Anchors and Pillars: Pharmacies, the Mainstay of Nigeria’s Healthcare

By Michael E. Umoh

The COVID-19 pandemic has exposed the limitations and in some cases, inadequacies of healthcare systems, globally – with some regions and countries faring worse than others. It has also revealed how crucial certain professions and services are to our societies. That list includes pharmacies.

In many countries, pharmacists – the third-largest and most accessible healthcare professionals in the world – are often the first point of contact with the healthcare system.

In Nigeria, for example, the healthcare system is split into the private and public sector. The private sector makes up 38 per cent of the healthcare facilities in the nation, while the public sector, fully controlled by the government, is divided into primary, secondary and tertiary systems. Primary healthcare, mainly located in rural areas, only offers essential healthcare services such as maternal and child healthcare.

However, secondary and tertiary, which are mostly in urban areas, often cater to specialised healthcare needs such as mental healthcare, cardiac surgery, cancer management, etc.

Due to the fragmented nature of healthcare service, most Nigerians pay for healthcare services directly out- of-pocket (these payments account for about 75 per cent of total health expenditure in Nigeria). To most Nigerians, quick access and immediacy are important considerations and pharmacies often meet those needs – even as they deal with a low pharmacist to population ratio.

While the World Health Organization (WHO) recommends one pharmacist to 2000 people in a population, the reality in Nigeria and indeed, most of sub-Saharan Africa is different.

“In Nigeria, as professionals, we are faced with about 50,000 people to one pharmacist,” says Sam Ohuabunwa, President of the Pharmaceutical Society of Nigeria (PSN).

Although it is common to think that only pharmacies are charged with preparing, dispensing and selling medications, in reality, those roles also apply to Patent and Proprietary Medicine Vendors (PPMVs). Known as ‘chemists’ in Nigeria, these vendors have no formal training in pharmacy but sell pharmaceutical products for profit. In some cases, these chemists are the only access community members have to healthcare.

In reality, pharmacies play much bigger roles. While they dispense and sell medicine, they also educate patients, provide consultation services, help with immunization programmes, blood and sugar monitoring, diet modification, weight management and stress management. A 2012 study also established that pharmacies in Nigeria contribute to the maternal, newborn and child health (MNCH) system. Over 15 per cent of community pharmacies see between 5 and 10 pregnant women and 10–20 children per day. A 2016 study also revealed that community pharmacies are important to Nigeria’s immunization programmes.

The multi-faceted role that pharmacies serve in various communities is critical. Emmanuel Edekere, a 64- year-old father of seven living in Uyo, a city in the South-south region of Nigeria, gets his blood pressure checked at the licensed pharmacy nearby. “I can have one of my children do it for me, but the people at the pharmacy went to school for this and I also want proper information I can trust”.

Fighting the Pandemic
Globally, pharmacies have been essential to efforts against the COVID-19 pandemic. They have helped with drug review and therapy, patient counselling, patient screening, PPE preservation, patient rounds, mitigating drug shortages, research and data analysis.

In Nigeria, pharmacists swung into action when the first COVID-19 case in the country was confirmed on February 27, 2020. The Pharmaceutical Society of Nigeria (PSN) has lobbied the federal government to provide grants for the local production of medicines. ACPN, the Association of Community Pharmacists in Nigeria ran a nationwide awareness campaign on drug misuse during the azithromycin hydroxychloroquine controversy.

Additionally, the Association of Industrial Pharmacists of Nigeria (NAIP) mitigates shortages of COVID-19 and essential medicines while the Association of Hospital and Administrative Pharmacists of Nigeria (AHAPN), part of the front line team in COVID-19 isolation and treatment centres, are involved in medication review, dispensing and monitoring.

Nigerian pharmacists also play an important role in producing hand sanitisers and disinfectants, both necessary resources in the fight against COVID-19.
Pharmacists have also had to act as fact-checkers, dispelling rumours and misinformation that range from the mundane to the deadly. “I can’t count how many times I tell people that drinking alcohol won’t ‘wash down the virus’ from your throat, or that the pandemic is not a hoax,” says Adekunle, who runs a pharmacy in Lagos.

Nasiru who owns two pharmacies in Niger state and Abuja notes an increase in his responsibilities. “Each day, my staff and I have to persuade more and more people to listen to us, ignore rumours and stay safe. It can be hard but you are literally saving lives, so we buckle up”.

Pharmacies have also helped patients and the public deal with the mental strain from the COVID-19 pandemic; often providing counselling and support services. “We are in extremely trying times for both our physical and mental wellbeing. A key part of what it means to be human today is to have to grapple with so many mental strains. The conversation around guarding our mental space has been ongoing even before this pandemic, while we are in it and it will continue when we overcome it,” says Joke Bakare, MD, MedPlus.

As a result of their added responsibilities, pharmacists themselves have not been spared from the disease and its impact. In June 2020, the Pharmaceutical Society of Nigeria (PSN) and Association of Hospital and Administrative Pharmacists of Nigeria revealed that six of their 359 frontline workers had tested positive for COVID-19. In July 2020, 17 additional pharmacists were reported to have tested positive.

“Aside from the 359 hospital pharmacists directly involved in attending to COVID-19 patients in hospitals and isolation centres, there are other thousands of community pharmacists out there that are daily exposed to preclinical or asymptomatic patients who see pharmacies as their first port of call,” says Ohuabunwa, PSN President.

Elijah Mohammed, Registrar of the Pharmacists Council of Nigeria (PCN), the government body which regulates the practice of pharmacy in the country, has also urged pharmacists to maintain a high level of personal protection even as they meet the needs of others: “The structure and nature of your work continue to make you vulnerable, you must therefore ensure you prioritise your personal and personnel protection”.

Navigating the Future
As the COVID-19 pandemic rages on, pharmacies have adapted their mode of operations. Face-to-face counselling has given way to window-dispensing/counselling in community and hospital pharmacies.

“Players in the profession and the pharmaceutical industry need to think bigger; they must dream dreams and build real pharmaceutical entities that will meet the expectations of the nation,” says Osagie Ehanire, Nigeria’s Minister for Health who believes that the industry’s entrepreneurs need to pool their resources to compete properly.

Bryan Mezue, Co-founder and CEO of Lifestores Healthcare – which is focused on primary healthcare delivery – agrees: “Our thesis is that the massive opportunity for transformation in healthcare delivery in Nigeria is finding a way to support pharmacies to professionalize the whole industry,” he says.

In February 2020, Lifestores raised a $1 Million seed round and in November 2020, unveiled its online B2B pharmaceutical marketplace, OGApharmacy in a pre-launch. “We see community pharmacies as the first port of call for primary healthcare, and work hand-in-hand with pharmacists to deliver health programs that serve all Nigerians,” says Mezue.

That commitment to communities and the future is also echoed by Chidi Okoro, Chief Transformation Officer, HealthPlus, West Africa’s largest retail pharmacy chain: “Digital transformation remains at the forefront of our thoughts. The industry is headed towards a point where healthcare services are not location- locked. Ultimately, we believe that quality and affordable healthcare is a fundamental right of citizens and a critical part of any human capital development process”.

Okoro is correct. Nigerian pharmacies are embracing technology to aid their service delivery and reach more people while organisations like The Association of Community Pharmacists of Nigeria (ACPN) has urged its members to use digital technology to improve patient care and make healthcare services more accessible.

As the Nigerian healthcare sector evolves, pharmacies will continue to serve critical roles in the nation – making the most of available resources to provide quality healthcare service to Nigerians.

…Umoh is Creative Strategist at RDF Strategies; an organisational strategy and stakeholder engagement firm headquartered in Lagos, Nigeria, serving clients across Africa and around the world.