By Samuel O. Adekola
The use of the word “Prescription” is changing the world over and medicines or drugs are being reclassified from the simple ancient days ’classification of prescription only medicines and non-prescription medicines because of the ever-increasing needs for equitable access to medications and improved continuity of patient care.
Pharmacists play very important roles in the delivery of primary health care across the world. In the wake of the dramatic devastation and unprecedented loss of human lives inflicted upon the world by the COVID-19 pandemic. During the lock-down period and the attendant restriction of access to public health centers orchestrated by the pandemic, community pharmacists courageously stepped in to meet the healthcare needs of Nigerians. Unfortunately during the pandemic Pharmacists faced a peculiar challenge of accessing certain prescription medicines indicated for some common conditions in primary care. This was at such a sensitive time the entire Nigerian population relied on the Community Pharmacists as the source of medicines for primary care. This underscores the need for speedy approval of the category of Pharmacist-Initiated-Medicines (PIMs) in medicines classification in Nigeria as obtainable in other climes. This is supported by the latest policy document of the International Pharmaceutical Federation/Community Pharmacists Sector FIP/CPS Vision 2020–2025. According to the NAFDAC DG at the last NAPHARM/NG virtual conference ''Pharmacists are the backbone of the Nigeria’s healthcare delivery system
Eight models for pharmacists’ prescribing have been implemented internationally varying in their dependency on protocols, formularies and collaborations with physicians, to be specific, the models include:
- NON-PROTOCOL: 1) Formulary Prescribing (2) Referral to Pharmacists (3) Independent Prescribing
- PROTOCOL: 1) Patient Group Direction (2) Repeat Prescribing (3) Supplementary Prescribing (4) Protocol Prescribing (5) Collaborative Prescribing.
For instance, Dr. Samuel O. Adekola was certified to prescribe and administer Naxolone injectable for the management of Opioid over dosage since September2019 by the MARYLAND Department of Health USA. Indeed, practice of medicine in relation to health is changing across the globe and Nigeria needs to get ahead of it to the benefit of the ever growing population.
The National Agency for Food and Drug Administration and Control (NAFDAC) is the primary agency saddled with the responsibility of regulating the importation, exportation, manufacture, sales and utilization of medicines in Nigeria. One of such responsibilities is the classification of medicines used in the country.
The Association of Community Pharmacists of Nigeria (ACPN) has enjoyed unfettered access, collaboration and supports from NAFDAC under the current leadership, with improvements in Internally Generated Revenue base and gadgetry in NAFDAC laboratories which both combine to improve service rendition in the Agency. But a previous effort to introduce the Pharmacist-Initiated-Medicines(PIMs) in Nigeria was not achieved due to non approval. For Pharmacists to effectively carry out the primary responsibility of providing primary healthcare services there is need for PIMs to be approved. This will enable Pharmacists to ethically explore their clinical judgment in recommending medicines within the PIM category to patients who need them.
Furthermore, the Federal Ministry of Health had enacted the Task Shifting Task Sharing Policy which implies that some primary care tasks should be shifted to other health care providers such as Pharmacists. So far, services such as Family planning have been successfully implemented. However, for other primary care services such as Medication Therapy Monitoring amongst others to be effectively implemented, Pharmacists must be authorized to recommend certain class of medicines. That way, the health care needs of the Nigerian populace would not be in jeopardy should there be acute lack of access to clinicians as was experienced in the heat of the Covid-19 pandemic. Pharmacists need to be properly re-positioned as Primary Healthcare Providers in Nigeria. This is to guarantee the achievement of universal health coverage. In many other countries across Europe and Americas, the capacities of community pharmacies have been maximally harnessed in the combat against Covid-19 pandemic. Pharmacists were involved in patient education, counseling, point-of-care testing, supply chain management of vaccines as well as administration of vaccines. This strategy tremendously helped in better handling the ravaging pandemic in these countries. Conversely, in Nigeria, Pharmacist were not adequately engaged in the entire response to the pandemic. This sad situation encouraged a number of vices in our Country, prominent among which are drug abuse and misuse.
To change this unenviable narrative, the Association of Community Pharmacists of Nigeria birth a foundation known as the Transgenerational Pharmacies Development Foundation, TGPDF, having one of its strategic primary objectives of repositioning community pharmacists and working to integrate Pharmacists as primary health care providers as being promoted by World Health Organization, WHO in partnership with the International Pharmaceutical Federation FIP. The later was consummated in the ASTANA DECLARATION of 2018 that was equally conveyed in the ABUJA DECLARATION of December 2020 signed by Community Pharmacists in Nigeria. Kindly referred to the 50-point communiqué endorsed during the 2020 ACPN National Scientific Conference. The vision of this noble initiative was contained in the 50-points communiqué endorse during the 2019 ACPN conference in Abuja. Given the need for Pharmacists to be highly clinically inclined in order to provide high quality primary healthcare services to the community they serve, the Transgenerational Pharmacies Development Foundation, deemed it necessary to build the capacities of both upcoming pharmacists as well as practicing pharmacists through the PharmD undergraduate and conversion programs respectively. The ACPN-Transgenerational Pharmacies Development Foundation under the leadership of Prof. Lere Baale are sedulously working on strategic project of achieving a primary healthcare driven community pharmacy practice in Nigeria.
It is hoped that these activities will set a momentum that will galvanize the overall interest of NAFDAC in expediting actions towards the actualization of a holistic primary care delivery in community pharmacies across Nigeria beginning with the approval/authorization of Pharmacist-Initiated-Medicines, PIM.