The future belongs to those who prepare for it today — Malcolm X
I chose to start this piece with the quote of a revolutionary even though I am aware of the likely makeup of my audience and how the word revolutionary sounds. But as you will realise in the next few paragraphs, if there’s anything the noble profession of pharmacy in Nigeria requires more than everything else, it is revolution.
While waiting to address the community pharmacists in Lagos in the last bi-monthly meeting of the Association of Community Pharmacists of Nigeria, I listened as pharmacists passionately discuss the issues and the challenges of the practice in Nigeria’s centre of excellence. For me, it was an episode of puzzles and problems back to back, from speaker to speaker. Even though the approaches to solve these problems changed and differed, the problems were the same.
Today, the community pharmacist is seen more as a businessman/woman than as a health care provider. This, above all, is where the problems converge. It explains for example why the Lagos State Government can decide to go ahead with an insurance scheme and not factor in community pharmacies.
The same attitude was experienced by pharmacists with regard to National Health Insurance Scheme. Even though all patients require the service of a pharmacist before getting healed, it doesn’t seem to make any difference in the attitude being accorded pharmacists in Nigeria.
As far as the business of dispensing is concerned, patent stores can (illegally) conveniently carry that out as well as open stores. When it comes to prescriptions, auxiliary nurses can now do as well as a pharmacist if the doctor chooses to pass the buck. When it comes to consultation, anyone can make the argument that even though illegal, anyone who’s been selling drugs for years can at least advise on most drugs being sold in stores.
“Everything” the community pharmacist does can be done by someone else who’s not a pharmacist.
Where does this leave the community pharmacist then? Should he just continue to pick the crumbs that fall off the primary health care centres and hospitals? Should he just stick to the business of buying and selling drugs and re-selling to whoever wants to buy? Or should he start to switch to other roles?
There’s no way you can remove the pharmacist out of the health care equation. Without drugs, health care is not health care! This is true, but to a point.
As much as the pharmacist can’t be removed from the health care equation, he can be made so irrelevant from the healing equation that the only time a pharmacist is needed is when the drugs need to be manufactured. The patient therefore has no need for interactions with a pharmacist. This is grave for a couple of reasons: The consultations that the patient needs on drug interactions, compliance and drug therapy optimisation for example are lost.
It will be easy to lay all of the blame for this on the government as regards regulation, registration, nepotism and all sorts. That however, will be like the biblical Daniel trying to beg the lions once he was thrown in the lions’ den.
For every challenge that pharmacists in Nigeria have, there is a technological solution. Shortage and distribution for example is a huge problem that is already being solved by a technological platform that helps pharmacies get orders from as many wholesale clients at once, track delivery and load inventory without as much as moving from point A to B.
Registration of pharmacies and the mapping of community pharmacies for example can be done using technology in such a way that every pharmacy premises that are registered can be accessed on one’s computer. Insurance cover for drugs for Nigerians anywhere they are in the country can be rolled out in an e-insurance scheme where every subscriber has access to drugs from any pharmacy in the country.
The unavailability of pharmacy premises to patients in rural areas is a challenge that has been solved by telepharmacy years ago in other climes and there already exists companies who can deliver drugs to patients in need with drones.
Just last year, Apprecia pharmaceuticals printed Spritam, an epilepsy drug from a 3D machine. Atomwise discovered two drugs that will reduce Ebola infectivity using Artificial Intelligence and Machine Learning in less than 24 hours. These kinds of innovation might be a long shot for the Nigerian pharmaceutical space at the moment, I understand. However, if there must be a role for the pharmacist in the healing process, the adoption of technology in the practice is not an option. It is a must.
It is obvious that there is a gap in the health care industry in Nigeria as things currently stand. There are not enough doctors to attend to the patients that continue to access health care facilities and more doctors are leaving the country by the day. Until the pharmacy community can prove its critical role in this health care gap, I do not think there’s much to be said about a future of pharmacy in Nigeria in 2050 and beyond.
Feranmi, a pharmacist, sent this via email@example.com
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