Healthcare Is Incomplete Without Pharmacy – Ohuabunwa

Mazi Sam Ohuabunwa, President, Pharmaceutical Society of Nigeria (PSN), in this interview with CHIOMA UMEHA, gives the scorecard of the seven-point agenda of his administration in the first year. Excerpts:
 What efforts have you put in place to end the suffering of intern pharmacists?
We held advocacy meetings with Federal Ministry of Health (FMOH) of which they agreed to central post­ing, but yet to begin implementation; held discussions with Pharmacy Council of Nigeria (PCN) and they are agreeable, working on modalities for implementation.
We also made it a major issue during advocacy and courtesy visits to institutions and pharmaceutical companies and some accepted to increase their intake, while others even agreed to double the number of interns on their pay roll.
I personally undertook through my office to get placements for some interns and included it as a man­date for the Committee on Strate­gy, Entrepreneurship, Innovation and Empowerment; rewarding the company with the highest number of internees in employment with a Presidential Award.
Can you give more details on the outcome of the advocacy meetings between PSN and FMOH to tackle the challenges of in­tern pharmacists?
Pharmacy is at the centre of healthcare. Without pharmaceuti­cal products and pharmacies, health­care will not be complete. So the ne­cessity of having pharmacies both at the intern and full professional levels in their positions is to ensure that we have adequate manpower to enable interphase between the prescribing doctor and consuming patient or public.
This intervention serves two purposes. First, is to pro­tect the patient, because medicines or drugs are double edge sword, as I have said repeatedly, they can kill as well as heal. Because of that, the idea is always to sway the consequence to healing, not to killing.
So the phar­macist is the one who interphases with a patient to interpret the inten­tions of the doctor or prescriber on the kind of medicine to be taken, how is to be taken, under what con­dition, dose-ology and all that.
So if you take away the pharmacist and have a direct intervention between the doctor and the patient, you now cause a risk, the risk level increases. If there were any incompatibilities, if there were any possible drug to drug reactions, they will happen.
A direct prescription of doctor to the patient will increase the risk of possible drug to drug interaction, risk of incompatibilities; it will also increase the risk of inappropriate and misuse of medicines. And these can turn what’s supposed to be a cu­rative activity to a damaging one.
You also need a pharmacist in tak­ing those drugs that do not require prescription, or even in medicines that can be purchased over-the-counter(OTC) or by self-prescrip­tion recommendation because the law allows you to recommend drugs for yourself, what is called over-the-counter.
So you still need a pharma­cist because a drug called over-the-counter does not mean that is free from risk, just that it is generally regarded as safe. Take Paracetamol for example which is one of the com­monest medications, but can I shock you that it is one of the drugs with highest deleterious effect if taken in the wrong quantities for longer than it is necessary, it can cause more damage than many other medica­tions.
That a drug is OTC does not mean it can be taken anyhow. Why is it OTC, It has been proven that if everybody who has a headache or pain or malaria waited to see the doctor, many of them will be dead before they saw the doctor.
Reason is simple – how many doctors do have a relationship with the population? In some communities, the doctor – pa­tient ratio has gone up so much that before you take any medication, you need to get a prescription but in the rest of the world, it is recognised that it is not possible. So you are allowed.
Health is yours to take some risk be­fore you see a doctor or healthcare personnel. But our position is that even when you don’t have a prescrip­tion, you still need the intervention of the pharmacist to be able to advice and counsel you as to how to get the best out of your medication. So in both ways, whether you are taking prescribed drugs or self-recommend­ed drugs, you need the intervention of the pharmacist, so you can have a wholesome outcome.
Across the country, there are hospitals that are being run with­out pharmacists; there are clinics and health centres that are being run without pharmacists. Can you imagine the amount of danger pa­tients is being exposed to? So that is why we insist that we must make sure that the entire pharmacists are given their rightful place so that they can have the experience to practice independently.
, every hospital and health centre must operate un­der the supervision of pharmacists when it comes to drug regimen. So those are the issues we are focusing on. Sometimes it might not mean anything to a government that doesn’t have a pharmacist in a hos­pital because they think they the job of the pharmacists is to count tablets or just to dispense.
Dispensing is just a small aspect of the job pharmacist. The greater aspect of the job of the pharmacist is what we call, ‘Clinical Care’ in terms of relating with the patient on his drug regimen, monitoring it and ensuring that he is taking the drugs a responsible way.
Physical dispens­ing is something anybody with some training can do. We have pharmacy technicians who do the physical dis­pensing job under the supervision of the pharmacist.
You promised to ensure expansion of opportunities for career and professional achievement in hospital and administra­tive pharmacy. How far have you gone in achieving this?
So far, we have embarked on ad­vocacy visits to the Ministries of Health (Federal and States) to em­ploy and adequately remunerate pharmacists in their employment; treating pharmacists fairly and cre­ate opportunities for their career growth.
Our effort has led to subsequent creation of additional director­ates in the Federal Ministries of Health(FMOH) and some state MOH; modeling of the specialised departmental structures in Univer­sity of Nigeria Teaching Hospital (UNTH) and University of Ilorin Teaching Hospital(UITH).
We are promoting the inclusion of pharmacists in the Boards of Teaching Hospitals and Federal Medical Centres, including pursuing legislative action.
The strategy also include advoca­cy visits on the resuscitation of the Drug Revolving Fund (DRF) Scheme; the removal of all outstanding chal­lenges to the full acceptance of the PharmD degree by other healthcare professionals; adoption of models from Royal Pharmaceutical Society of Great Britain (RPS) and FIP in Clinical Pharmacy Practice Advo­cacy; follow up on the issuance of the gazette for the recognition of the consultancy status for gradu­ates of West African Postgraduate College of Pharmacists (WAPCP) in collaboration with Nigeria chapter leadership with significant progress attained.

Can you elaborate on your recent progress in the creation of additional directorates in the Federal Ministries of Health (FMOH), some state MOH and teaching hospitals?

God has granted us the grace. Un­til last year, we had only one Director in the Federal Ministry of Health, that is Director of Food and Drugs was the only director.
But, today we have six Directors in the Federal Ministry of Health. We have a Director in tradition­al medicine, we have Director in charge of logistics and others in dif­ferent sub-segments in the health­care delivery not just food and drugs, but practitioners who have reached the peak of their career.
Before practitioners only served as Deputy Directors because there was only one Director, but now we have now six of them who are at the top of their career. So if they retire now they are retiring as Directors, six of them now in the Federal Ministry of Health.
I am not taking credit for all the work. Some work has been done, but God has granted us His grace that it is during our presidency that the little work we have done added to the work that has been done by previ­ous leaderships to bring the results.

And this is also happening in States, States also had just one Director for Pharmaceutical services, but some States are now having more than one they are dividing the pharmaceuti­cal sector into some sub-segments to allow pharmacists to achieve their potentials and also reach the top of their career.

And what is more even pharma­cists are being moved from a pure health system, they are now being moved from pure pharmaceutical services to larger roles in health­care. Some are moving to primary healthcare, some to other health­care departments, where previously pharmacists did not show up.

What we are seeing in Ilorin is the sub-specialisation in pharmacy. As we have sub-specialisation in medicine, we have counter sub-spe­cialisation in pharmacy.
We believe that an oncologist in medicine should be commu­nicating with oncologist in pharmacist; a neurosurgeon should be communicating with a neuro physician, a physician that specialises in neurosurgeon or neuromed­icine.

If you pick a standard pharmacist to come and be speaking to a neurosurgeon, you see that there is going to be a disconnect, you know neurosurgeon is a special­ised physician and he will need medicine to complete his work, so he needs a pharma­cist who is at the same level of sub-specialisation to be able to advise him.

This is what we are saying, sometimes we are being misunderstood by some people in healthcare who think we are bringing in competition, we are not into competition, rather it is com­plementarity so that the patient will get the best. If you go to UNTH, you will see those sub-specialists or Univer­sity of Ilorin, you see those sub-specialists.

So we are taking that as a model for another teaching hos­pitals to create these sub-spe­cialties so that the patient will get the best they can afford and to also give support to other healthcare profession­als, especially our colleagues the medical doctors.

The implementation of NDDG has lingered for long. Is there hope that this is going to be achieved soon? You were on a recent advocacy visit to Federal Ministry of Health on quick implementation of NDDG.

You also met with some State Gov­ernments to close drug markets and support PCN regulation. What was the outcome?
The call that was terminat­ed now is from one Mrs. Ugwu, she used to work in the Feder­al Ministry of Health and she is retired. It was during her tenure that the National Drug Distribution Guidelines (NDDG) the proposal came and I have persuaded her to be the Chairman of the NDDG Com­mittee of PSN.
 We are having a meeting this week in Lagos, the Registrar of PSN, PCN and other key persons in the indus­try would be involved to discuss this issue of proper regulation, sanitisation and NDDG.

This is a practical demon­stration to let you know that we are eyes on the ball and our determination is to make some progress this year. We want to force the hand of government to begin imple­mentation. 

We cannot wait until everything becomes perfect because there are cer­tain things which we can be implemented now within the NDDG, some of the guidelines are implementable, while oth­ers can wait because of inad­equate infrastructure. 

I want implementation to start soon now that I am PSN President and that is why I am calling this meeting this week has be­come necessary. I am rejigging the committee and putting up a strong mandate that there are deliverables this year.

You earlier said that the relentless pursuit of the signing of the new Pharmacy Act by the President which fell through has now been restarted with greater zeal in con­cert with the PCN. What are some of the issues which the Pharmacy Law is going to address?

You know there are a cou­ple of things. First you have the Pharmacists Council Law Of Nigeria (PCN Law) and it is regulating pharmacy pro­fession, but what we are try­ing to get on now is Pharmacy Council Law.

The reason this is being done is that some people who has been in the indus­try think that the PCN Law is just for pharmacists?

Whereas the law is supposed to cover all spectrum of pharmacy, it starts from drug manufac­ture to drug consumption, the whole process is inclu­sive. Like the way, you have it in journalism – the copy editor, sub-editors etc. 
So if you say there is Journalism Law, there are people work­ing under the media, but are not qualified journalists, but they are practising in the media, so if they want to be mischievous, they will tell you this Journalism Law does not cover them.

So that is exact­ly what is happening with Pharmacists Law. There are people who feel that the cur­rent Pharmacists Law did not cover them. If we now have a Pharmacy Law, it will cover that lacuna, that’s one major reason we are pushing for this Pharmacy Law. So it’s going to increase more wholesome regulation that will cover ev­ery aspect of pharmacy. 

The second reason is going to pro­vide more resources for PCN to enable to them do their job.
They will be better em­powered than where they are now because the terms, the recognition and penalties for certain infringements would be stronger and harder than they are currently. It would also provide more manpower, resources and ability to cover the space called, Nigeria.

And above all, it would bring every actor under one regulator so that we can have wholesome, more regulated and sanitised an environment where some­body will not claim that the laws don’t cover them.
The registration of phar­macists is under the Phar­macists Council of Nigeria. 
As I speak to you now, the original law on it was with the Ministry of Health and it was Ministry of Health that donated it to PCN. Under the then Minister of Health, Prof Olukoye Ransome Kuti, he do­nated the power to the Local Government Area(LGA). So LGA was registering Patent Medicine Stores. That is why you have the proliferation of Patent Medicine Stores.