Nigeria at the moment is at crossroads regarding the level of performance as well as the critical role that the community pharmacist is cut out to play in the society. However, in an emerging market economy such as is the case with Nigeria, there seems not to be a better time and opportunity than now for the community pharmacists to make their impact really felt. And as the Association of Community Pharmacists in Nigeria (ACPN) congregate this time in Jos, to deliberate and forge a way forward, PharmaTimes Editor, MORGAN NWANGUMA, and Correspondent, GABRIEL IFINNWA take a deep look at the key ingredients required in the discharge of their responsibilities in such an environment.
The Pharmacy profession has expanded significantly around the world in terms of professional service delivery especially in the last two decades. It is being recognised as an important profession in the multidisciplinary provision of healthcare because of its current evolution towards clinical orientation otherwise called pharmaceutical care.
Over the next decade and beyond, advances in healthcare will continue to increase in tempo. In particular, significant changes are expected to occur in medicine and therapeutics that will require new and innovative models of care to enable patients to obtain the maximum benefits.
Pharmaceutical care is a key component of safe and effective healthcare anywhere in the world, and it is a model of pharmacy practice which requires pharmacists to work in partnership with patients and other healthcare professionals to obtain optimal outcomes with medicines.
Pharmacy Practise In The Context Of International Community
The World Health Organisation had a long time ago advocated for specific roles for pharmacists particularly in the area of quality assurance and the safe and effective administration of drugs. In what appeared to be a demonstration of that advocacy, the WHO in conjunction with the International Pharmaceutical Federation developed a concept of “The Seven Star Pharmacist” which stated that a well- rounded pharmacist should be a compassionate care giver, decision maker, active communicator, lifelong learner and good manager who should possess good qualities and the ability to be a good teacher and researcher.
According to the WHO, future pharmacists must possess specific knowledge, attitudes, skills and behaviour in support of their role. Besides their pivotal role in public health, The WHO also emphasised the need for pharmacists to act as advisers to physicians, nurses and also contribute to the policy making process while recommending one pharmacist to 2000 population in order for optimal healthcare to be delivered. A host of nations around the world especially the developed ones had since began to review their health policy along the line of giving community pharmacists expanded responsibilities for the efficient and cost effective delivery of healthcare to the larger public.
The United States, United kingdom among other nations of the world have fully embraced the idea of expanding the responsibilities of community pharmacists in order to tap the skills and professionalism inculcated in them through years of training and place those skills and professional attitudes to effective patient care. This is the direction in which Nigeria should be going. The health authorities need to increase the responsibilities of community pharmacies, and pharmacists in the primary healthcare in addition to their traditional roles of dispensing prescription and selling medicines.
The Role Of Community Pharmacists In An Emerging Economy
Community pharmacists by their job description are the most accessible healthcare providers to the public because of the proximity of their pharmacies to the community residents. However, evidences have shown that they are an underutilised resource in the healthcare delivery chain in the developing country like Nigeria. Pharmacists undergo a five to six years university course as the case may be, considering the newly approved PharmD programme; there is also the additional one year internship before one is properly listed in the pharmaceutical register.
In addition, many also undertake higher levels of academic qualification and training which exposes them to diverse areas of skill acquisition in health and as such the expertise of pharmacists can be put to better use than what currently obtains in the profession. The practice of balancing between business (selling medicines and other products) and healthcare (using the pharmacist’s knowledge in order to improve drug utilisation) which is currently common among community pharmacists is extinct in the 21st century healthcare delivery.
The world has discovered great potentials in the pharmacy profession necessary for the improvement of care for the patients and reduces pressure on other parts of National Health Service of nations. And only practitioners with enlightened eye can see the roadmap to revolutionising pharmacy practice. As Professor Timothy Chen of Faculty of Pharmacy, University of Sydney, Australia observed during the 74thInternational Pharmaceutical Federation in Bangkok in 2014, the pharmacist is at the centre of access to medicine care and information.
He suggested that the 21st century role of a community pharmacist demands that practitioners jettison with tying themselves to the apron string of a product centred mentality-supply of medicines as well as shift from a business-focused to a health focused way of thinking. The pharmacy expert further suggested that community pharmacists should find a way to integrate into healthcare team, collaborate with patients by way of sharing decision making on their health and also collaborate with government in policy formulation.
Prof. Chen believes that community pharmacists can help reduce hospital admissions due to drug related adverse effects through reviewing patient’s medicines and the uses in addition to continuous education of patient’s especially on self- help
How Community Pharmacists Can Impact Positively On Nigeria’s Economy
Community Pharmacists in Nigeria are members of the international body of pharmacists at least by professional calling. Therefore, whatever professional standards that the international body adopted as international best practices should ordinarily form a major part of the practice among practitioners in Nigeria.
Though the environment in which community pharmacists operate in Nigeria falls below acceptable standards based on a number of extraneous factors, yet, the fact remains that practitioners of community pharmacy in the country have a significant role to play in the effective provision of qualitative healthcare delivery in Nigeria, regardless of the impediments they face.
Drug use in Nigeria has frequently been described as irrational and the communities are worst hit by it. In fact dispensing of drugs has been hijacked by non professionals who have no business in handling medicines as a result of which the general public see everyone running a pharmacy as a patent medicine dealer.
The community pharmacists have a responsibility to alter this misconception by offering value added services that carry professional touch in the day to day running of their pharmacies because they are the closest and also occupy a vital position in the hierarchy of healthcare providers to the public.
For instance, a community pharmacist should be able to dispense, control and distribute medicines according to legal and ethical guidelines. In other wards he should be able to verify the authenticity, safety and accuracy of prescription orders and ensure that quantity of medication dispensed is accurate.
Nigeria is a typical example of an emerging market economy because it has all the trappings of an economy that is progressing toward becoming more advanced. Nigeria is on the verge of rapid growth and industrialisation, and experiences an expanding role in the world economy, while advancing her roles on the political frontier as well.
In such an environment, the role of the community pharmacists is one that affords them a greater (sense of) responsibility. The stakes are equally higher in that the situation leaves room for desperate behaviours on the side of the patients who are easily encouraged to embark on self medication or the patronage of quacks and itinerant medicine vendors, not to talk of the ever present local herb and concoction dealers. But this is where the community pharmacists are challenged to come into their own.
Here, the community pharmacist is supposed to seize the opportunity to draw even closer to the local community. In this regard they are expected to become even busier, and the practice is bound to be also more rewarding as more and more patients are likely to rely more on their services due to the high cost of attending clinics at designated hospitals or health centres.
An emerging market economy usually has low per-capita income; it is however, above-average in sociopolitical indices regarding instability, unemployment, and low levels of business or industrial activity as compared to the advanced economies like we have in North America, Western Europe and Japan. Nigeria typically has also an appreciable economic growth rate to boot, just like some less developed nations throughout Asia, Africa, Eastern Europe and Latin America.
Many emerging market economies become important bases for global manufacturing operations. At the same time, many emerging markets are enjoying booming export business. As they gain global presence, many emerging markets also benefit from regulatory reforms, cross-border trade, and loose monetary policy. And so the opportunities are high such that the needs to be met are so multifarious including health care delivery – with regards also to drug availability and affordability.
Usually, quality healthcare is out of the reach of many, while desperate people and syndicates are always lurking in the corner to infiltrate the drug market and flood it with fake and adulterated products. This is where the community pharmacists should cash in on the situation to affirm their professional place in the scheme of things. As Nigeria gradually pulls out of recession, community pharmacists in the country can then turn the current economic situation in the country to their advantage.
Another significant role community pharmacist in Nigeria should be playing is to take advantage of their closeness to the greater population of the citizenry to get involved in appropriate patient counselling practice. Community pharmacists in United States and Philippines for example are already doing that. They provide information, education and counselling to patients about medication-related needs. They counsel patients on their proper use of medicines and they ensure that the public is aware of the potential side effects of the medications they are taking. Patient education is one of the primary responsibilities of a pharmacist.
Besides providing information, they also help treat minor ailments. However, first, they determine whether an over-the- counter drug treatment is suitable and in what circumstances need referral to a physician. They use an evidence-based approach, relying on the information provided by a patient to address problems and make recommendations for optimisation of therapy. If necessary, they provide special instructions and precautions such in the event of a missed dose.
The Nigerian health sector is constantly battling with control of infectious diseases and emerging non-communicable diseases with inadequate number of healthcare personnel to contain the health challenges of the country. In this regard, the clinical expertise of community pharmacists could be tapped. Again, in the United States and in Philippines according to reports, pharmacists provide preventive care services. They provide individualised health promotion and disease prevention, including administration of immunisation – where this is legally and organisationally authorised. They perform screening tests for blood pressure or cholesterol.
There is also the need for community pharmacists to re-position themselves in such a way as to become effective partners with government in the implementation of the Primary Healthcare programme designed to give the greatest majority of Nigerians affordable and qualitative healthcare by 2020. They can put at the disposal of government the wealth of experience garnered through regular contact with the public in the form of ideas that would aid policy formulation and effective execution.