Adewale Oladigbolu is the National Chairman, Association of Community Pharmacists of Nigeria (ACPN). Oladigbolu, in this interview with The Guardian, unveils his team’s blueprint on how to improve healthcare delivery in Nigeria. He spoke with CHUKWUMA MUANYA and CHARLES OZIOMA.
•Unveils plans to improve drug distribution, achieve Universal Health Coverage before year 2030
You raised an issue. It used to be said that we are ranked 187 out of 191 World Health Organisation (WHO) member nations on health systems. But you just said the country has now moved up to 163 out of 191 nations. Does it mean we made progress? Also, the Federal Government (FG) recently announced that community pharmacists would be part of the COVID-19 vaccination programme. Is it one of those things on paper or has it started?
Nigeria is not static and I used to tell a lot of people that the rest of the world cannot leave us behind for a long time. And that is because information technology is helping us in a number of ways. For example, whatever knowledge is not available to me now, will be available to me in the next one minute, if I am serious about it. And that is helping a lot of people to live a better life. It is helping the healthcare providers to be better informed and better in the management of disease conditions. It is also helping our nation, Nigeria, in a way because people are now informed about what takes place outside the country.
So, I will link this to vaccination programme because in the United States (U.S.) and United Kingdom (U.K.), pharmacists are vaccinators, so it breaks down barrier. People can walk in at any moment because of improved access to pharmacies, no barrier to pharmacists. So, they walk in and take their vaccine and they go out.
Because Nigeria has learned a lot of things from these, the National Primary Health Care Development Agency (NPHCDA) has come out with that policy that we are going to have pharmacy-based immunisation programme. We have had several discussions with them. They have accredited at least 30 pharmacies in the Federal Capital Territory (FCT) Abuja and we are using the opportunity to call on state governors and commissioners of health in Rivers State, in Lagos State to, please, collaborate with NPHCDA so that pharmacies that are willing to be used as vaccination centres can have quick accreditation. In FCT, I can assure you in the next 72 hours, there will be rollout of vaccination in community pharmacies. This is the way to go because it will improve access and it will drive down vaccine hesitancy because pharmacists are trusted within and outside the Nigerian system. We are trusted healthcare providers to the extent that sometimes when we have to refer people to government hospitals, they will be begging us not to because they will be wondering whether their case is that bad that we have to send them to a hospital.
So, they believe us and if we tell them that vaccine is safe, they will believe us. Not only that, our involvement with antiretroviral drugs refill in community pharmacy partnering with public hospitals has shown that the degree of apathy and the degree of depression that Human Immuno-deficiency Virus (HIV) patients suffer is no longer there because they are coming to community pharmacies. They see HIV like everyday illness and they are living a better life. So, we know that this programme is for the good of Nigerians. It has started in the FCT and it will spread round the country.
We commend NPHCDA for the inclusion of community pharmacists in the COVID-19 vaccination programme. These are examples of how policy changes can contribute to the wellbeing of Nigerians and we commend NPHCDA and the IntegratE project for these. With your good office, we believe that a larger percentage of the population will be better informed about the potential of community pharmacy practice.
The IntegratE project is a proof-of-concept that community pharmacists (CPs) and Patent and proprietary medicine vendors (PPMVs) can provide a wider range of family planning services when trained in family planning counseling and service delivery.
When did the idea of having community pharmacists making demands begin? What influence does the idea have? Before now, we were used to the Pharmaceutical Society of Nigeria (PSN) and suddenly we started seeing every pharmacist introducing things we are not used to.
Let me first say that pharmacy in Nigeria belong to one body and that is the PSN. And then based on your area of practice, you now have four technical groups. We have the ACPN, which are people we see everyday.
They also dispense knowledge and commodities within the community pharmacy practice space. And then we have pharmacists who work in the academia, which belong to another technical group. We have pharmacists who work in administration and in the hospitals. We group them into one technical group. The nearest examples are workers in National Agency for Food and Drug Administration and Control (NAFDAC); they belong to Association of Hospital and Administrative Pharmacists (AHAP). We have National Association of Industrial Pharmacists (NAIP), which is another technical arm of PSN. So, we have these four technical arms making up the whole, which is the PSN.
Interestingly, I was on my bed, I think two days ago. Somebody called me on phone and addressed me as Mr. It took me back to the days when we just left school and when every pharmacist was addressed as Mr. so and so.
But we need to make a difference and somebody moved a motion at one of those PSN conferences that pharmacists henceforth should be addressed as Pharm. So, that motion was adopted at one of our inaugural conferences and since that time, there has been a transformation, which is for the good of our profession and the people. So, when you enter a pharmacy, the person who has the authority and the commodity that is inside that pharmacy is easily identifiable. That is why we approach it from that direction.
What do we need to do as a nation to move up from where we are in terms of healthcare delivery?
There is need for increased funding for the health sector. We also need to have more services for the fund that is allocated to the health sector. That has to do with a whole lot of things. It has to do with our policy framework, about getting members of the private sector – that is private health practitioners – to partake in public healthcare policy and public health programmes. And that is why this vaccination programme is important. The family planning programme is important and many other programmes that can take place in the private healthcare sector and decongest the public healthcare sector. Getting more value for funding of the health sector is so important as curing the corruption in the health sector. We have people who are in the health sector who work for two to three days in a week and earn the resources that is multiple of what people who work everyday in that health sector are getting. We have a problem where instead of us to developing the culture of training administrators for our public hospitals, we have people who are skilled (and their skills are still useful to Nigerians) being taken away from the medical practices into administration. I often imagine what a consultant will be doing for hospitals? What does he or she have to do with buying computers for hospitals? So, we should develop that system if we need to create a curriculum for a different field of study, so that we have the right peg in the right hole. When you train a cardiologist or a surgeon, and he or she wants to be buying diesel and be managing people, instead of managing patients on individual basis, you cannot have value for money that way. We need to look at that direction, like getting more values for resources that are allocated to the health system. The other side is getting more resources allocated to the health system and you will agree with me that it is very important.
These days, there is growing popularity of traditional medicine in every neighborhood. How much of that has impacted on your work as a community pharmacist?
When a particular customer asked for a particular antibiotic, I asked her why she needed it. She requested that I answer her so that she could leave while offering me money, but I refused. Then she said her customers were coming. And this is somebody who claims to be selling herbal medicine not too far away from my pharmacy. She said she opens the antibiotic and then pour it inside her concoction for them to take. But I still refused, which made her go to the other shop to get the medicine and then came back to show me that this is the same drug I refused to sell to her. So, that addresses the concern about safety of many herbal medicines. Sometimes, they add mixtures of the orthodox medicine. There could be over dosage or under dosage, there could also be degradation because you have mixed it with something else which could be a potential toxin to the body. Herbal medicine in the truest form of it is not a bad thing. As community pharmacist, there are special interest group that are being set up so that community pharmacists can move from being a general practitioner to a specialist in some areas. Herbal and complementary medicine is one of such special interest group. So, we can put community pharmacies with special interest in that area together.
They will learn together and be able to provide credible alternatives to what we have in the motor parks.
What is the ratio of local and imported medicines in Nigeria?
Practically, every medicine in Nigeria is imported one way or the other. Both the finished product and raw material, none of them is produced in Nigeria including common starch. The numbers of imported products outweigh the locally manufactured products. Even the locally manufactured product, what we just do is formulation.
What are your recommendations on how to improve healthcare delivery in Nigeria?
ACPN is the umbrella body of over 6,000 community pharmacy practitioners spread across the length and breadth of Nigeria, typically members render first-level and advanced level healthcare services along the five spectra of health delivery: promotion, prevention, curative and palliative services to the public.
The Guardian Newspaper without any iota of doubt has been of great impact on these trajectories over the years, fulfilling the overarching goal of many human endeavors, which is to build a better society. The ACPN on the other hand is a forward looking Association with key objectives of establishing and sustaining high standard of professional practice for her members for a better service delivery to Nigerians. We also advocate for health policy changes and advancement that will see to the improvement in our country ratings on WHO INDEX of health system.
A strategic relationship between ACPN and The Guardian Newspaper means so much to us as this has the potential to improve the healthcare practice, systems and indeed the health and wellbeing of Nigerians.
We are calling for media support in the following critical areas, which form the strategic focus of ACPN executives: clean medicine initiative and DEPTH project.
Clean medicine initiatives seek to reorder drug distribution system in Nigeria through advocacy, implementation of existing government policies, mass education and technology. A situation where every Tom, Dick and Harry sells medicines in the open markets is a disgrace to our health system. We call on the Federal Government of Nigeria to implement the National Drug Distribution guidelines without any further delay. The Guardian Newspaper can support this advocacy and education through the creation of weekly columns for our members and a front-page promotion of our registered Neon Signs as a signpost of premises where professional practice of Pharmacy takes place.
The DEPTH project is on aiding the Federal Government in the achievement of Universal Health Coverage (UHC) before the year 2030 in alignment with WHO, Astana Declaration of 2018. This project would also support the United Nations Sustainable Development Goal 3: Ensure healthy lives and promote well-being for all at all ages.
The ACPN would speak to these objectives through advocacy for policy frameworks that support the expanding roles of community pharmacists in primary health care delivery system in Nigeria. Between October 2017 and September 2021, community pharmacists were able to reach 300,0000 people with family planning commodities and services, with 101, 000 new acceptors of family planning services, averting 17, 871 unintended pregnancies.