As the Association of Community Pharmacists of Nigeria (ACPN) prepares for its 44th Annual National Conference in Awka, Anambra State between July 22-27th, newsmen spoke to the duo of National Chairman, ACPN Pharm Ambrose Ezeh MAW, DCPharm and National Secretary Omokhafe Ashore, FPSN on contemporary health matters.
Excerpts:
Reporters: In your recent pre-conference press briefing you spoke about high incidence of drug faking and a need for a better sanction culture.
How then can we grow the pharma sector against this background?
Association of Community Pharmacists of Nigeria (ACPN): - Please make no mistake about it. The Pharma Industry continues to grow despite all odds with over 150 registered pharma manufacturers including 5 that are WHO certified for Good Manufacturing Practice (GMP).
I can confirm to you that local pharma manufacturers including prominent Nigerian investors are building Active Pharmaceutical Ingredient (API) plants which are in tens of million dollar range investments in a bid to change the structure of the game as we impose medicines/drug security in Nigeria as well as create a local manufacturing hub in Africa.
You will recollect the exploits of Fidson Healthcare in the manufacture of anti-retrovirals at a time donor agencies are withdrawing funding that guaranteed free supply of these drugs to Nigerians. Emzor commissioned a specialised Cephalosporin plant in its ultra-modern factory a few month ago, while Indian giants, Jawa Pharm also recently inaugurated a factory-site for beta-lactam range of anti-infectives.
At some point the value of our industry was estimated to be about $2Billion, but with recent investments we would be cruising to an ambitious $10Billion dollar range sector in the next five years especially now that Codix healthcare recently launched a factory for the local manufacture of invitro-diagnostic kits and medical consumables.
Despite challenges we are certainly unrelenting and will continue to be fruitful to contribute significantly to National Gross Domestic Product (GDP) like we see in India and China where the pharma sector remains very strategic to national growth and development.
The ACPN will partner the local Pharma Industry to attain increased access of drugs and economic viability of the sector.
The Government at all levels must support pharma manufacturers through a deliberate special incentive for the pharma industry to facilitate access to equipment, excipients and other materials that are expedient to GMP because local manufacture presents opportunities for more jobs, international trade, economic growth and development as well as boosting national security.
We must make Nigeria benefit maximally from the African Free Trade Continental Area (AFTCA) which is adjudged as one of the largest in the world.
When we create the environment for the listed goals, we can easily meet the goals of both the National Drug Policy 2021 and the National Health policy which both priotises the availability, accessibility and affordability of safe and efficacious drugs in our Health System.
This is why we reiterate albeit with a sense of responsibility that the Federal Ministry of Health (FMoH) must reach-out more to stakeholders in Pharmacy practice and industry before churning out policies like it did with MEDIPOOL.
We hasten to say that a policy can be good or bad depending on its implementation mode particularly when we set out clear rules of engagement with relevant players in affected constituencies.
Our industry once contemplated an Expedited Medicine Access Programme akin to the bulk supply of local drugs in a central template like it happened in the PTF era.
It is therefore important that FMoH must promote reforms and a strengthened legal framework through an amendment of the Fake Drug Act by bringing heavier sanctions on defaulters of the law, while also implementing the approved National Drug Distribution Guidelines of 2015 for maximum effect.
A progressive implementation of these shared values will be the springboard for a wholesome and virile pharma sector.
2) In the last few months there has been a renewed wave of media rows between Pharmacy groups and stakeholders in Medicine.
What is the crux of matter?
ACPN:
It is unfortunate to say this but the reality remains that these fellows you described as stakeholders in medicine have been existential adversaries to our aspirations and destiny as a profession.
The philosophy of these medical groups is grounded in a diabolical spirit of mesmerism which the Government falls for at both the Federal and state levels.
Let me say with deep conviction that these physicians have been succeeding in episodes of tainted development in the Health Sector because of a distinct subservience on the part of Government and I will give empirical data to support this.
Nigeria physicians under the banner of Nigeria Medical Association (NMA) and some other sub-professional interest recently pointedly called on the Federal Government to withdraw the reviewed circulars for allowances for different cadres of healthcare workers in Nigeria and have threatened to go on strike in 21 days if Government does not accede to their spurious demands. From a lawful perspective of labour laws in Nigeria which have also been affirmed by the National Industrial Court of Nigeria (NICN), the law does not recognize a 21 day ultimatum for those on emergence services which any healthcare association/union falls within in terms of bracketisation. It is not my responsibility to teach these dwarfs labour laws since the only area of life they are familiar with is there core area of practice.
Realistically as its stands today there is no ultimatum before government from any of the groups which symbolize medical interest.
A recent panic alert issued by the Association of Nigeria Private Medical Practioners(ANPMP) is absolutely unnecessary and uncalled for.
As usual the basis of the hues and cries of the medical groups is vested in privileges and benefit packages. One of the areas of their needless confrontation is the government recognition of PharmD and consultant cadre in Pharmacy practice which they claim undermines clinical skills and output of physicians in healthcare, a position that is as senseless as much as it is meaningless because a Nigerian version of healthcare will not be benchmark for healthcare practice in a decent world.
I am a critical stakeholder and l am worried because Government at all levels is courting a violent disaster as it continues to over-indulge these physicians who are Government employees who demand what they want and proceed to put a ceiling on what all others can get including not recognizing certified skills acquisition paid for by Pharmacists in millions of Naira (between 5-7.5million naira for the 5 and half duration of the fellowship programme which leads to granting Consultant Cadre, when doctors are on government scholarship through medical residency programmes which were instituted by FMoH). In Nigeria today, all FHIs have continually frustrated the implementation of the residency programme circular approved by the FMoH on the prompting of the Pharmaceutical Society of Nigeria (PSN) in June 2015, more than 10years ago. In apartheid Nigeria, Pharmacists who spend their hard earned money to acquire skills through the fellowship programme are forced to pay by the management of FHIs in pursuance of their residency programmes as part of strategies to frustrate them, while physicians who government paid for elope(JAPA) a few months after utilizing taxpayer’s money for their training thus shortchanging Nigeria perennially.
Global best practices and all modern tenets of skill acquisition or manpower development modes advocates an ability to potentiate potentials for improved competencies and boost in service delivery.
With the active connivance of Government, physicians are the only people DECREED to be CMD/CEOs of Federal Health Institutions (FHIs), Chairman-Medical Advisory Committees (C+MAC) and a full plethora of deputies who are all Physicians.
In the last few months, the Government keeps expanding the range of designated Universities of Medicine and attempts to mutilate the configuration in the Health Sector by placing Faculties of Pharmacies in University systems designed to have only Physician-VCs. This is a distorted equation that imposes psychological atrophy on Pharmacy and other student health professionals from the beginning of their careers.
Government continues to expand the latitude of influence of Physicians who insist every title, office or privilege in healthcare must be mutually exclusive to member of the Nigeria Medical Association (NMA). Today there are 5 physicians in charge of non-health related ministries including the Education Ministry without protest by stakeholder in these callings.
The Education Minister a very inexperienced Physician who was causing chaos at FMoH with his infamous policy drives has in less than 6 months disrupted the processes for the appointment of new VCs at UNIZIk, UNICAL and UNIUYO because Consultant Physician (his Physician colleagues) under the aegis of Medical and Dental Consultant Association (MDCAN) proceed on strike to compel the Federal Government to allow them participate in the selection process for VCs contrary to the NUC Act which dictates that holders of the office of VCs must have PhD because it is an ACADEMIC and not a PROFESSIONAL calling.
Physicians it must be declared have now established a unity of monolith in alliance with Government to subsume the liberties of all other healthworkers in dangerously unprecedented political phoenixism in Nigeria.
What does anybody expect with the visionless appointments of 7 Physicians (2 of them are in charge of the FMoH), a Special Adviser, Health Matters, and CEOs of the main MDAS in the Health Sector (NHΙΑ, ΝΡΗDΑ, NACA, NCDC and others) but fruitlessness in a multidisciplinary sector.
Prof Pate arrived the FMOH stressing a political catharsis that he was given a mandate to create hibernation from the unending conflicts amongst health professionals and workers, but he has entrenched a belief system that compels an average non-physician health worker to suspect his motives as Coordinating Minister alongside his band of delusional messiahs in all spheres of healthcare.
President Tinubu might have given slim hopes in the area of infrastructural development, Agriculture as well as Internal Affairs particularly Immigration but what he institutionalising in the healthcare is a usurpation of the authoritative exclusivity of all non-physician health professionals by physicians.
Given the scenario, physicians through the NMA are now officially at National Assembly (NASS) to legitimately wrestle to claim the professional autonomy of all other professions in Nigeria with an ill-conceived NHFRA bill having failed to achieve that 11 years ago with the National Health Act and a failed legal bid at the FHC, Abuja by the MDCAN which brazenly requested the NASS to hands off enacting regulatory laws to pave way for MDCAN to take over such regulatory functions.
In Lagos State where I practice, the Governor Sanwo-Olu's wife who is a Physician in collaboration with the Ministry of Health have perfected a parallel to the distasteful state of affairs at the federal level.
Lagos State is the only Southwest state that has refused to formalise its Consultant Cadre circular because all the relevant implementing officers in Lagos State Government will not dare incur the wrath of madam who the emperors that epitomise the leadership of medical stakeholder have sworn must ensure symphonies of progress which consultant cadre in pharmacy represents be obliterated.
For us in Pharmacy we rely on the Solvito Ambulando principle which believes there will be a solution as long as you keep moving.
Physicians mouth sustainance of hierarchies in the Health Sector, but it is Pharmacists who have been seriously shortchanged because up to 1990, Pharmacists and Doctors started their careers on the same grade level during internship and after youth-service contrary to a 2-grade level differential today. The existing contraption is one of unholy legacies of late Olikoye Kuti an infamous Health Minister in the 80’s in the reckoning
We call on the 4 trade unions under the umbrella of the Joint Health Section Union (JOHESU) and the Assembly of Healthcare Professional Associations (AHPA) connected to JOHESU to be prepared. It is time to expose the congressional hypocrisy of those who allow the rot and madness with regards to the unproductive leadership in Health to continue to thrive.
We must go all the way this time albeit legitimately to prove the point that when injustice becomes law, resistance becomes a duty.
It has become imperative to challenge the unconstitutional proviso which grant exclusive privileges to physicians who are not trained health administrators to be CEOs of all the FHIs in Nigeria.
If the Federal Government is sensitive and responsive enough it must hold serious dialogue with non-physician health professionals and workers immediately because they are over 80% of the workforce. Such engagements may however not be the respected under the auspices of the leadership of the FMoH which has refused to inaugurate the boards of the Professional regulatory councils and FHIs under the guise that their enabling laws are under review in a process that does not recognise the major players in the law review of their professional practice or their stakes in hospitals they work.
The PSN and JOHESU are in best position to coordinate this advocated dialogue directly under a President Tinubu led initiative.
The impunities and the resulting conundrum at FMOH need a pathological and not a mere symptomatic change or intervention.
For me, I am relying on the imperatives of scriptures which says "All the trees of the forest will know that I the Lord bring down the tall tree and make the low tree grow tall. I dry up the green tree and make the dry tree flourish "I the Lord have spoken and I will do it".
3. Independent: - There is a new National Health Facility Regulatory bill before the senate. Is this acceptable to the ACPN and generality of Pharmacists?
ACPN:- JUSTIFICATION FOR NOT MERGING, THE PHARMACY COUNCIL OF NIGERIA (PCN).
We have looked at the legal background and development of Pharmacy regulatory laws in the Country beginning from the Lagos Pilotage and Harbour Ordinance 1878, the Hospital Ordinance of 1881 and the Ereko Dispensary Rules of 1889. These early legislations recognized the purpose of regulating dispensers, druggists and chemists. The regulation of the practice of the profession in that regard was overseen by the Pharmacists Board as contained in the pharmacy Ordinance of 1927, The Poisons and Pharmacy Act 152 of 1958 and the Pharmacists Act No. 26 of 1964. Despite changes in the contents of the legislations, the substances were basically the same. The Decree No. 91 of 1992 created the Pharmacists Council of Nigeria which was further improved upon by the Pharmacists Council of Nigeria Act Cap P17 LFN 2004. The current extant legislation being the Pharmacy Council of Nigeria (Establishment) Act 2022 not only emboldened the previous legislations but substantially expanded the scope of practice and personnel involved in the practice and brought the law to be at par with the best international practice.
Pharmacy practice and business has been subject of legislation and regulation by the Council, we provide further justifications below as to why the Pharmacy Council of Nigeria should not be merged with any other health regulatory body or bodies in the Country.
- The Pharmacy Council of Nigeria has undergone phenomena development and growth in the performance of its duty as regulator of pharmacy practice, premises and personnel. It currently has developed its regulatory personnel and structure to such an extent that it is well entrenched with state offices in each state of the Federation, 8 zonal offices in each of the geopolitical zones, Lagos and Abuja as a special Zonal offices and its head office/Registry in Abuja. These physical structures manned by staff who have acquired capacity in regulatory activities over the years, have adequately reached a stage whereby the Council is now effectively regulating the drugs distribution system in the country.
- Due to the effectiveness of the Pharmacy under the new dispensation, the World Health Organisation benched marked Nigeria as haven attained Maturity Level 3 along with NAFDAC which are the Agencies jointly recognized as National Regulatory Agency for Nigeria. With this rating, Nigeria is now rated one of the very few in Africa with that capacity, the National Regulatory Authorities have been found to have a well functional and integrated system to facilitate regulation and thus can effectively ensure that the country produces vaccines, among others.
- International Best Practice and Alignment with Global Standards: It is the general practice globally that Pharmacy profession, practice and business is regulated exclusively by the practitioners of the profession as an entity. We looked at the practice environment in countries with similar background as Nigeria including Great Britain, the United States of America, Canada, Republic of South Africa, Ghana and Kenya. These Countries each have a pharmacy regulatory body as the sole sector regulator.
- Preservation of Professional Standards: The pharmacy profession has unique ethical and practice standards that require focused regulation. A merger could lead to generic regulation that fails to address the specific challenges faced by pharmacists and other cadres of the pharmacy profession thereby lowering professional standards and impacting the quality of pharmaceutical services provided to the public.
- Prevention of Bureaucratic Overload and Resource Misallocation: Combining multiple regulatory bodies could lead to unnecessary bureaucracy and inefficient resource allocation. Pharmacy-specific functions may be underfunded or neglected, as the regulatory focus becomes divided across various health professions. This could undermine the effectiveness of pharmacy regulation and weaken the profession’s ability to protect public health with respect to the drug component of same.
