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– The Association of Community Pharmacists of Nigeria (ACPN) has petitioned President Bola Tinubu to quickly reform Nigeria’s healthcare system through reforms that will create the office of an adviser for pharmaceutical services and chairman for drug distribution restructurings.
Specifically, there are three areas where ACPN wants urgent reforms. They said that the National Health Act of 2014 must be fully implemented, and the entire potential of primary healthcare in Nigeria must be fully defined.
The management of the National Health Insurance initiative in accordance with due process and the public interest is the third area in which community pharmacists are advocating for reforms.
In a letter dated July 3, 2023, entitled: “Attaining universal health coverage through urgent reforms in pharmacy and healthcare practice” ACPN explained why it is important to appoint an adviser for Pharmaceutical Services/Chairman Reforms on Drug Distribution systems.
According to the pharmacists, the adviser for Pharmaceutical Services/Chairman Reforms on Drug Distribution will champion the resuscitation of drug distribution generally with a specific mandate on all three agenda items earlier mentioned.
The letter was addressed to the President, Bola Tinubu, and jointly signed by the ACPN National Chairman, Adewale Oladigbolu, and National Secretary, Pharm Ezeh Ambrose.
It partly reads, “In contemporary times, the ACPN has continued to monitor the evolving and progressive strides of the Bola Tinubu Presidency which is gradually beginning to engender a season of fulfilment in national life.
“It is in the light of this ray of hope that the ACPN wishes to canvass urgent reforms in Pharmacy and healthcare that can birth fruitfulness in the Health Sector as well as activate sustainable Universal Health Coverage (UHC).”
Full Implementation Of National Health Act 2014
ACPN also solicited the appointment of a seasoned Health Administrator or Insurer to head the country’s Health Insurance Scheme, noting that the benefit of the scheme has declined.
The letter further reads, “The NH2014 ordinarily ought to be the supreme legislation in healthcare in Nigeria. It is a product of twists and turns spanning over a decade before it was eventually enacted as an Act of Parliament. One of the most positive reflections of this Act is the creation of a Basic National Healthcare Provision Fund (BNHPF) which is meant to be an accrual of one percent from the Consolidated Revenue Fund.
This proviso of the law, if well implemented, will make healthcare more impactful as it will guarantee better funding of the Health Sector which groans under both a paucity of funds and gross mismanagement of even budgeted funds often times bordering on an average of just about five percent relative to the 13 percent prescribed by Heads of Government that facilitated the Abuja declaration of 2021.”
According to the letter, BNHPF remains a major tool to drive the actualisation of Universal Health Coverage (UHC) as it lawfully provides that the BNHPF should fund Social Health Insurance to the tune of 50 percent of dedicated funds, while 30 percent of these funds be devoted to the procurement of essential drugs and vaccines. 15 percent of the funds will be employed to undertake the training of health personnel and five percent will be used to cater for National Emergency Health Services.”
ACPN argued that if experienced and transparent Managers are made to run the MDAs in the Health Sector, negative indices like a high child and maternal mortality would begin to nosedive.
“A synopsis of the areas covered above gives an indication that if experienced and transparent Managers are made to run the MDAs in the Health Sector, we might just begin to reverse some seemingly irreversible indices in our sinking health system.”
The ACPN said that systemic failure in the country’s health system was due to the relegation of other health professionals by not seeking their contributions before policies are made, the changing of the advisory status of the National Council on Health, NHC, to the Minister of Health to that of a decision-making body.
They added that one of the landmark reforms in the NH-2014 was the proviso in law that changed the advisory status of the National Council on Health to the Health Minister to that of a decision-making body which was structured to involve all the frontline professional bodies in healthcare for detailed input in the spirit of a true democratic order.
They alleged that the Federal Ministry of Health, FMOH, in the last nine years has deliberately truncated the section of the law as most professional bodies are never part of the NCH meetings.
It noted that in the last nine years except for doctors, most of the professional bodies were not part of the NCH meetings.
“It is sad to put on record that the Federal Ministry of Health (FMOH) in the last nine years has deliberately truncated this particular section of the law as most of the professional bodies are never part of the NCH meetings to facilitate the rubber stamp designs of the leadership of the FMOH.”
ACPN further lamented that the interpretation clauses of the NH2014 list the categories of professional practices officially designated as Health Facilities in Nigeria including Pharmacies, Clinics, Hospitals, Medical Laboratories, PhysioClinics, and among others.
“It is a major irony however that the health authorities have oftentimes failed to explore the proximity of Community-based health practices in the logistics and protocol designed for a rendition of all cadre of services which is a major reason for systemic failure in Nigeria’s fumbling health system,” it lamented.
Defining Nigeria’s Primary Healthcare
ACPN further noted that health policy chiefs and advisers have persistently negated Primary care services for pecuniary interests or other normal professional gains.
They pointed out that the quest for UCH will continue to be a ruse if it is not grounded on a well-worked primary healthcare concept.
Designate Community Pharmacies As Immunisation Centres
They noted that the National Primary Healthcare Development Agency (NPHDA) should be empowered to go full blast by designating Community Pharmacies as immunisation Centres for all clinical disease states. The group explained that this would pave the way for routine immunisation as opposed to the presently imposed National Immunisation Days (NID) with a propensity to improve coverage rate in vaccination.
It says one of the professional groups that can boost the PHC ideology is Community Pharmacy facilities and Pharmacists who practice in them. ACPN noted that the National Primary Healthcare Development Agency NPHDA confirmed this in 2021 when it designated Community Pharmacies as Vaccination Centres for COVID-19 to promote easy access to the vaccines. According to them, the move is commendable as events proved it was a right step in the right direction.
Set-Up Community Pharmacy-Based Ante-Natal Clinics
ACPN noted that Nigeria can substantially reduce infant and maternal mortality significantly if it encourages the setting-up of Community Pharmacy-based ante-natal clinics like in some climes.
No health professional is in a better position to counsel patients on the essence of drug use in pregnancy and other situations than a pharmacist.
The Pharmacist, apart from stressing the compulsion in the usage of ferrous products, folic acid, and so on in ante-natal care, will highlight all the risk factors in drug-drug, drug-food, and drug-pregnancy interaction profiles.
“Nigeria can substantially reduce infant and maternal mortality albeit significantly if we encourage the setting up of Community Pharmacy-based ante-natal clinics as we see in some climes.”
Certify Community Pharmacists As Family Planning experts
The letter further noted that the regulation of the country’s expanding population is germane to the quest for National growth and development and that Community Pharmacists being certified as Family Planning experts are able to run good Family Control Clinics at the Community Pharmacy level.
“The roles of Pharmacists in managing other areas like smoking cessation, diet management, and control, prevention of non-communicable diseases, and other wellness strategies need to be tapped into as we perfect our healthcare planning in the months ahead,” ACPN added.
Running NHIS In Line With Public Interest
On the National Health Insurance Project, ACPN observed that the scheme was well administered in the early years when Health Administrators like Mustapha Sambo and Dr. Mohammed Lecky called the shots with the scheme attaining ten percent coverage only for it to nose dive when Medical doctors began to head it.
The letter points out that the gains of the scheme began to decline when Dr. Dogo Mohammed took over as the CEO, pointing out that for over 13 years of the 18 years of the establishment of Social Health Insurance in Nigeria, it has been anchored by inexperienced Physicians.
The letter says that the failure is hinged on factors including, Unlawful Payment Mechanisms and indiscriminate Capitation Payment.
It points out that the lawful payment by virtue of the old NHIS Act now amended as the NHIA Act are Capitation Fees for Services, Case Payment, and Per Diem. But for administrative convenience, the NHIA Secretariat continues to employ an unlawful payment mechanism called Global Capitation to compensate providers in Social health insurance.
The NHIS pays all compensations for secondary providers who should enjoy fee-for-services to Physicians who are primary providers and in turn expect these Physicians to pay for these services. In simple terms, Physicians are paid for drug use services, laboratory services, and related care services in Nigeria’s version of Social Health Insurance which paves the way for unmitigated disaster.
In addition to the above challenge is the indiscriminate capitation of facilities. Rather than the norm of capitation to General and Teaching Hospitals which are tertiary facilities. This constitutes a great distraction to teaching and specialist facilities which are structured to handle referrals, research, and specialised care.
It notes that in Nigeria, Social Health Insurance has become a public sector-driven concept rather than a private sector-oriented agenda which is one of the main reasons it does not inspire confidence in enrolees.
As of eight years ago, the coverage rate in social health insurance dropped from almost 10 percent to 1.72 percent with a chance that it might drop even further.
Community pharmacists pledged to collaborate with the government as it targets to revive dead structures across the board in all sectors of the economy including Health.
