(Being the keynote address delivered by Dr Lolu Ojo FPSN at the Pharmacoposium organised by the Pharmaceutical Association of Nigeria Students (PANS) at Oduduwa Hall, Obafemi Awolowo University, Ile-Ife on Tuesday, 11 April, 2017).
The theme of this symposium is apt and contemporary. The whole world has moved and Nigeria, in particular, has moved in many directions at the same time. It is true that we can have a quantum shift as experienced in the value of the naira against the dollar in the past two years.
It can also be a shift of ideas or ideology or tactics or rhetoric, or all of the above, as in the ascendancy of Donald Trump as American President. For the pharmacy profession, the shift has been substantial in terms of contents and practice. You may be able to assign numbers to the magnitude of change if you consider where we were about three decades ago and where we are now.
Perhaps, it will be safer to incline our mind to being proactive in anticipating and adapting to changes, which must come, as of necessity; now or in the future. There is no doubt that business models are already adapting to changes in government policies and economic dictates in the environment in order to remain competitive and for survival.
There is, therefore, a need for the pharmacy profession to be creative enough and take proactive steps necessary to make it responsive to the changing needs of the society and especially to get the younger generation of pharmacists attuned to this reality. We can discuss some of the recent changes under the following headings:
It is no longer appropriate to look at medicines as the only sphere of influence of the pharmacists. A public health role for pharmacist is now a reality that must be vigorously discharged in order to remain relevant and add value to the society. The desire to improve the health status of the population requires a multidisciplinary and multiagency approach and pharmacists must be involved. The profession’s current strategy is based on management of prescribed medicines, management of chronic conditions and common ailments; promotion of a healthy lifestyle and provision of health advice. We now have to find a space in the overall health package that involves other health professionals, NGOs and volunteers.
There should be more emphasis on defining, addressing and monitoring the real health needs of the population. Some public health roles for pharmacists include provision of health advice on self-care; management of health emergencies; counselling on maternal and childcare; parental counselling; health promotion campaign; sexual health and drugs; creating, updating and maintaining medication records, disposal of waste medicines; complimentary medicine advice; drug use awareness, etc.
Drug distribution (Logistics and supply chain)
The safe movement of drugs, vaccines, medical devices and equipment from the point of production to the patient, without compromising the efficacy, requires a very efficient process that will optimise space, quality, price and profit. The network of distribution, warehousing and record tracking, especially at complex levels, require the skill of logistics and supply chain management. This training involves computerisations, use of software, transportation models, when to re-order, trade management, pricing, import and export documents, among other things. Pharmacists must position themselves for these roles, including third party representations of multinational pharmaceutical industries, in other to be ahead in competition with non-pharmacists.
We have also heard of the likelihood of closing down the open markets in Nigeria this year, to ensure a more efficient, safe and controlled distribution of drugs in Nigeria. This will pose a challenge to pharmacists to evolve logistics and supply chain skills in other to fill this gap.
Pharmaceutical care is the responsible provision of drug therapy for achieving definite outcomes that improves the patient’s quality of life. These outcomes include cure of a disease, elimination or reduction of patient’s symptomatology, arresting or slowing of disease process and the prevention of disease.
The whole emphasis of the pharmaceutical care concept is on the patient and not on the drugs anymore. The training curriculum certainly recognises this new emphasis without compromising the science of Pharmacy. The fundamental relationship in pharmaceutical care is a mutually beneficial exchange, in which the patient grants authority to the provider, and the provider gives competence and commitment (accepts responsibility) to the patient. This concept is the panacea for increased relevance of the pharmacist in public eyes and public health care institutions.
It is critical for pharmacists to be abreast of the use of the drugs they are dispensing and be able to offer primary health needs of the public. This is only possible when he is a true expert of drugs. Patients find it easier to access a pharmacist for consultation on drug information. If this task or duty is handled with utmost care, expertise and professionalism; then our connection with the public will be stronger and better.
The pharmaceutical industry
The world pharmaceutical industry is an oligopoly, controlled by 10-15 pharmaceutical giants. Regrettably, Nigeria does not exist on the world pharmaceutical map, despite our huge potential demand base. We are, basically, consumers of what others have done. As at today, about 80 per cent of medicines consumed in Nigeria are imported, and a paltry 20 per cent produced locally.
The irony of this disturbing statistics is that the capacity utilisation of the local industry is a meagre 42 per cent. The federal government has a policy of purchasing 70 per cent of its needs from the local manufacturers; but the operators of this policy always find a way to circumvent it. Thus, today, we have an unattractive local pharmaceutical manufacturing sector struggling for relevance in the country.
The importers have not fared better. The market is largely unorganised and competition unfair. You have a small group of ethical and focused players competing with a larger group of corner-cutting and substandard products purveyors.
The real question is: how can we get a vibrant pharmaceutical industry in Nigeria? We must start from the value-creation basis of relevance, which is basic research. We need to discover and manufacture novel molecules that will be used in the treatment or management of old or emerging diseases. We cannot afford to be a follower forever and expect our industry to catch up with the rest of the world. The emphasis must extend to local manufacturing with an effective public-private sector partnership. The establishment of cottage industries must be encouraged in all the states of the federation. These cottage industries can produce the needs of their immediate environment. We must gradually acquire the capacity and the technology to produce other sensitive products.
Today, Nigeria has no comparative advantage in pharmaceutical manufacturing and no one is going to help us to move away from where we are now. It is to the advantage of India and other countries in Asia that the bulk of our raw materials and finished products are imported.
While we continue to mount pressure and do the best we can, it is the prerogative of the government to determine what kind of development is required in all the sectors of the economy, including the pharmaceutical sector. Governments, at all levels, must listen to us and implement her own policy towards self-sufficiency in drug production in Nigeria.
Role of the media
We are now on information super highway. Nothing is sacred or hidden anymore. You can get virtually everything now with the press of a button. Just ask google! A drug information centre that cannot be accessed from a remote location has lost its relevance in the new world. How do we utilise the media in advancing the cause of the new shift?
The traditional media strategies can no longer work. We must get involved with new offerings, particularly on social media. These considerations (negative or positive) and general articles about the expanding role of pharmacists are a great opportunity to engage patients and continue the conversation.
We must take the lead in helping the society to filter the information about their medications and prevent them from falling victims of false claims on performance-enhancing drugs. The pharmacists’ roles in public health can be facilitated through dedicated blogs, websites or platforms that are easily accessible to all categories of medicine users. If we are going to win the war against quackery and fake drug peddlers, the media is a necessity.
The development in social media (e.g., Facebook, Twitter, YouTube) has completely altered the way society communicates. These new applications promote openness, user-generated content, social networking, and collaboration. The technologies, along with patient behaviors and desires, are stimulating a move toward more open and transparent access to health information.
The social media is a very good target for pharmacist to participate in well-targeted awareness programmes. Patients now post online their experience of medicines. They also go online to search for information on medicines, even before they approach the health professional. They are now more informed about their conditions and the applicable therapy. They will demand more from the pharmacist whenever they make contact.
The pharmacy profession needs to re-invent itself for the digital world in which medical information is no longer an exclusive privilege of the health professional. New access models such as remote consulting of the health professional will emerge; geographic boundaries of the neighbourhood pharmacy may become irrelevant, if an Abuja patient can leverage the power of the internet to remotely access their pharmacist based in Lagos. There will be disruption in distribution channels and service models of health and pharmaceutical services. It will create new opportunities for some, while it will leave others behind.
The future area of focus is digital marketing. A future of virtual audience for your presentations. A future where we may not have to leave our current location to educate an audience about our ideas, products or services. No particular group will be able to escape the new way of life. It is, therefore, in everyone’s interest to key into the new way of doing things.
As I conclude this address, I will ask the young pharmacists and the aspiring ones never to underestimate the value of an idea. Men of ideas build the world we have today. You have in you the potential to change or shape the world that you live in. My favourite quote is: Success in life is measured not by fortune nor acclaim. A venture tried, a challenge met, a future that you embrace is successful if ONLY if it makes the world a better place to live.