I see myself today as public health pharmacist, but some of my colleagues would say I am no longer practising Pharmacy because they don’t even know that I am still practising the profession. So, it shows that we don’t really know how versatile and rich the profession is; we don’t even know that a hospital pharmacist could be a clinical pharmacist and even specialise in Paediatric Pharmacy, Oncology Pharmacy and many more. Here, once a pharmacist decides to go into a hospital, such may continue working without even thinking of specialising, although things are changing these days.Presently, I am happy as we now have pharmacists who are specialising in Oncology, Paediatrics and so on, even though they are not so many.
The fact that people are not practising properly (they are not specialising) has, to an extent, prevented our voices from being heard in the comity of healthcare practitioners and that is why I said I don’t like the way Pharmacy is being practised here. Even if a pharmacist is in the industry, he should try and specialise more in a particular area and not just be a generic practitioner. Though there is nothing wrong in being in general practice, that does not mean everybody should be general practitioners.
Also, I don’t really like the way pharmacy is being practised within the health system because we don’t have enough pharmacists who are specialists in certain skills and areas to have a voice. So, if a general practitioner comes in and want to make a pronouncement in an area that is highly specialised, the specialists may disagree because they believe they know more in that field; but if a pharmacist also has specialisation in that field, it would be an issue of exchanging ideas, collaborating and discussing. So, I think for our voices to be heard, there should be more empowerment for the practitioners.
When you have empowered practitioners, they are better integrated within the health system. If you look at the way health care is being practised in advance countries, we have what is called integrated teams or multi-disciplinary teams, in which everybody comes in with their own specialties and they are all practising together, and the patient benefits from it.
As a devout Christian, how would you react to the accusation that some NGOs are mere money-making ventures.
An NGO is supposed to be an organisation that identifies and fills social gaps. Incidentally, a social gap is so defined because the government is supposed to be responsible for the people in every nation; but the government cannot do everything. So,when there is a gap which the government ought to be filling but is failing to do so, it is identified as a social gap.An NGO steps in to fill those social gaps and that’s why they are called non-governmental-organisations, in other words, filling the gap for the government.
Now, because of the nature of NGOs, there are lots of donors who usually want to work with them in order to fill in those gaps left by the government. Some of these donors are philanthropists; some are venture-philanthropists who give out money and ensure proper monitoring of the money; while some are just social investors. So people who invest in NGOs do so for different reasons.
Because the human nature is unpredictable, there are some selfish people who go into this non-profit venture because they want to make money and get donor funds. They set up a seemingly philanthropic and charitable organisation under the pretext of filling social gaps, but what they are filling is their own pockets. The corruption that has eaten deep into our society is also affecting NGOs in the country and there are only a few NGOs that are really working with probity.It is even difficult to identify these sincere ones.
How would you assess government efforts in supporting NGOs in the country?
I am really sorry to say this but I am going to be very frank: I have not really seen much evidence of any government support for NGOs in the country. Actually, because of the fraud in the sector, government has said that any donor funds coming in to the country must pass through them and they also set up enabling committees through which those funds pass.So most donor agencies pass through the government in order to support NGOs; but the truth is that the funds are nowhere to be found.
Assuming the government had a transparent method of disbursing funds to NGOs that are truly working, they should be able to question the NGOs on what they are doing and possibly make a request for evidences to show they are truly performing. So to me, it’s not a transparent thing at all and, as hardworking as we are at LWI, I don’t want to believe we are invisible to the government, except they shut their eyes to what they don’t want to see. It is very unfortunate but it is the truth.
Where do you hope to see LWI in the next five years?
When we started off, I remember I made a statement that in 20 years’ time, whenever LWI is mentioned, the WHO would blink an eye; and in 50 years, when the name is mentioned, the WHO would shake. What I was trying to say then was that, we really did want to become an international organisation, even though we started off as a community-based organisation. Now I have seen that those lofty dreams we had at inception will surely come to pass and we will get there.
So, in five years’ time, I see a globalised LWI, even though our goal for globalisation was the year 2017. Considering the way the economy has been going and so many things that have happened in Nigeria, including political instability across the country, I don’t think we can still meet up with our 2017 target, but we are convinced that we will get globalised by the year 2020.By globalisation, I mean we will have our presence in key cities and become an household name in the country and also have our presence in at least, four to five city capitals around the world. That’s where we see ourselves before the year 2020.
How do you juggle running an NGO of this magnitude with giving attention to your family life?
It is actually the grace of God, because it is not easy combining work and family as a woman. Giving attention to your husband, your children and – for someone like me who is a grandmother – grandchildren at home and, at the same time, actively working, is a difficult task.Butwith God’s grace that has been sufficient for us, I am happy to do it.