Why Nigeria’s healthcare performance is still poor at 57

Ahmed Yakasai is the president of the Pharmaceutical Society of Nigeria (PSN) and a veteran practitioner of almost 35 years experience. He is also a former chairman of the PSN (Kano State branch), first deputy president at national level and two-time past commissioner in Kano State for eight years. Yakasai, in this interview with journalists ahead of the 90th yearly national conference of the PSN scheduled for Umuahia, Abia State from November 6 to 11, 2017, identified why Nigeria’s health indices and healthcare performance are still poor after 57 years of independence and proffered solutions among other issues. CHUKWUMA MUANYA (Assistant Editor) writes.

PSN President proffers solution to frequent workers’ strike, advocates petrochemical plant to engender industrial revolution

Nigeria was 57 years as a country on October 1, 2017. What are the challenges of our peculiar health system? What is the way forward?
Nigeria continues to contend with a plethora of challenges not necessarily created or caused by this incumbent administration. Amongst numerous challenges the following stand out: poor funding; delayed and unlawful appointments in regulatory agencies; poor composition structures in the health sector including lopsided appointments in Federal Health Institutions (FHIs); and poor attitude as well as culture with regards to research and development.

If we restrict ourselves to the highlighted, you will agree that the inherent tendency of health tourism (because the pharmaceutical component is very significant is predicated on poor funding.

Presently over 95 per cent of the health workforce is on an avoidable strike action traceable to challenges in funding. Low wages and obsolete equipment combine to make our health system largely unproductive. Universal health coverage is impossible because of a deficiently administered social health insurance agenda.

Delays in appointments that are also sometimes unlawful in sensitive regulatory agencies like National Agency for Food Drug Administration and Control (NAFDAC), Pharmacists Council of Nigeria (PCN) and others ultimately take a toll on the quality of care consumers of health receive fro caregivers. An agency like NAFDAC, which normally should enhance a high safety margin in the range of available regulated products, cannot dwell on ad-hoc structures in perpetuity. It can be even more tragic when government conducts unlawful appointments like we have witnessed in previous dispensations at NAFDAC, PCN, Nursing and Midwifery Council of Nigeria (NMCN) and Medical Laboratory Science Council of Nigeria (MLSCN).

You are familiar with the position of stakeholders in health with reference to the composition of the board of management of Federal Health Institutions, which is unduly skewed against majority of stakeholders. Our apathy for research and development is tragic because it compels a largely anonymous status on our health system if we can research into peculiar disease states or produce local remedies to solve our own unique problems with made in Nigeria medicines.

The way forward is to redress the highlighted challenges. The pharmaceutical sector is an often-neglected goldmine because we have requisite expertise in this share.

In the United States of America (USA), the pharmaceutical sector contributes one per cent of Gross Domestic Product (GDP), which is raised to between 2.5 per cent – five per cent in China and India.

We advocate for petrochemical plant, which will engender industrial revolution. We can meet over 90 per cent of local needs this way and export to other African countries (African hub for pharmaceuticals). It will be my joy to see this actualized in my lifetime for the good of Nigeria.
Where does the PSN stand in the quest to improve the welfare of health workers in Nigeria especially against the background of the excruciating strike in Federal Health Institutions?

We wish to appeal to the President Muhammadu Buhari led federal government to give immediate attention to the clamours of health workers including pharmacists to redress some pressing welfare demands.

These demands include:
1. Immediate release of the circular on adjustment of the Consolidated Health workers Salary Scheme (CONHESS) scale by the Salaries and Wages Commission.
2. Full payment of balance of arrears of the skipping of CONHESS 10, which remains outstanding since 2010 in some Federal Health Institutions.
3. Proper implementation of the circular which prescribes sanctions on defaulting Federal Health Institution Managements which frustrate the promotion of health workers from CONHESS 14 to 15 as Directors.
4. Issuance of enabling circular authorizing consultancy cadre for health professionals who have adhered to due process by scaling the hurdles of approval of the National Council on Establishment.
5. Sponsoring an amendment bill to correct once and for all the litany of contentious provisions in the enabling statute that establishes teaching hospitals in Nigeria (cap 415 463 LFN 2004).

The PSN encourages the Federal Government to sustain the lofty ideals of the intervention championed by the late Minister of State for Labour and Productivity, Barrister Ocholi who calmed frayed nerves within the ranks of the various Joint Health Sector Unions (JOHESU) and Health Professional Associations (AHPA) that had threatened to go on strike in February.

While we agree the strike option should always be the last option, it is imperative the PSN also appeals to the Federal Government (FG) to understand the plight of aggrieved health workers who also want reward for labour and have patiently endured in long suffering especially after firm assurances were extracted from former President Goodluck Jonathan at a series of consultations which peaked with two different meetings with the former President in February 2015.

The PSN strongly commends and urges JOHESU/AHPA to continue to embrace dialogue with government as it remains optimistic that dialogue will ultimately be fruitful and productive in public interest especially now that a strike action in on-going.

The PSN believes now is the time to give all care-providers unlimited latitudes to showcase their potentials and skills in a larger bid to enhance their competencies in areas of specialization. As players in the global space we must continue to align with the modern objectives and targets of healthcare, which places a huge premium on all health workers in the value chain.

Finally, we call on all the appendages of government including the Office of the Secretary to Government of the Federation, Head of Service of the Federation, Budget Office, Federal Ministry of Health (FMoH), Federal Ministry of Labour and Productivity and all others involved in negotiations with JOHESU/AHPA to do everything humanly possible to facilitate a prompt end to this on-going strike of health workers which can only hurt our economy as well as inflicting morbidity on the generality of our people.

The 90th Annual National Conference of the PSN holds in Umuahia from November 6 to 7, 2017. What do we expect?
This conference has as its theme “Medicines Availability and National Security”. The Honourable Speaker, Federal House of Representatives – Rt. Hon. Yakubu Dogara is expected to declare it open as a Special Guest of Honour, while the Governor of Abia State is Chief Host and the Minister for Health will be the Guest of Honour. Mr. Peter Obi, former Governor of Anambra State, would chair the occasion.

Our nation needs to develop an efficient manpower base in the quest for self-sufficiency and economic growth. You are also aware that this is a 90th birthday celebration, which is why medicine availability becomes a very topical and contemporary subject matter. We shall strategise on improving local drug manufacturing, while ensuring all other drugs that will assist in wellness and life threatening situations will be available in our health system.

This unique conference will therefore exploit avenues for this much sought after maxims as it concerns the Pharmaceutical Sector of the economy.

It is a peculiar gathering of pharmacists and other scientists nationwide as well as the diaspora, so you can only expect us a new positive force to emerge pharmaceutically speaking after November 11, 2017.

What efforts are in place to realize the commencement of the amended National Drug Distribution Guidelines?
In this regard we are on course absolutely. The PCN, NAFDAC, Federal Ministry of Health and pharmaceutical stakeholders including Pharmaceutical Manufacturers Group of the Manufacturers Association of Nigeria (PMGMAN), Nigerian Representatives of Overseas Pharmaceutical Manufacturers (NIROPHARM), Association of Pharmaceutical Importers of Nigeria (APIN), Association of Industrial Pharmacists of Nigeria (AIPN), Association of Community Pharmacists of Nigeria (ACPN) and representative of non-pharmacist wholesalers who are expected to move to the proposed Coordinated Wholesale Centres (CWCs) are in one accord to change the unhealthy status quo we have allowed in the country.

The CWCs are already being constructed in some parts of the country. You will agree with me this is very strategic to our overall success.

It is my belief that when PCN and NAFDAC structure are fully established, we shall mobilize to consolidate our present level of commitment and gains.

The PSN remains committed to decorous drug distribution channels and I assure the consuming public we shall not fail in this regards. The Federal Government has now given the Coordinated Wholesale Centres a new deadline of December 2018 and I must say all stakeholders must ensure a no-going back posture on this deadline.

We have had appointments in most parastatals including some in the Health Sector, when and what do you expect with notable appointments in the pharmaceutical sector?
You must continue to reckon and remember that it is the prerogative of the Federal Government to carry out these appointments whether at PCN, NAFDAC or Nigerian Institute for Pharmaceutical Research and Development (NIPRD), which I believe, you are referring to. I however presume that your interest is predicated in public interest especially in the value such appointments can bring to bear on public health endeavours.

Our first priority is to ensure lawful appointments on all pharmaceutical platforms because we certainly do not envisage or pray for the disruption in equilibrium we experienced at PCN when representatives of PSN was compromised due to a distasteful manipulation by an interested party.

We once had the same scenario at NAFDAC, which degenerated to a court action in another dispensation.

To avoid an unpalatable discourse the PSN has since recommended its representatives to the Honourable Minister for Health as provided for in Section 3 (1) F of the PCN Act. The Federal Government is also familiar more than ever before with the condition precedent to appoint substantive Director General (DG)/Chief Executive Officer (CEO) for NAFDAC.

We shall continue to believe that an administration that abhors corruption like the incumbent Government has practically demonstrated will be seriously mindful of appointing elements that have antecedents that are tainted with corruption or other negative vices in previous positions they held in public or private sector.

The protracted delay in the appointment of the DG NAFDAC in particular has encouraged rumour mongering in the media, which generates entropy in the pharmaceutical space.

Our profession is at a critical junction because of the appointments in the regulatory agencies because more than ever before we are unduly vulnerable to the whims and caprices of merchants of death and other violators of the law.

The seeming invincibility and internal controls needed for optimum pharmacy practice is sliding very fast and our stakeholders are beginning to run out of patience. The pace of progress in infrastructures like rail, air travel, agriculture and other mainstay of the economy must be brought to bear in the pharmaceutical sector.

It is instructive to put on record too that to appoint regulators especially in our sector, such must be premised or built around persons who are conversant with the terrain to be regulated. I therefore appeal to the Federal Government to give us lawful and befitting appointments in the pharmaceutical sector in the days and months ahead.

Pharmacists recently celebrated World Pharmacists Day. What is it all about?
Every 25 September of the year marks the annual World Pharmacists Day (WPD). Many years ago, the International Pharmaceutical Federation (FIP) Congress in Istanbul encouraged the world’s pharmacists to celebrate this day and use it to organise activities that promote and advocate for the role of the pharmacist in improving health in every corner of the world.

The theme of this year’s WPD is “From research to health care: Your pharmacist is at your service”.

The FIP President, Dr. Carmen Peña, said: “This theme was carefully chosen to reflect the numerous contributions the pharmacy profession makes to health. From research and development of medicines, to educating future pharmacists and pharmaceutical scientists, and providing direct care, we do all this in the service of our patients and communities.

“We want to emphasise that pharmacists are the backbone of health care in many different settings. But providing care does not begin in community or hospital pharmacies. Taking care of patients starts with recognising the health issues of populations and developing medicines, policies and education to tackle them. We pharmacists are often there at the very beginning of the process — when the first molecule that effectively treats a disease is identified.”

The pivotal roles pharmacists play in healthcare delivery from research to care giving can never be overemphasized. Pharmacists are the choke cord of healthcare anywhere in the world. In every community, pharmacists have positioned themselves to serve you and help you improve your quality of health.
WPD, September 25 highlights the value of the pharmacy profession and impact on improving health to authorities, other professions and the media, as well as to the general public.

The PSN is calling on all Nigeria pharmacists to celebrate this day by using FIP designed placard, twibbon and educating people around them about the critical role of pharmacists to their wellbeing and quality of life.