Pharmacists Knock NHIS Implementation

Pharmacists under the aegis of the Association of Community Pharmacists of Nigeria ( ACPN )Edo State chapter have condemned modus operandi of the Nigerian Health Insurance Scheme (NHIS) which empowers the physician to be Prescriber and Dispenser of drugs at the same time.

In a communique issued at the end of a summit in Edo State, chairman of state chapter of ACPN, Duke Otite, described as an aberration, the existing practice in the nation’s NHIS, saying “it contradicts the known global best practices which forbids a prescriber or dispenser to derive undue economic advantage in the totality of drug management mechanisms.”

The document argued that “value addition remains jeopardised in NHIA operations till date because what obtains presently is that the physicians who prescribe and dispense only give out drugs in the stock of their clinics which oftentimes is not the best drug of choice from a clinical perspective.’’

According to the document, the summit identified four major services covered by health insurance as including diagnosis, investigation (laboratory) procedures (surgery) and pharmaceutical care. It declared that the major credibility and integrity issues arising from Nigeria’s brand of health insurance is grounded on the non-incorporation of community pharmacies, who are the most accessible and affordable link in the value chain of healthcare.

It further posited that “drugs confer credibility on healthcare services to a significant

extent which places the community pharmacist in vantage position to facilitate insurance payments, resolve coverage denials, serve as representatives to help select favourable schemes, educate, sensitise and mobilise enrollees.’’

The summit lamented the serial violation of existing pharmacy laws which encouraged unauthorised personnel to dabble into drug dispensing over the years.

The pharmacists criticised the NHIS secretariat and HMOs which relies on branded drug products in the running of Nigeria’s version of Social Health Insurance programme.

While lamenting the serial violation of existing pharmacy laws which encourages unauthorised personnel to dabble into drug dispensing over the years, the pharmacists body blamed the federal government for encouraging unethical and unlawful acts by tolerating the status quo.

“We draw the attention of the federal and state governments to the tendencies of HMOs which have service provider network to expressly handover strategic opportunities to cater for enrollees to their own provider networks as hospitals with a full complement of all professional services including pharmacy, medical laboratory, radiography, physiotherapy and others.’’

It called on the authorities to bar HMOs with service provider networks to desist from utilising those provider networks for service rendition in the NHIS. It also recommended the incorporation of Mobile Health Technology (M- Health) because of the prospective benefits for achieving UHC by improving access to health services particularly for those in hard-to-reach communities. And advised that “Unstructured Supplementary Service Data (USSD) code be adopted because they are often simple, cheap and have wider coverage with Mobile Apps which are already being deployed by a few of the HMOs.’’

The summit posited that, “The purpose of any health insurance programme was to provide affordable and cost-effective access to quality healthcare to enrollees, which ultimately eliminates out-of-pocket expenses, which comes with financial hardship.

 “We have reviewed the operations of the National Health Insurance Authority (as amended by NHIS amendment Act 2022) and concluded that it was an abysmal failure as the emphasis was on only the formal sector which accounts for less than 15 per cent of the population of Nigeria.

The communiqué emphasised on the need to “scale up community pharmacists involvement with health promotion activities which will help to accelerate universal health

coverage while maintaining access to many public health services in the communities through the over 6,000 registered community pharmacies.

“The ease of access pharmacists have to patients has positioned the pharmacy profession towards the incorporation of advanced health promotion activities and involvement in various stages of awareness campaigns. The shortage of healthcare providers in public health facilities, especially in rural areas, could be leveraged by pharmacists who are adequately trained to educate or train the community towards a particular end or attaining set goals.

The summit advised the ACPN Edo State and national to consider exploring judicial interpretation of relevant aspects of the various Acts of parliament to permanently redress the misnomer non-pharmacists involvement in dispensing of drugs, an Act that compromises patient lives and safety.