Pharmacists Decry Inappropriate Drugs Prescription, Dispensing in Nigeria

Pharmacists under the auspices of the Association of Community Pharmacists of Nigeria (ACPN), have raised the alarm over the safety of Nigerians due to inappropriate drug prescription and dispensing practices in the country.

In a letter to President Bola  Tinubu, the ACPN drew the attention of the government to unwholesome practices, including the violation of relevant laws on prescription and dispensing of drugs by private hospitals, which puts Nigerian health consumers at risk.  

The document which was signed by the National Chairman of ACPN, Adewale Oladigbolu, noted that the sale, prescription and dispensing of drugs in Nigeria is “ravaged by a departure from global norm in many respects.”

ACPN accused private hospitals in the country of promoting quackery in the health sector through abuse of privileges of the medical profession.

“Private hospitals contribute a great deal to quackery in the health sector because these facilities “train” Auxiliary Nurses, Pharmacy and Laboratory attendants, as well as a plethora of other quack sub-health personnel. This periodic cyclical discharge of undesirable elements continues to constitute a hindrance and stumbling block towards responsible healthcare delivery. Even when pharmacy laws and regulations, as well as the National Drug Policy, are clear about the latitudes of influence in dispensing and prescribing,’’ it said.

“We are all familiar with the realities on the field where World Health Organisation (WHO) studies have confirmed that private hospital facilities enjoy extreme pecuniary indulgences in the sales and dispensing of drugs. The referred study declares that the prices of drugs in private hospitals is 184 per cent above baseline prices in public hospital pharmacies and 192 per cent above what is obtainable in private community pharmacies.’’ 

According to ACPN, the huge profits private hospital owners make on drugs is a major incentive to violate pharmacy and drug laws. “When this is juxtaposed and aligned with operational methodologies of drug regulators like Pharmacists Council of Nigeria (PCN), NAFDAC and the various task forces at state and federal level which do not regulate or control drug use endeavours in hospital, in both the public and private sector, but constantly monitor registered pharmacies, you begin to understand why all classes of drugs are sold and dispensed at prohibitive costs in the unregistered pharmacy facilities in hospitals by untrained hands especially in the private sector.”

The ACPN accused Nigerian doctors of being guilty in the phenomenon-styled dispensing in both the public and private sectors. It noted that, “Although, medical and dental practitioners are not trained to dispense drugs, and therefore, they are part of the problems of drug abuse and misuse as well as the inherent complications of this unwholesome development.

“It is also very fundamental to indicate that private doctors, in furtherance to their agenda to boost quackery stock and dispense drugs in unlawful facilities contrary to the provisions of Cap PCN 2022 and the Fake Drug Act, which prohibits the sales and dispensing of drugs in unregistered pharmacy facilities.”

They claimed that the “usually widely publicized activities of state regulatory authorities for the private hospital have never indicted any of these hospitals for violating relevant drug laws, even when over 99.5 percent of private doctors are guilty of this odious crime against the citizenry.’’

“In Nigeria today, there are only about six thousand (6,000) registered pharmacy facilities in the various cadres of practice, including retailers, wholesale, importation and manufacturing. Of this number, less than four thousand (4,000) are retailers who provide services directly to the consuming public.

Continuing, it stated that, “While there are less than four thousand (4,000) registered retail pharmacies; there exist over a mil­lion different drug sellers who are unregistered. It is this plethora of illegal drug sellers who are largely unregulated that perpetrate most of the obnoxious and dirty practices in drug distribution in Nigeria,” it added.

It further said, “These lapses in dispensing and prescribing of drugs are major draw-backs in Nigeria’s version of Social Health Insurance dubbed the National Health Insurance Scheme (NHIS).”

Describing the NHIS as a white elephant project because the anomalies in payment mechanisms to providers and challenges in the separation of professional roles have not been redressed, the ACPN called for government intervention in the regulation of drug prescription quality and dispensing by compelling legitimate prescribers, including medical doctors, dentists and veterinary surgeons to embrace generic drug prescribing in alignment with existing norms and guidelines in the country.

ACPN identified deficit in the ratio of Physician-Patient as one of the factors promoting hazardous prescribing practices in Nigeria. “For a country of about 160 million people, the doctor population is only about 40,000, giving a doctor-patient ratio of 1: 4000. Even then, there is a skewed distribution of these doctors who are predominantly located in the urban areas, leaving the mass of Nigerians with a worse ratio.”

It also listed inadequate healthcare facilities as a contributory factor. “Our hospitals and healthcare centres are grossly inadequate in terms of number, even when they exist, the out-of-stock syndrome of drugs and insufficient personnel discourage patients from visiting them sometimes.

“Drugs are essential for preventive, curative, and rehabilitative healthcare; the number and types of drugs are constantly increasing while the financial resources for health services remain limited.” 

The pharmacists’ body lamented the prohibitive cost of drugs, which is rapidly becoming a global phenomenon, and advised the government to compel legitimate prescribers, including Medical Doctors, Dentists, and Veterinary Surgeons, to embrace generic drug prescribing in alignment with existing norms and guidelines in all health systems.

“The federal government must resuscitate the National Prescription and Dispensing Committee, made up of eminent Pharmacists and Physicians under the Chairmanship of the Permanent Secretary of the FMOH as constituted in 2013 based on a clarion call of the PSN.”

It expressed regrets that committee’s assignment was abandoned due to “the pecuniary interests of some professionals who were not ready to let go of their unlawful practices.’’

 “Prescribers must be made to gen­erate prescriptions with their stamps and seals, while dispensers of drugs will affix their stamps and seals on all prescriptions duly dispensed, adding that calling on the “federal government must authorise a comprehensive survey of dispensing and prescription practices to identify gaps.

“The NAFDAC must clearly delineate OTCs, POMs, and Pharmacist Initiated Medicines (PIMs) in line with its statutory powers. While the International Pharmaceutical Federation (IFP) guidelines on Good Pharmacy Practice (GPP) should become the minimum standard for dispensing medication to Nigerians,” ACPN insisted “Our health system must place a premium on prescription quality and appropriate dispensing rights before we can vouch for the safety of consumers of health in Nigeria.’’