The World Pharmacists’ Day is celebrated every year on September 25th, which is coordinated by the International Pharmaceutical Federation (FIP) worldwide. The theme of this year’s Annual Pharmacists Day is “Safe and effective medicines for all” which aims to promote pharmacists’ crucial role in safeguarding patient safety through improving medicines use and reducing medication errors to the general public, the clinicians, political actors and all stakeholders in the health sector.
Role of pharmacists’ in safeguarding patient safety through improving access to safe and effective medicines and their rationale use, as well as the tremendous efforts pharmacists are putting in reducing medication errors have increasingly manifested in many ramifications related to positive therapeutic outcomes and human health in general.
In Nigeria, unlike many other countries of the world, an ambitious middle-income country and Africa’s largest economy, it struggles to provide some of the most basic health services to its citizens. Access to essential medicines is yet threatened by high poverty rate. Affordability declines drastically down the population profile of poverty lane, for instance, an anti-diabetic drug could costs minimally about N1,500 for a 30-day supply, thus costs a low class citizen with N30,000 minimum wage approximately 2 days salary to get it. Indeed, cancer care costs about 5 times the monthly minimum wage for a government employee and an anti-hypertensive drug costs about half a day’s work for a month course of treatment in Nigeria.
It is disheartening that out-of-pocket health service and detaining patients to pay their bills are a reality. There is great disparity in the availability of health services between urban and rural areas, between poor and rich. Some years ago, all African countries met, and agreed in Abuja to give at least 15 per cent of their entire national budget to health. Unfortunately, Nigeria’s health budget is hovering between five and nine per cent annually.
The state of pharmacy practice in the country poses a public health concerns mainly with uncertain access to quality medicines, weak standard of practices and a weak regulation of controlled drugs. It is no coincidence that Nigeria currently has one of the worst drug market controls in the world, a high rate of antibiotics resistance and one of the worst cases of drug abuse.
In order to fulfill the Declaration ‘Health for all’ which encompasses ‘”Safe and Effective Medicine for all’ the WHO presented the concept of ‘universal health coverage’ (UHC), which is defined as “all people receiving quality health services that meet their needs without exposing them to financial hardship”.
Research has also shown an existing data indicating a shortage of pharmacists necessary to achieving safe and effective medicine in Nigeria. This is supported by a research being done by Aniekan et a.,l “Analysis of pharmacy workforce capacity in Nigeria” that suggest that only 12,807 pharmacists are in active professional practice as indicated by the number of licensed pharmacists in 2016 which represent 1:15,000 of the country population.
Restructuring the drug distribution sector is key to achieving safe and effective medicine for all. Distribution of drugs requires efficient supply chain systems and appropriate regulation to ensure that the medicines that reach the consumer are in their intended qualitative state, ensure that the medicine that gets to the consumers are qualitative, effective, affordable, safe and supported with the required instruction to ensure rational use in entrenching a distribution system that drug and related facilities must be well managed to ensure they can deliver quality service.
Today, we are talking about the spread of chronic illnesses like kidney and liver diseases. A lot of these problems could be traced to the uncontrolled proliferation of medicine stores in Nigeria. When medicines are available everywhere, people tend to abuse them.
Even so, the inability to effectively address the country’s numerous challenges on open drug market has contributed to the persistent barrier towards achieving the safe and effective medicine for all. The production, distribution and consumption of fake and sub-standard drugs no matter the form, reason or quantity, approach taken should not be condoned or trivialized which happens a lot in open drug market. Most of the occurrences of fake drug dealings go unrecorded which has contributed tremendously to untimely and avoidable deaths especially of the uneducated.
The quality of health care services and medicines is poor and remains a huge source of concern. The private sector remains the main hub for counterfeits and substandard low-price product and main source of medicine for many Nigerians with over 10,000 unregistered patent and proprietary drug stores predominating the sector.
Information and communication technologies offer the opportunity for tremendous innovation in medicine access with rigorous citizen education and sensitization, especially of the uneducated with regards to the what, how, when and where to use drugs. While mobile technology is essential to the medicine for all efforts, data coverage towards getting a central database for prescription, over the counter (OTC) and controlled drugs which are abuse will go a long way toward reducing abuse, resistance, misuse and dependence.
On the back of the need to adopt technology towards sanitizing drugs distribution and ensuring its quality in Nigeria, circulation of counterfeit medicines dropped from 40% in 2001 to 16.7% in 2015. NAFDAC pioneered several authentication technologies targeted at fighting counterfeit drugs and as first regulatory agency in the world to use the TRUSCAN. A new mandatory method called “mass serialization,” often combined with “track-and-trace” requirements, is becoming the worldwide standard for regulators in securing the supply chain end-to end. Mandatory licensing of patented drugs to improve access to essential treatments for NCDs and infectious diseases is necessary with increased funding for health.
Finally, it is important to generate political will towards the achievement of Safe and Effective Medicines for all. This should be championed by the Nigerian government in collaboration with some international health agencies, NGOs, health advocacy agencies and the state ministries of health. This requires strategic education at all levels of political institutions in the country. Politicians and public office holders should be convinced to view the effective and safe medicine for all goals as an official mandate which must be achieved.
Hopefully, as implementation gets into place, all these issues could be resolved. A more structured system of action and stewardship will lead to a health service standard worthy of emulation, by ensuring strict compliance and the enforcement towards achieving safe and effective medicine for all.
Yusuf Hassan Wada writes from Usmanu Danfodiyo University Sokoto. He can be reached at firstname.lastname@example.org