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.