Community pharmacists advocate urgent reforms in health insurance

Determined to improve the health indices of Nigerians through universal health coverage, the Association of Community Pharmacists of Nigeria (ACPN) has called for a wide range of reforms in the new dispensation to offer much better and robust therapeutic outcomes for consumers of health in Nigeria.

Newly elected National Chairman ACPN, Samuel Adekola, at his inauguration ceremony of in Benin City, Edo State, told journalists: “Specifically, we shall collaborate with stakeholders in health to institute a well defined prescription policy for prescribers and dispensers in both the public and private sector in tandem with the law.

“We note with disdain that prescriptions are non-existent in the private sector of our healthcare practice to the detriment of patients.“Community pharmacists as part of the agenda of the newly elected National Executive Council (NEC) is already mobilizing its membership especially in Lagos and Abuja to kick-start a new labeling initiative geared towards optimizing drug delivery in conformity with good pharmacy practice.”

Adekola said the biggest priority in the quest to ensure accessible healthcare for all citizens is to facilitate proper enforcement plans in the overall implementation of the National Health Insurance Scheme (NHIS) to include the primary care concept; payment mechanisms and global capitation; and drug use and procurement in the scheme.He said the various fundamental distortions in managed care are responsible for the refusal of State governments, private sector and professional associations to key into the vision of Social Health Insurance. “Prior to the incumbent management team of the NHIS, coverage was less than three per cent of the estimated population of 170 million.

The pharmacist argued that if Rwanda has an enrollee base of 92 per cent, Ghana 60 per cent and Nigeria has about four per cent after eight years of implementation of the NHIS, then it is obvious that the Frankenstein monster called the Nigerian factor is at work yet again in an endeavor which optimists had imagined would bring far reaching reforms to the totality of the healthcare industry in the country.

Adekola said perhaps, the biggest of the assaults on the NHIS remains the implementation of the unlawful concept of global capitation.For the records, the only lawful payment mechanisms in the statutes (Decree 35 of 1999) manuals and guideline of the NHIS are: capitation, fee for service, Case payment, and per diem.He said the global capitation concept was a shortcut devised by Health Maintenance Organisations (HMOs) for administrative convenience to suit them but which short changes other key stakeholders. Global Capitation involves payment of capitation and all elements of other payment modes meant for other providers (secondary and tertiary) to the primary provider.

The pharmacist said this system compromises service delivery to the enrollee because he is not guaranteed the best drugs or diagnostic services since the primary provider who has been paid upfront for these services tries to maximize his profit from the advanced payment.

The ACPN Chairman said despite the Association’s misgivings arising from the poor implementation of the scheme, they believe that NHIS is one of the most credible alternatives for funding healthcare in Nigeria. “It is assumed that this scheme will offer equitable and physical accessibility to the enrollee but in my assessment, the scheme is yet to ensure delivery of efficient, quality assurance, effectiveness, sustainability and harmony amongst providers. We are at a loss as to why the prescribed working guidelines that were extensively reviewed and rehearsed by stakeholders were never tried.”

Adekola said the ACPN despite these challenges in the NHIS observes the new resolve to achieve results by the incumbent Executive Secretary of the NHIS, which encourages the Association to seek a new partnership that can work maximally in the public interest.

The pharmacist called on the secretariat of the NHIS to open borders of restriction in the running of Social Health Insurance as witnessed through some State statutes (Ondo State is an example), which now gives opportunities to all health professionals to excel in service rendition.“The Association of Community Pharmacists assures the consuming public that we shall energise the entire health community for the sole purpose of fulfilling potentials as we settle into office in the days ahead,” he said.