Pharmacy in Practice spoke to pharmacist Osezefe Isaac Ehimen PharmD. He is currently an intern pharmacist with the University College Hospital (UCH), Ibadan, Nigeria. His passion is to turn academic information into action. Osezefe is now learning more about quality in healthcare provision, pharmacy-community relationship and healthcare financing. He freelances with various organisations on strategic healthcare research, health data collection and medical outreaches. Osezefe graduated with a Doctor of Pharmacy (PharmD) degree in 2017.
How long have you been a pharmacist?
Less than one year. I was inducted into the Pharmacists Council of Nigeria in November 2017.
What sector of pharmacy do you currently work in?
Hospital pharmacy. I’m currently undergoing my 12-month internship period with the University College Hospital, Ibadan
Could you tell us what pharmacy is like in Nigeria?
Pharmacy is a recognised & respected profession in Nigeria. Although a number of citizens especially in the peri-urban and rural areas still don’t know the distinction between a community pharmacist and a medicine store owner. Three areas of practice are easily visible: community pharmacy, hospital pharmacy and industrial pharmacy (production pharmacist and sales/medical representatives). These are the ones the society relates to daily and recognise as pharmacists. However, there are other equally important practice areas in Nigeria today: administrators & researchers.
What does a normal days work as a pharmacist involve for you?
I have a duty to patients who make use of the hospital’s healthcare facilities. I’m presently working in the outpatient clinics which has 5 pharmacy units. I get to the hospital at about 7:45 am. First I have to do a stock reconciliation of all medications in the pharmacy unit and make a requisition to the central pharmacy store for products that are low in stock. Then I create a new page for the day’s work on the pharmacy records software. Usually, patients get to the pharmacy at 9am after seeing their physician. I work under the supervision of Senior Pharmacists to do the following;
- Assess prescribed medications.
- Identify medication therapy problems.
- Work with patient’s physician to correct any real or potential errors.
- Dispense patient medications and counsel them appropriately.
- Review and update patient medication profile.
The day’s work usually ends at about 4pm – 5pm depending on the patient traffic on the day.
Is the community pharmacy sector thriving there?
Yes, it is thriving. We have a vibrant and energetic community pharmacy sector. I think it even has more exposure than any other sector here in Nigeria because of the business aspect of it. Many pharmacists I interact with enjoy the freedom the community pharmacy provides to really take charge of your patients’ medication therapy and offer continued care/support especially for patients managing chronic conditions.
How are community/retail pharmacists funded? Is there a contract with the government or do they sell the drugs directly to the public?
Community pharmacy revenue comes from profits on the sale of products to patients. Payments are basically out of the pockets of patients/users. Today in Nigeria, healthcare payments are still made out of pocket for the majority of people. Health insurance cover is still underutilised in most cases, and community pharmacies haven’t adopted insurance payments. Possible reasons could be a lack of understanding of how insurance payments work, and complicated regulations guiding insurance operations in the country.
I recently started studying how to integrate and extend health insurance coverage for people when they use a community pharmacy. I’ve started designing the systems and internal operations. Hopefully, we should start testing by September this year.
Do all patients, regardless of income, receive the medicines they need?
No. A few times we have to assist patients who are unable to pay for their medical care. Generic brands have been helpful in providing a level of care to patients who can’t afford certain innovator brand medications.
Do community pharmacists deliver clinical services?
Yes. Community Pharmacists are the first point of contact patients have with any member of the healthcare team. Now with the PharmD clinical training, Pharmacists are more confident & better equipped to respond in some clinical cases that would otherwise have been taken to a GP.
What are the biggest health issues in Nigeria right now?
Accessibility and affordability. I believe that quality healthcare should be accessible and affordable to the majority of the population. Sadly this isn’t the case yet. Achieving this requires a wholistic understanding of how health systems operate, and the government will to get it right. Over the years, government’s health care efforts have been inadequate and focused on tertiary health care, to the detriment of primary health care. I am a proponent of fully functional primary health care. I believe it’s the bedrock of any successful & sustainable health care system. My three areas of focus in Nigeria’s health system today: primary care, health financing, emergency care services.
Can pharmacists become independent prescribers in Nigeria?
Pharmacists can and ultimately will become independent prescribers in Nigeria. I think this is the inevitable future. And it’ll happen in a short while. The role of community pharmacists in expanding access to primary health care cannot be overemphasised. Pharmacists are the most accessible health care experts. Thus improving access to care in any society will require leveraging on the presence of community pharmacists who have built trust with the community members over time. Several reports have showed that the majority of GP visits are minor cases where a pharmacist’s training and skill afford him the prerequisites to make informed clinical decisions and make referrals where appropriate. Taking advantage of pharmacist’s presence will reduce the burden on the primary care physician and allow him to focus on those cases that really need inpatient care.
Do you think pharmacists prescribing is a good idea?
Yes. Actually, it is something pharmacists already do indirectly. When we make recommendations to the physician concerning a patients medications, we are indirectly prescribing. I just think we should know when to refer a patient to the hospital for more expert attention. A good pharmacist professional should know the difference between a pharmacy case & a case requiring a physician’s attention.
What needs to improve in pharmacy in Nigeria?
All over the world, pharmacy is a continually evolving field. The flexibility in practice is something I like about pharmacy. You have several areas of practice to choose from: administrative, industry, community, hospital. Whatever you’re passions are in life, there’s an area of pharmacy practice just for you. At the same time, we have a lot to do concerning regulations in the profession in Nigeria. The practice of pharmacy and healthcare, in general, is critical because human lives are involved. Proper regulatory frameworks should guide the profession from training, licensing to every stage/area of practice. This is of greater concern in Nigeria because of the issue of corrupt practices in our public service.
Do you feel the future for pharmacy in Nigeria is bright?
There’s is a lot of unexplored potential. Hence so much for growth. At the same time, it won’t happen on its own. Growth is deliberate. So the steps we take today, the decisions we make today, will ultimately determine the future of the profession.