Dr Yahaya F. Abuh is the president and CEO, Webb’s Square Pharmacy LLC, United States – a family independent pharmacy; with his wife, Bridget J. Abuh, as managing member and accountant. A graduate of School of Pharmacy, Ahmadu Bello University (Zaria), he bagged his master’s degree in Pharmacology from the same institution, and soon began his lecturing career there. Thereafter, he gained admission into the University of Toledo, Ohio, United States for his PhD, and subsequently transitioned to community practice.
In this insightful interview with Temitope Obayendo, Abuh emphasises the necessity of having a prescription law in Nigeria, saying this will reduce cases of prescription errors in the country. He also speaks on other burning issues in the healthcare system, such as the roles of pharmacists in health insurance, vaccine administration, disease outbreaks, and more. Excerpts:
What informed your decision to study Pharmacy?
My studying Pharmacy was almost an accident, as I had no idea of what the profession was all about, while going through secondary and post-secondary schools in Nigeria. Everyone in my class then doing science subjects like Biology, Chemistry and Physics all had their eyes on Medicine. However, I always had a phobia for blood and other sights of human anatomy, coupled with the length of time required to be in school, considering my poor family background, although I had the qualifying entry grades.
Looking back now I can attribute my journey into Pharmacy as God’s destiny for me, with no regrets. Without blowing my own trumpet, I can proudly say that I could have excelled in any area of pharmacy practice, including academics. It is worth noting that I could have remained in academics if I had returned to Nigeria after my PhD degree in 1994.
So, why did you abandon lecturing for community practice after obtaining your PhD?
My decision to venture into community pharmacy practice was shaped by my financial background, which I mentioned earlier. I came from a poor family and I needed to do something to alleviate the sufferings of my people, being the fifth of six children and the only one privileged to be educated to any level.
Aside from my financial disadvantage, my wife and two children were denied visas to join me in the States for the four-year period within which I went to school. The community pharmacy practice was the quickest way for me to get my family to join me.
With your experience of community practice in the US, what are the gaps you have observed in the Nigerian practice system?
In the United States of America, community pharmacy is practised in either the chain or an independent store setting. For so many years, I had the opportunity to practise in both settings. The chain stores operate at sub-regional, regional and national levels; while the independents are individually owned, with some operating in more than one location.
In Nigeria, the concept of chain store model is gradually being embraced by some individuals, especially in big cities like Lagos and Abuja; while independent store ownership is still the main focus for community pharmacy practice.
The major gap in the practice of pharmacy generally and community pharmacy in particular in the United States compared to those in Nigeria is the use of prescription dispensing computer software. Prescription dispensing computer software is a mandatory component of a pharmacy department in any setting – be it community, hospital outpatient, inpatient or nursing homes. Numerous prescription software abound but the principle is the same: input and output of data, with respect to prescription orders, dispensing of medications and counselling of patients along with inventory and overall pharmacy business management.
In Nigeria today, with the exception of few pharmacies owned by pharmacists that were trained or are practising abroad who are trying against all odds to introduce similar operating systems, the vast majority of the local pharmacy owners do not see the need for such investment. From my understating, computers in Nigerian community pharmacies are meant for inventory management and point-of-sale services only.
That the use of computers in pharmacy prescription dispensing and management is non-existent in Nigeria today is disappointing. The advent of computer dispensing software dates as far back as early 1980s, when Prof. Isa Odidi displayed the computer software and its pharmaceutical dispensing capabilities at a PSN conference. It was the most exciting display at the PSN conference that year. The memory lingered in my head until I had the opportunity to make use of the concept years later. I am sure the fate of that system died a natural death due to lack of foresight in our regulatory system then.
Unlike Nigeria, where the regulation of pharmacy practice is centrally controlled by the Pharmacy Council of Nigeria (PCN), every state in the United States controls or regulates the practice of pharmacy and other professional practices within its jurisdiction, such that what is legally obtainable in one state may or may not necessarily apply in another. However, the principle of professional practice is similar across the various boards of pharmacy or other professions.
It is the responsibility of each state board to make rules regarding various aspects of Pharmacy or any professional practice in general, which will then be passed as bills by the state legislatures. And upon signing of the bills by the governor of the state, such become laws regulating the profession. Only certain issues affecting a given profession nationally are dealt with by the United States congress.
That there are no mandatory laws with respect to handling of prescriptions, both at state and national levels, in Nigeria is a huge gap, when the pharmacy practice in the two countries are compared. Here, in America, a prescription has “legal” definition and so, a lot of requirements abound as to its control and regulation. Simply put, a typical prescription must contain certain minimum information to make it legal.
Similarly, a prescription must be written by a legally qualified “practitioner”; hence must contain traceable information to locate such a practitioner by way of name, address, phone number and personal national identification numbers and signature – together with the date the prescription is written – to be valid by law. Also important is the name of the patient for whom the prescription is meant, the date of birth (to determine whether adult or paediatric) and other personal identification information like address and or phone number.
Then at the core of the prescription is the drug(s) prescribed in its dosage form, directions for use, duration and the total quantity, commensurate with the intended duration of use. There is the emphasis by law that all these details must be legibly written. This emphasis is to prevent errors in interpretation and hence dispensing errors, which is a big deal in the American healthcare system.
When the prescription is tendered in the community pharmacy for instance, the pharmacy is guided by law to handle it professionally, from reception to data entry, assembly, packaging and dispensing to the patient at the final point of sale, including counselling offer. The prescription then is filed and preserved in storage for a given number of years, depending on the state requirement.
The above illustration is to directly contrast the situation as obtained in the Nigerian pharmacy practice, be it in the hospital or at the community level. When I visited retail community pharmacies in Nigeria owned by some of my friends, I observed that a typical prescription sometimes is written on scrap paper and handed to a patient to take to the pharmacy to buy the medications. Usually, several of such prescriptions are scribbled on the same paper.
When this happens, the pharmacist or mostly the assistants or sales associates, will assemble the drugs, cost, bag them and hand to the patient, with directions of usage as single strokes, separated by hyphens to indicate the number of times to take in a day. The scrap paper is then either given back to the patient or is thrown into the dustbin. This practice is allowed because there is no law that dictates that a prescription should be handled in a certain manner as described above.
My personal experience in trying to set up a standard practice, as obtained in the US, was met with stiff resistance by various pharmacists I have engaged in the last seven years that I opened the community retail pharmacy in Anyigba, Kogi State of Nigeria. In collaboration with a pharmacist colleague and a prescription software producer, we set up and trained the first set of pharmacists and technicians. To my greatest surprise, it was the pharmacist that resisted the programme, letting me know it was “too much work” to type a prescription, count pills or place a label on the medication package before selling to customers.
I practised with the staff for about a week, which was the time I had before returning to the States. Behold, as soon as I left, the pharmacist packed up the computer and refused to use the programme. Needless to discuss the cost implications here, but the fact is that the pharmacist was able to resist the venture simply because there is no law that requires her to go that length in doing something different in her professional practice.
The bottom line here is that the PCN is the right body to initiate the rules, which they can channel through the National House of Assembly to make the necessary laws to regulate this aspect of pharmacy practice. If the law mandates a prescription to be legibly written on a letterhead format, carrying specific information, with defined roles to be played by physicians and pharmacists, healthcare delivery will take a turn in the right direction.
The role of pharmacists in health insurance is paramount, but it appears the Nigerian government has not got this right. What is your take on this, sir?
The role of pharmacists in health insurance can only be appreciated when pharmacists can present government with relevant data as regards their patient management. This still boils down to the use of prescription dispensing software, as previously discussed.
With the software, data can be generated for the number of patients seen, or prescriptions filled, medications dispensed and the costs; and all these can be electronically sent to the insurance scheme for reimbursement. This is where there is a government centralised system; unlike in the USA, where insurance is a private affair, with government having limited regulatory roles.
Aside from vaccination, what other new roles are appropriate for Nigerian community pharmacists in the face of disease outbreaks?
Nigerian pharmacists are currently impacting a lot in healthcare delivery, particularly in the less urban settings where they are involved in the management of symptoms of common illnesses. Rendering vaccine services in a community pharmacy setting can be very challenging because of the sophisticated nature of handling vaccines. Information dissemination for public awareness by pharmacists can play major roles in alleviating fears, in cases of disease outbreaks and how to prevent spread.
In what ways can the Nigerian government assist pharmacists in the community to make more impact?
As discussed previously, government’s role is very vital in ensuring passage of laws that will set the practice of community pharmacy at par with the rest of the world, particularly in the way prescriptions are handled. There is also the case of drug distribution, which is a huge problem, with the open market sale of pharmaceuticals. Governmental regulation of the distribution industry can go a long way in enhancing community pharmacy practice in Nigeria.
This is an excellent insight into the great future of Pharmacy in Nigeria as for as continuous quality improvement and stronger continuity of care for the consumers and practitioners. I hope to travel to Nigeria soon and bring my 46 year pharmacy knowledge with me.