The year 2020 was one like no other. It was a year that changed our lives completely and gave us something that is now commonly referred to as the “new normal”. We will have cause to discuss the details of the new normal in due course in this new year, 2021.
Glory to God that we survived the year 2020 with all its baggage of COVID-19 pandemic, economic dislocation, and family distress. We can now focus our attention on the brighter future that 2021 offers. It is a time for us to examine our environment for latent opportunities that can be professionally and profitably exploited, starting with community pharmacy practice.
Pharmacists represent the third largest healthcare professional group in the world. They are also the most accessible, particularly in the community setting.
The traditional role of pharmacists is to manufacture, store, distribute, and dispense medicines. This role has been expanded to include pharmaceutical care of guiding, counselling the patients and other health workers on the use and administration of medicines. In a developing society like ours, this role can be said to be partially fulfilled because we rely substantially on imported drugs and drug distribution remains largely unsatisfactory.
The hospital system in Nigeria, as at today, has not given room for the concept of pharmaceutical care to be firmly entrenched. It is an undeniable fact that there still exists a huge gap between the training and practice of Pharmacy. This topic was first discussed with the Lagos State branch of ACPN in 2008 and nothing has changed significantly since then, 13 years after! The level of discontent has become so high that many pharmacists, particularly the young ones, look for solace in some other endeavours in IT and other business or entrepreneurial activities.
Changing the narrative
The “low hanging fruit” in changing the narrative for the pharmacy profession in Nigeria lies principally in tapping the potentials of community pharmacy practice. To do this, we must understand the current challenges and use our knowledge and experience to overcome them.
A community pharmacy is set up to perform the following functions, among others: drug procurement, storage and management; patient counselling and guidance; dispensing of prescriptions; patient follow-up; pharmacy administration; compounding; drug information service; documentation; and research.
However, the challenges are many and daunting, ranging from unhealthy and unprofessional competition (from traders and dispensing clinics/hospitals in the community), limited finance and access to fund, to poor sales and return on investment, poor public perception, poor infrastructures, security issues (Nigeria is in trouble generally on this scale), drug procurement issues, continuity issues and lack of professional fulfilment.
The solution to our problems lies with us. We need to change our orientation towards the practice. Individual, corporate or group goals must be clearly defined, and success pathway outlined. The profession must unequivocally dedicate itself to a philosophy that clearly identifies the patient as its primary beneficiary practice.
Professionalism is the number one tool to be deployed in overcoming the challenges identified. The practice must be based, PRINCIPALLY, on the knowledge, skill, expertise, or competence expected of a professional. What truly is the difference between a pharmacist-owned premises and the others? We must put on our “thinking cap” and our “running shoes” and get our customers or clients to know and appreciate the difference.
Everything communicates: From the shop arrangement, dressing, manning, working hours, to dispensing, and counselling habits, record keeping, relationship, follow up and other extras offered (public health campaign in the community, health promotion, etc). Do we have a “standard operating procedure” (SOP) to guide activities or operations in our Pharmacies? Are we operating a professional premise (a health care centre) OR is it just another provision store next door?
Pharmaceutical care must be embraced as the philosophy of the community pharmacy practice. There is no future in the mere act of pill dispensing and pharmacists must move away from “behind the counter” and start to serve the public by providing care instead of pills. We must embrace the new concept and demonstrate the value of professional pharmacy services by improving patient outcomes and medication use in the community.
Inclusion of disease management in services rendered by community pharmacists could significantly improve the clinical outcomes. Chronic illnesses like hypertension, diabetes and arthritis do not require the patient to visit the clinics regularly. A community pharmacist could take up the responsibility for such patients in consultation with the physician.
Monitoring of therapeutic progress, consulting with prescribers, and collaborating with other healthcare practitioners on behalf of the patients are of utmost importance. HIV/AIDS management is a classical case which the pharmacists must be actively involved in, outside the hospital system.
It is the duty of the community pharmacist to provide drug information service to the community being served and this include the healthcare workers. The community pharmacist must provide relevant information on drugs and diseases which are important to a given community. Regular publication of bulletins, newsletters, etc, will surely endear a pharmacy to the community. This is also true of research, documentation, and reporting. There is virtually no reliable and published data on drug distribution and utilisation in Nigeria. The community pharmacist can gather useful information from the public, do a proper analysis and publish for professional and or public consumption.
In addition to disease management, there is health prevention and promotion activities that can take place in Pharmacies as part of contribution to public health. A Community Pharmacy can be the centre for immunization, weight reduction, smoking cessation or any other public health related programmes. The community Pharmacists has a high level of contact with often hard to reach drug users. The potential for maximizing such contact must be explored.
Business and technology acumen
Business management skill is important to profitably tap the opportunities of community practice. The community pharmacist must understand the dynamics of a modern-day business and the advantages inherent in group procurement, where substantial discount and favourable terms can be negotiated with manufacturers and importers. This will reduce cost of doing business and improve profitability.
The business must be managed for growth and development through a finance management expertise of keeping a separate record for the business and its owner, as well as involvement of an auditor to check the books and advise on compliance issues.
The world has become a global village and virtually everything, including medicines, can be obtained at the click of a button. The world has gone digital and community Pharmacists must not be left behind as Information Technology (IT) has taken over. In today’s world, access to and frequent use of the Internet must be adopted to solve a lot of problems.
The importance and impact of online pharmacy should not be taken lightly. Online business is the way of the world now and sooner or later, transactions involving medicines will be the norm rather than the exception. It is important for community Pharmacists to seize the moment and lead the way to a sanitised and regulated online pharmacy before it becomes crowded and too late to control.
Home service, therapy monitoring and follow-up of patients can foster a long-term relationship between families and pharmacies. In networking, the community pharmacist needs to expand the horizon of influence to move up the ladder. They must seek networking opportunities to expand their business and professional interests. Now is the time to get out of the unhealthy and worthless rivalry or supremacy battle with the doctors. It is possible to reach out to the GPs in our communities for a professionally enhancing and potentially rewarding relationship. Some pharmacists are already doing it and we can take lessons to upscale.
Attitudinal change, a necessity
For the unlimited potentials of community practice to be fully optimised, there is need for attitudinal change. Pharmacy has always had to contend with attaining a good balance between its mercantile and professional nature. To make an impact in this environment, we must choose the professional path to achieve whatever goal we have set for ourselves.
The attitude towards the profession must change. It must not be seen primarily as a route to affluence anymore but first and foremost as a service to humanity. We must be patient and allow our professional efforts to grow and yield the desired effects, which include professional satisfaction and wealth.
The old ideas, skill and knowledge can no longer work. We must seek retraining opportunities to update knowledge and obtain the necessary skills and competencies. Above all, let us get excellent at the basics. Let us follow the Chinese in the assertion that “the journey of a thousand miles begin with the first step you take.”
Tapping the untapped potentials will not be an easy task. Let us start with the ones that we know very well and move gradually to the ones considered difficult. Attaining professional excellence is a process. Success will be determined by the energy and commitment we put into it.
God bless community pharmacy practice in Nigeria.
By Pharm. (Dr) Lolu Ojo, BPharm, MBA, PharmD, FPCPharm, FPSN, FNAPharm