Recently, a colleague who has run a community pharmacy in Lagos for 19 years told me he is shutting it down. His landlord doubled the rent. The supermarket two doors away now sells antimalarials. His best customer, a hypertensive widow in her 60s, switched to the PPMV down the street because her son said it was cheaper. He counted everything he had built, looked at the math, and decided to walk away.
He is not alone. I have heard versions of this story from pharmacists in Ibadan, Abuja, Port Harcourt and Enugu. Margins are squeezed. Rent is up. Online pharmacies are eating the easy prescriptions. Unregistered medicine sellers are eating the rest. The PCN keeps shutting them down. They keep reopening under new names.
If you are a community pharmacist reading this, you already know the numbers don’t work the way they used to. The retail model – buy at one price, mark up, sell, repeat – is dying. And I want to say something that will sound strange coming from a pharmacist: I think that is the best thing that has happened to our profession in a generation.
Here is why. For too long, we have measured ourselves by what we dispense. Boxes counted. Prescriptions filled. Sachets sold. But the patient walks out the door and disappears. We don’t know if she takes the medicine. We don’t know if it works. We don’t know if she lives or dies. We have built an entire profession around a single transaction, and that transaction is now a commodity. Anyone with a shelf and a willingness to break the law can do it. We cannot win that race. We should not try.
The real issue
The real work of Pharmacy was never in the dispensing. It was in the outcomes.
Think about the patients you serve. The man with type-2 diabetes who has been on metformin for eight years and still does not understand why his sugar swings. The young woman with sickle cell who shows up in crisis every three months because no one is managing her hydroxyurea between episodes. The mother whose child has been on the wrong antibiotic for ten days because the GP rushed the consultation. The hepatitis-C patient who finished her first cycle and disappeared because she did not know what cycle two was for.
These are not dispensing problems. They are coordination problems. And they are the problems patients are actually dying from.
At HubPharm, we serve over 5,100 patients with chronic conditions. When we measured what changed once a pharmacist was actively coordinating their care, not just dispensing but checking in, adjusting, escalating, educating, adherence improved by 42 per cent. Satisfaction climbed to 92 per cent. These are not marketing numbers. They are the difference between a patient who lives and a patient who quietly stops her therapy because no one called.
Facing the truth
What we are watching, in Nigeria and across the continent, is the slow death of the pharmacist as merchant and the slow birth of the pharmacist as clinician. This is not a threat. This is a homecoming. It is what we trained for. It is what the framers of our profession had in mind when they fought for the B.Pharm to be a six-year degree and for the pharmacy councils to set ethical standards. We were never meant to be shopkeepers in white coats.
I know this is uncomfortable. I know rent is due at the end of the month. I know the old model paid the school fees and built the house in the village. I am not asking anyone to romanticise this. I am saying that the model we are mourning was always a stopgap. The real model, pharmacist as care coordinator, pharmacy as clinical infrastructure, is what comes next. And the pharmacists who see it first will own the next decade.
In the next two parts of this series, I will walk through exactly what the coordinated care model looks like in practice, and how any pharmacist, community, hospital or entrepreneur can begin the shift. We will use real cases from sickle cell, hepatitis C and oncology programmes. We will look at the new revenue models that make this work economically. And we will talk frankly about what each of us must do differently.
The old Pharmacy is dying. Good. Let us build the one our patients actually need.
Sesan Kareem is the founder and president of HubPharm Africa, a speciality pharmacy and coordinated care platform based in Lagos. He writes on health access, health systems, and the business of chronic care.
