National Chairman of the Association of Community Pharmacists of Nigeria, Adewale Oladigbolu, speaks to AYOOLA OLASUPO about the shortcomings in the country’s drug prescription, sourcing, dispensing, and distribution, and the need to encourage local production amongst other remedies
Recently, your association sought President Bola Tinubu’s intervention in the regulation of drug prescription and dispensing in the country. How best do you think the Federal Government can easily achieve that?
The first point to start with is the fact that the Federal Government long time ago formed a committee of experts on this matter and that committee worked to a certain extent. To move forward, we need to resuscitate such a committee or constitute a fresh one that will look at the laws of the federation that separates dispensing from prescribing and when they look at these laws, we will need to bring out regulations that support the rights of veterinary doctors, physicians, non-practitioners, pharmacists prescribing and the right of pharmacists to dispense all prescriptions written by a physician, veterinary doctors, and other stakeholders that are mandated to make prescriptions, including dental doctors.
The Federal Government must set up a committee that works on the extant laws to bring out regulations about prescribing and dispensing by pharmacists. Once we get this one right, we will be moving forward towards a national drug distribution system and national use of medicine in our country.
Why has the committee that you said was earlier constituted not functioning?
I think I will put it at the doorstep of the Federal Ministry of Health, and as far back as 2013 through 2014, if I’m not mistaken; but since that time, the committee has been moribund. It is just to call on the Federal Government not to look back and form a fresh committee that looks at the dispensing rights of pharmacists and the prescribing rights of all the prescribers and be able to say, ‘We need to move forward in this country’. Nigeria is the hope of the black nations and in the health sector, and when you have the same person prescribing and dispensing, it is not right. It does not go well for the health of the citizens of such a country.
Will you say that lack of continuity in some of the programmes initiated by the Federal Government has been the major factor affecting the effectiveness of the committee?
That is right because this lack of continuity has been the thing in the health sector. You will remember that there is a national drug prescription policy of the Federal Government, which the government came out openly to say that there is a flow chart for the distribution of medicine in Nigeria. The government’s plan for the enforcement of that was lacking and at the end of the day, they made a pronouncement as to the discontinuation of the open-door market in Nigeria which the government itself has failed to adhere to, but lack of continuity is a major problem in re-crafting the health sector in Nigeria. It is a very great problem.
Many policies have been abandoned and some are just on the table without implementation. Having said all this, it is good that the government reactivates the committee on the prescription and dispensing of drugs in Nigeria as long as this committee has a timeline to work and deliver and for the government to implement the resolution of such committee. We have seen a lot of things and one of the things that the government does sometimes is to use committees to slow down the progress of things. So, I hope that this won’t be like that.
What is the association doing to ensure that illegal drug sellers who contribute to the dirty practice of drug distribution are stopped?
It is indeed a very sad thing that in 2024, people still buy and sell drugs inside buses and in the market. It is very sad, and it just showed that as a nation, we still have a lot of work to do. The medicines are very potent chemicals, and there are some medicines that when we want to dispense them in the hospital, we must wear gloves. Some medicines require being stored under controlled temperatures. There are some that if we dispense them to a patient, we will advise them that they should not stop for three days. We tell the patient to continue to take it for the rest of his life. Don’t even stop for more than three days because if the patient does, it may lead to the end of that patient. Living this kind of chemicals in the hands of illiterates and for irresponsible distribution of this kind of cogent chemicals says so much about the desires of our nation.
I will therefore call on the regulatory agencies concerned to be strong in their oversight functions and responsibilities. I just finished writing a letter to say that NAFDAC is not fully empowered to carry out its functions because you only need to step out around 7pm, you will see people hawking medicines in a basket and some of those medicines are antibiotics. For some of those medicines, when we give them to patients, we need to advise them to finish the dosage. While some of those medicines are spoilt by age, some are so potent that when used or taken more than necessary, it may lead to the death of that patient.
What can end this problem is to place a ban on the open-door market. It is not necessary. If these people who sell this medicine in buses and markets do not have access to sourcing it; then they won’t be able to sell it. Wholesalers will not sell to you if you don’t show them your licence to practise, but in an open-door market, anybody can enter and buy anything.
What role do you think the National Orientation Agency can play in this regard?
The National Orientation Agency needs to promote good access to medicine and medical information. It has the responsibility to ensure that people know where to get access to health information and quality medicines and access to quality medicines in the community pharmacies in the private sector and even hospital pharmacies and tertiary institutions. They need to tell the people not to go to the market to source their medicines and look for the green cross sign of the community pharmacy to know the pharmacy they want to patronise or the permit of the patent medicine dealer that they want to patronise. Look for the licence of the pharmacy, and that should tell you where to get your medicines and the appropriate health information, care, and support.
Reports showed that the prices of essential drugs have risen from the previous amount to 300 per cent, thus having grave effects on the final consumers. Don’t you think it is high time the Federal Government started looking at ways to facilitate the reduction in the prices of drugs across the country?
There are many solutions to the high prices of drugs, but one solution stands out. The Federal Government is not paying adequate attention to it because people are paying out of pocket. The idea is that if I’m sick, I will look for money and buy my drugs no matter what the price is, especially if I can afford it, but the greater solution lies in National Health Insurance. Let the government start the National Health Insurance where everybody pays a token when you’re sick you will just go to the hospital and the community pharmacy to get the prescriptions.
If the Federal Government starts that, all of us will not know what the drug prices are. If it is the Federal Government paying for those drugs, we will know the right thing to do, and they will do it because what is happening right now is that there are many things to be done but we have not seen movement in that direction. Thank God that the Federal Executive Council said they were doing a memo on the reduction of tariffs for the importation of raw materials and finished medicines. If that is done, prices will come down.
One major thing that I keep emphasising is that is the open-door market. Even if the Federal Government removes tariffs today, prices of medicine will not come down because there is a collusive oligopoly in the open-door market. They control the prices of drugs in Nigeria. Without abolishing that open-door market, we cannot have a reduction in the prices of drugs. They hoard the medicines, and you will find a situation whereby a few individuals, two or three of them will come together and buy the whole products that a company is importing and sell the drugs at their price. How can the country survive? How can a country that is so much interested in the welfare of its citizens allow those kinds of things to happen? That we allow the open-door market to strive in Nigeria does not mean that we do not prioritise the health of our citizens. There will always be an open-door market and drug prices will come down and the prices will also respond to whatever other payment you are giving as the Federal Executive Council. If they remove tariffs today, which I’m advocating, it does not mean that the prices of drugs will come down because there is a collusive oligopoly from the open-door market.
Don’t you fear that this may lead to an increase in mortality rate if the issue is not treated with the urgency it requires?
People are already dying. There is one drug used by epileptic patients and a pack of it is N65,000. That is a drug that someone who has epilepsy must take daily non-stop. How much does such a person need to have to be able to maintain that? So, the price of drugs is keeping people in the hospital. The way the government is investing in the refinery because petroleum cuts across everywhere is the same way they should encourage the production of pharmaceutical starch so that there will be encouragement for pharmaceutical production in Nigerian companies.
People are saying that the instability in the exchange rate of naira is part of the factors contributing to the rise in the prices of medicines. How do you think local production of some of these drugs can bring about a substantial reduction in the prices of pharmaceutical products?
According to NAFDAC, 70 per cent of what we use in Nigeria are imported, but I will tell you that even from the 30 per cent that we manufacture locally, we still depend on foreign exchange to bring in the active pharmaceutical ingredients to make those drugs tablets and capsules. The instability in forex is affecting the pharmaceutical sector. There is global scarcity for some of the medicines too because some of the countries and industries have yet to recover from the COVID-19 pandemic. So, we have a tree factor that is driving the instability and availability of medicine in our sector.
Your association once said that the safety of Nigerian health consumers was at risk due to poor prescription quality and dispensing rights. Can you throw more light on this?
For now, I’m defending all healthcare professionals and I’m doing that because the basic business of health is paramount to most healthcare professionals. Anybody can write prescriptions. There is no prescription policy in Nigeria and there is no standard prescription pass for doctors in Nigeria. Ideally, there should be a standard prescription pass if we want to do the analogue method for all physicians, veterinary doctors, and dental doctors in Nigeria. They should have a standard prescription pad and especially the registration number of the prescriber. That is the starting point. If you’re in Sokoto and you’ve written a prescription and brought it to my family in Lagos and I look at the prescription and see that there are things to be amended or explained, I will just go on the platform and put your registration number there and I can get your phone number and put a call through to you. That is how to reform the health sector.
What is your take on the stance that community pharmacists should be recognised as primary health care providers?
We are already rendering primary health care services in a community pharmacy. We offer vaccination in community pharmacies and do a lot of family planning, including the insertion of implants. So, the tendency is that there will be a growing number of primary health care services being offered by community pharmacies in Nigeria.
So, as it is, what message do you have to the President on the exit of foreign pharmaceutical companies from the country?
My advice for the Federal Government under President Bola Tinubu is that the business environment should be made more conducive, and he should eliminate the open-door market because, with that, the investors do not get the kind of return on their investment that they envisaged. It embarrasses multinational companies that their products are found in the open-door market and some of them are fake.
That is why you see many of them leaving the country. The business environment needs to be set right and we are thankful that sourcing forex is receiving attention from the federal government. We are hoping that the naira will be stable. Apart from that, we need to look at the energy sector. It is critical to the success of businesses in Nigeria.
