In this exclusive interview, the immediate past Chairman of the Nigerian Association of Industrial Pharmacists (NAIP) and Chief Operating Officer of Alpha Pharmacy and Stores, Pharm. Ignatius Anukwu, speaks with Moses Dike on the significance of this year’s World Pharmacists Day to pharmacy practice globally, with particular emphasis on Nigeria. Excerpts:
What is the significance of this year’s World Pharmacists Day to you and why does Alpha Pharmacy and Stores seem to attach much meaning to it?
From a historical perspective, World Pharmacists Day was established by the International Pharmaceutical Federation to be marked every 25 September. And this year, like every other, the FIP selected a theme for the celebration. This year’s theme is “Pharmacy Strengthening Health Systems”.
For us at Alpha Pharmacy and Stores, this theme resonates with us in the sense that when you cast your mind back to three years ago when we had COVID-19, the health system was challenged. It was pretty much challenged.
Maybe we can take on three dimensions – the availability of medicines and other health commodities, the capacity of the human capital in the healthcare space, and the burden of the disease itself at the time. When you look at what happened in Nigeria and many other countries, the health system, as it was known, was so challenged that, most times, the hospitals could not cope. We had many people trooping to pharmacies and because of the nature of the disease itself, many were scared to go to hospitals in the first place. So many people in the communities depend on pharmacies.
So we found out that the numbers that went to pharmacies for either counselling or to procure their medicines were higher. And we found out that the pharmacies were playing more roles, either in advising the patients or providing immune boosters or giving medications that would help them to manage their circumstances. Also, when the vaccines were available, pharmacies were designated as centres where vaccination would happen.
Now, three years after, a lot of things are being discussed. How can we strengthen the healthcare system, so that, God forbid, should this kind of thing come again, we will be better prepared? It is in light of this that the FIP has chosen this theme. And the summary of what they are saying is that pharmacists can do more. So, stakeholders can demand more from pharmacists.
While we are increasing what we do, we are also making the other healthcare practitioners have more time to do other things. All for the good of the patients. The whole idea is for the patients. So, if we can give more value to the patients and the other healthcare practitioners can give more value to the patient, the patient is winning all the more.
For us at Alpha Pharmacy, this excites us. It gives us a sense of responsibility – that, as pharmacists, we are contributing and are also ready to contribute more. It makes us to dedicate ourselves and recommit ourselves to our calling, to our service, to our profession. We recognise ourselves and we know others recognise us.
You mentioned that in the wake of the COVID-19 pandemic, the health systems were challenged. But for us here in Nigeria, we are witnessing a new sort of challenge, which is the brain drain of healthcare professionals, including pharmacists. In light of the World Pharmacists Day, how would you want government and other stakeholders to look at the plight of health workers, especially pharmacists, and ensure that this post-pandemic brain drain is curbed?
The challenge of brain drain is not only in Nigeria, but it is impacting us more. Why so? Because we have the capacity, the human capital. Our pharmacists can compare to pharmacists all over the world; same goes for other healthcare practitioners. But now, it’s like when you have a gradient, there is a flow. So if you have a gradient at a higher level, the water will flow to the lower level. That’s also how it’s happening.
Now, there is a demand for the services of the pharmacists. Some countries are willing to pay more. Some countries are willing to provide better environments for the pharmacists to work and better tools. And this also presents an opportunity for the pharmacists to go in search of greener pastures and more. So it’s a natural thing. People will naturally move.
But the sad thing is, while other nations are building themselves and realising that they need to serve their populations better, we don’t seem to be rising to the occasion. Already, in Nigeria, the number of pharmacists per patient is nothing to write home about. We can’t even begin to check because we have roughly about 13,000 pharmacists serving over 200 million people.
Now, there are countries that are conscious of this and they do not want that ratio to tip so much. So they are willing to open their borders and invite well-educated, trained professionals with better capacity to come. Thus, while it’s benefiting the West and other countries in Europe, it seems not to be benefiting us. Even some other African countries don’t seem to have the number of pharmacists that we have. This is why it is affecting us.
Actually, we should be more conscious of not losing these pharmacists. It takes about 19 years to produce a pharmacist – from primary school to youth service – before he or she will begin to add value to society. So, the fact that you lose an investment of 19 years is not a joke. For example, here in our pharmacy, just in one month, we lost seven pharmacists. They are travelling out of the country. In other months, it could be three or four; but, in August, it was quite high. And there is no end to it because livelihood in Nigeria is getting even more difficult.
Everybody wants the best for himself and his family. So, now, it’s no longer something that we can leave for the government alone because, as it seems, government is not even prepared. Government doesn’t even seem to have a policy to mitigate this exodus. I don’t know if they have even begun to have workshops to think of what to do.
Therefore, my appeal is to the private sector. Let the private sector rise to the occasion. Pharmacists are not only employed in public sector. They’re also employed in private sector. Let the private sector begin to see what to do to see that pharmacists are better treated; that they have all the support they need to do their job and do it well.
And it’s also not so good that pharmacists who want to serve the community are not able to serve because there is a scarcity of medication. If I’m a pharmacist and people come to see me and I know what to give them and I don’t have it to give them, then I’m not giving them any service. We know that all of this started during COVID. Supply chain was affected. Some countries banned exports to other countries.
In Nigeria, we import almost 70 per cent or more of the medications. Even those we produce in Nigeria, we still import the inputs and the APIs. The availability of the commodities will make the pharmacists more relevant. When you don’t have the medicines, pharmacists are not relevant.
I would like to take you back to the issue of pharmaceutical care. Some questions are being asked in some quarters to know if what is referred to as pharmaceutical care is not encroaching into the territory of the medical profession. What’s your view on this?
Pharmaceutical care does not encroach into the medical profession in any way. Pharmaceutical care refers to how the pharmacist makes sure that the medication you take is most appropriate for you, and he follows you up to be sure that you are deriving the best benefit from it. The pharmacist helps you through the time that you are taking that medication to see that the untoward effects that may come from the medication are better managed. So pharmaceutical care has nothing to do with any medical profession.
The pharmacist is there to receive prescriptions from the doctor. When the prescription comes from the doctor, he has to evaluate it. And there are some things he checks – such as drug-drug interaction, and drug- food interaction. Then he checks for compatibilities, side effects and all of that.
Now, in dispensing the medication, he also advises the patient on how to take the medication. He lets the patient know the side effects he may be experiencing and what to do when those side effects happen. He is also going to tell the patient to comply with the dosage, and what the outcome of such will be. He can also follow up with the patient. Sometimes, by checking on the patient, he may be able to have something to discuss with the doctor. For instance, “Can you consider some other medications that can still deliver the same value but with reduced side effects?” So, it has nothing to do with the job of the medic.
One of the things that have resonated seriously during our interaction with pharmacists and patients is the high cost of drugs. Now that we are talking about strengthening the healthcare system and drugs is a major component of the healthcare system, how do we enhance the availability and affordability of drugs, especially in Nigeria?
This is purely economics. In this country, about eight or nine years ago, the naira was about 167 to a dollar. Today it’s hitting N1000 to a dollar. If you have a medication that we are not able to produce in Nigeria and have to import, and the cost of that medication is one pound or one dollar, what it means is that, nine years ago, it would have been sold at about N200 – which includes consideration of tariff, customs duty, freight etc. And, maybe, by the time it moves from the wholesaler, to the retailer, to the consumer, there is another N100 added. So that makes it about N300 Naira.
Now, let’s consider the present – one dollar is 1000 naira. By the time the drug gets into Nigeria, it is 2000 naira. By the time it gets to the patient, it will be 3000 naira. The same one dollar. Therefore, it’s not that the pharmacist has anything he’s doing with the medication; it’s just economic factors. And it’s quite painful that even as the cost of things are going up, the people who need them do not earn in that way.
It’s affecting all of us because nobody is earning at the rate that inflation is going. So it’s a natural thing that you now begin to choose what you have to spend your money on. This means that, if people are not so critically ill, they may choose not to spend, or they may look for different brands or whatever.
However, if these medications are produced in Nigeria, because of the local content, they can become cheaper and more affordable. So, government should encourage the pharmaceutical sector to produce more in Nigeria. And then also, by the grace of God, if our economy improves, the prices of these medications will come down.