Albert Kelong Alkali is the outgoing Chairman of
the Association of Community Pharmacists of Nigeria (ACPN). He is a Merit Award
Winner of the Pharmaceutical Society of Nigeria (PSN) FCT, Abuja branch, a
fellow of the West African Postgraduate College of Pharmacists and one-time
chairman of the ACPN (FCT, Abuja). In this interview with CHIOMA UMEHA, this
distinguished pharmacist shares his thoughts on sundry issues. Excerpts:
The Senate is currently working on two draft
bills, the Drug Control Bill and the Mental Health Bill to deal decisively with
the menace of drug abuse and misuse. What is your view about them?
We must commend the Senate for showing sensitivity
and sensibility in the obvious menace. Recall that the PSN and its technical
group especially the ACPN blazed the trail of consultations which signposted
the development you are talking about. The initial visit to the Senate was
followed up with a roundtable in Kano particularly because the menace appears
to be malignant in the Northern region of the country where youths and women
are substantially afflicted.
The challenge is directly traceable to the many
defects associated with our drug distribution channels which encourage
unlimited and easy access to all categories of drugs including Pharmacists
Initiated Medicines (PIMS) and Prescription Only Medicines (POMs).
Ordinarily, the pragmatic and best feasible option
is to appropriately regulate and control the various pharmaceutical premises,
deal decisive blows on the plethora of unregistered pharmaceutical premises
which are well over 2000,000 compared to the less than 6,000 pharmaceutical
premises and 20,000 patent medicine vendor duly licensed by the PCN to
legitimately handle what should normally be a professional endeavour.
Government must also strengthen regulatory
procedures modulating the endeavours of NAFDAC and the NDLEA. The NAFDAC
mandate dictates it must ensure circulation of safe drugs, water and other
regulated products. How do NAFDAC, NDLEA and PCN cope with their respective
mandates which normally should be restricted to less than 6,000 pharmaceutical
premises and 20,000 medicine vendors, if field experiences confirm that almost
two million unregistered premises exist today in our country?
In effect, if we legislate on the menace without
redressing the fundamental dysfunctions in the distribution channels, it might
just be another waste of time, resources and specialised personnel. The ACPN
posits albeit very strongly that the way forward remains: Diligent implementation
of the National Drug Distribution Guidelines (NDDG) with particular emphasis on
the closing of existing drug markets on June 1, 2019 to pave way for the
emergence of the Co-ordinated Wholesale Centres (CWCs) in Lagos, Onitsha, Aba
and Kano.
The CWCs which would have PCN, NAFDAC and the
police within have prospects of better regulation and control than had always
been impossible in the existing market structure.
Government must breathe down heavily on the
operators in the markets, as it is apparent some are still not ready for a
paradigm shift. While the CWC structure is taking shape in Lagos and to a
lesser extent in Onitsha, the same cannot be vouched for in Aba where operators
appear dodgy and non-committal. Even the training schedule for operators has
not been possible in Aba despite the January 1, 2019 deadline.
There is obvious paucity of funds associated with
funding the regulatory activities of PCN, NAFDAC and NDLEA. Rather than spread
lean and ineffective budgets on new bureaucracies, it might make a lot more
sense to appropriate meaningful budgets to the existing regulatory agencies
listed.
The Federal Government and state government must
approve of special funding for the Federal and state task forces on fake and
counterfeit drugs which remain the statutory and regulatory instrument to
remove outright all structures and places where drug sales are prohibited in
the country.
Government must also adequately enhance
professionalism in the health sector through discouraging open-ended access to
all cadres of drugs including potent ones with narrow therapeutic windows. This
is best achieved through a prescription policy that limits a prescriber to
prescription of drugs alone, while the dispenser is also confined to dispensing
responsibilities solely. You will have observed glaring indiscipline even
within the rank and file of health providers. Recently, veterinary doctors
openly canvassed at the House of Representatives an act of parliament which
allows them to open veterinary pharmacies as well as import veterinary drugs in
Nigeria.
You know as much as I do that rational logic does
not support this. It is also imperative to put on record that there are valid
courts that have clarified that veterinary doctors cannot seek to regulate the
practice of another profession which in this instance is a reference to
pharmacy.
For the sake of clarity, global best practices
dictate that licensed medical doctors, dentists and veterinary doctors are
legitimate prescribers, while only pharmacists are duly charged with the
responsibility of dispensing in Nigeria. Today in our statute book, this same
position is entrenched in the Poisons and Pharmacy Act of the Federal Republic
of Nigeria.
How then do you reconcile these positions
with the decision of Professor Isaac Adewale, the Minister of Health, to impose
a nationwide ban on codeine-based products in Nigeria?
We take a position that the decision was hasty,
shallow and an attempt to play to the gallery. It was just an escapist
mechanism that would ultimately aggravate the thriving impunity in the pharmaceutical
sector. Codeine still has a place in therapy in the global arena. There are
many other drugs that are perennially abused and so how many more of them would
Adewole ban? In fact, there are so many abused substances that are not of drug
aetiology including fumes from soak ways, super glue, paw-paw leaves etc, so
are we going to decree them out of existence? Nobody solves a problem by
running away from it, so our policy makers and government think-tank need more
intellectually inclined approach in nation building.
My biggest worry in the ban of codeine products is
that government may have unwittingly created a huge thriving black market for
these banned items especially because of our track record of poor regulatory
controls. The other dimension of that reckless decision is the propensity to
de-motivate the struggling local pharmaceutical industry in terms of capacity
utilisation. Other indices such as job losses will transcend into diminished
Gross Domestic Products (DGP).
Recently, there was a nationwide strike by
all health workers under the aegis of JOHESU/AHPA. What can be done to avoid
such crippling strikes in future?
It is only one bold move which is to embrace
global best practice in healthcare in an atmosphere that guarantees justice and
fair play to all. It is as simple as that.
As a player, I am both sad and worried that
government at the highest level chose to look the other way as Nigerians
perished in substantial hundreds between two compromised doctor-ministers who
decided to subvert a legitimate agreement between JOHESU and the Federal
Government signed on September 30, 2017.
It was certainly the shame of a nation. Even state
governments were responsive in that scenario as states like Lagos, Yobe, Edo
and Kano gave approvals to the adjustment of the CONHESS scale in their
respective domains.
Governor Akinwunmi Ambode also endorsed the
consultancy cadre for pharmacists in the employment of the LASG. The Federal
Government certainly has a lot to learn from the Lagos State government when it
comes to the workability of structures in the health system.
What is the latest about the NHIS which
potentially has a tendency to improve the health system?
We all continue to talk about Universal Health
coverage without redressing the concomitants of procedures which militate
against it. The two-fold deficiency of indiscriminate capitation of facilities
including secondary and tertiary in our health system and implementation of
global capitation at the expense of legitimate payment mechanisms are evils
that have stalled the growth of Social Health Insurance in Nigeria.
As I have explained again and again, we must
reckon with international best practices because healthcare is not indigenous
to us.
You are exiting as chairman in a few weeks.
What would you say are your achievements?
It is perceived as uncharitable by African
standards to sing praises of yourself. We have however excelled in better
relationship management with major health donors and partners.
We have worked tirelessly with PSN to improve
professionalism in this country despite formidable odds. Our conferences have
gone hi-tech and more scientific to the envy of our contemporaries I dare say.
One of the most enduring legacies of all time is
that we shall bestow a new and befitting National Secretariat worth about N100
million to our successors when we exit.
I have no doubt our successors are ready to take
the association to the next level and I will on this note wish them very well.
