-How to begin: A playbook for the pharmacist who wants more
Two months ago, I argued that traditional pharmacy is dying and that the future belongs to the pharmacist who owns patient outcomes, not patient transactions. Last month, I walked through what coordinated care looks like in our sickle cell, hepatitis C and oncology programmes. This month, I owe you the practical part. The how.
I won’t pretend it is easy. But it is doable, from wherever you are starting. Here is the playbook.
Begin with one diseaseDo not try to convert your whole practice at once. Pick one chronic condition you already see often. For most community pharmacists, that is hypertension or type-2 diabetes. For hospital pharmacists, it might be HIV, TB or cancer support. For specialty practitioners, sickle cell or fertility. Go deep on one. Learn what coordinated care really requires. Then expand. For that one disease, build three things. A patient register, a simple spreadsheet or notebook with name, contact, condition, medications, prescriber, and last refill date. A follow-up cadence, weekly for the first month, biweekly for months two and three, monthly thereafter. And a relationship with at least one prescriber who will take your call. That is the minimum viable coordinated care practice. You can run it from one counter with one phone.
Build the technology around the work, not the other way around
I have watched pharmacists spend three million naira on practice management software they never used. The software did not fail. The practice failed. Start with WhatsApp. Start with Excel. Start with the patient education sheets you already have. When the workflow is real and the patients are real, then layer in tools. At HubPharm, our care companion Afiya now serves over 15,000 users in 50 languages, but she was a WhatsApp number with a human behind her for the first 18 months. The technology grew into the work.
Partner with people who already have patients
You will not build a coordinated care practice by waiting for patients to walk in. They are already somewhere, in a hospital, in an HMO panel, in an NGO programme, in a faith-based clinic. Go to them. Approach the consultant who runs the diabetes clinic at your nearest teaching hospital and offer to take over post-clinic medication management for fifty of his patients, free, for 90 days. Approach an HMO and ask which chronic condition is driving their losses; offer to be their pharmacy of record for it. Approach a fertility clinic, an oncology centre, a sickle cell foundation. Most of them are desperate for a pharmacist who will actually follow patients between visits. Make yourself that pharmacist.
Get paid for the right things
The hardest shift for many pharmacists is accepting that the new economics are not about dispensing margins. They are about retainer fees from clinics, capitation arrangements with HMOs, programme fees from donors, and per-patient management fees from insurers. These models exist in Nigeria today. They are not theoretical. We have signed agreements with HMOs and clinical institutions on this basis. Once your outcomes are documented, the conversations become easy. “We improved adherence by 42 per cent in your sickle cell cohort. Here is what it would cost to do the same across your enrolled lives.” That sentence opens doors that “we sell cheap drugs” never will.
Document everything
If you take nothing else from this series, take this. The pharmacist who measures and documents her outcomes becomes the pharmacist whom funders, HMOs and partners trust with bigger work. Track adherence rates. Track hospital admissions. Track patient satisfaction. Track refill consistency. Do not wait until your data is perfect. It never will be. Start ugly and improve. The pharmacist with three hundred messy patient records and real numbers will beat the pharmacist with five thousand patients and no records every single time.
And finally, accept that this is a longer game. You will not flip your practice in a quarter. You may not see the full economic benefit for two years. The first year is investment. The second is proof. The third is when the practice becomes something your old retail self would not recognise. I have walked this road. So have the founders of every serious coordinated care practice on this continent. The pharmacists who started five years ago are now the ones being courted by hospitals, HMOs, donors and investors.
The profession we trained for is finally coming. Build for it.
If we get this right, across Nigeria, across the continent, no patient should die because no one was coordinating her care. That is the work. Begin now, where you are, with one patient, one disease.
