Top Line

Monday 20 October 2014

Why Nigeria is not on world pharmaceutical map - Lolu Ojo

Nigeria absent on world pharmaceutical map —Lolu Ojo, Merit Healthcare’s MD il 16.Oct.2014 DISQUS_COMMENTS Sade Oguntola Dr Lolu Ojo is the Managing Director, Merit Healthcare Limited and a past chairman Association of Industrial Pharmacists of Nigeria (NAIP). He speaks with SADE OGUNTOLA on how the rancour in the health sector can be put at rest and what Nigeria must do to make the industry exist on the world pharmaceutical map. The health sector crisis, is it more of failure of leadership, or a professional rancour? Of course, it is more of a professional rancor. That is where it started from and where it still is. I have interfaced a lot with both my colleague pharmacists, doctors, medical laboratory scientists and others in the health system like administrators and engineers. They are all complaining because their career progressions have been affected by this rancorous relationship between the different professionals in the health sector. Even others that are not trained primarily as healthcare professionals but working in the health team cannot make progress as much as their colleagues who are outside the health system. They are also not happy with the situation. It is based on this situation that I asked what exactly the problem is. My conclusion is that it is about leadership. It cuts also across all sectors, including the educational sector. It is because of the quality of leadership that we find ourselves where we are today. It is totally unlike in developed countries of the world. Fine, I will not in good conscience accept that just because you read pharmacy and you read medicine, that automatically makes me to serve you. No, there should be different cadres of workers for the system to move on. So, this idea that I am this and therefore, I am the head, to me, it doesn’t sound okay. For a very long time, doctors have been leading the health system. The question we are asking is that, what kind of leadership have they provided? If they had provided the right leadership, why are we where we are today? Look, if you say you are my leader, what are you doing that will make me follow you? And can there be leaders without followers? These are the questions we need to ask ourselves and this is what I am trying to say. Who is a leader? A leader is he who mobilises others for the achievement of a common goal to perform a particular task. Therefore, if you are the leader, your job is to mobilise the available resources within the system to achieve the goal. It is not the doctors alone that are available in the system, all other categories of staff including the administrative staff are in the system. It is your job to now bring all these people together to achieve the right goal, which is the health of the patient. I think we are where we are today because of the failure of that leadership. There is true growth actually when we are interdependent. What is the meaning of education? Training of mind and character, that is what education is all about. What is important is that your mind and character have been trained. And once that is done, you are able to actually react or adjust in whatever system you find yourself. I think the doctor should change their position; they need to bring everybody together. Even when you are Chief Medical Director, you are not performing surgery there, neither are you taking delivery. All you do is administration. So, we need to keep the best of our team there. But if it must be the doctor, let the doctor provide the required leadership. How can the government bring everybody together to work as a team? Well, everything starts and ends with the government. The objectives of the team must be defined. In my own concept, I have met many doctors in the hospitals; I don’t like the environment under which they work. But, it is not just the doctors alone. Go and check the laboratory or even the pharmacy, hardly will they find a chair and a table to sit on to do their job. These are the things we need to focus on. How do we make the system work better, how do we ensure that the patient don’t have to spend the whole day to get health services? These are what we should be talking about and let us make the best use of the skill that our people have. Honestly, to run a system, you don’t need to be a doctor. What you need to be a doctor is to be able to see a patient and diagnose what the problem is and make a recommendation for the solution. No doubt we have some doctors with good skill. Governor Mimiko is a medical doctor. Why would I say I don’t want Mimiko to be my leader because he is a doctor? I will look at him as a good leader, and I will want to follow this good leader. That is the point. So, if I have the competence to be a good leader, why would you stop me just because I am a pharmacist? I think these are the things we need to know. But is the problem not that of every profession protecting its territory? This territorial protection is what is disturbing us. It has become an ego. We have to drop it. But is this also not an issue in Pharmacy practice, where they say they don’t want anybody dealing in medicines apart from pharmacists? There is no rule that says you have to be a pharmacist before you can operate in the business of Pharmacy. What the rule says is very clear; for you to have a pharmaceutical organisation, you must be registered with the Pharmacy Council of Nigeria (PCN). And to register with the PCN, you need a superintendent pharmacist. Now, complaints are on those not operating under any regulatory control. For instance, Onitsha and Idumota markets have tolerated illegality. The rules are there, you cannot operate a pharmaceutical premise, unless you are registered with PCN. The superintendent pharmacist is to oversee activities in the premises. Drug is not just an article of trade. Given the situation of pharmacist and Pharmacy practice in Nigeria, how is the profession surviving? Well, the fact that we are surviving is why you met me in my office today. But the truth of the matter is that, government has not really pay much attention to pharmacy and it is unfortunate. The pharmaceutical industry has the potentials to contribute substantially to the national GDP. What we are contributing to the GDP is less than one per cent. We do not even exist in the world pharmaceutical map. Why is this so? 70 per cent of our products are imported. We are not producing to meet our national needs, talk less of being able to export to others. Why do you think the Indians are here, why are the Chinese here? It is because the opportunities are here. To me, what is happening borders on leadership. President Goodluck Jonathan cannot do everything; I want to plead with those that are giving the responsibility, particularly policy makers in health, to think out a solution to this problem. Why are Indians making it? They have a group in India called the Pharmaceutical Export Promotion Council whose goals is ensuring expansion of the pharmaceutical industry. The group organises exhibition everywhere. Also Indian government supports them in this business. They get loans at between four to six per cent whereas Nigerians get loans at about 25 to 30 per cent. There is also the challenge of multiple taxation in Nigeria. The theme of the Worlds’ Pharmacy Day; access to Pharmacy is access to health, how is this achievable? Pharmacist is one of the accessible professionals all over the world. You just walk into the chemist; you ask if the pharmacist is around and you just see him. In fact, you don’t pay consultation to see him. You tell him about your health problems, the one that he can manage he attends, the ones that he cannot manage, he refer you. That is why we say access to pharmacist is access to health. But by law, pharmacists are not supposed to prescribe, where does that come in all of these? There are different categories of medicine. That pharmacists are not supposed to prescribe is not an absolute statement. So, if you see the pharmacist and all you complain about is I have pains in my hand, and he gives you paracetamol, if you don’t get better in the next two days come to me. I don’t see anything wrong in that. What is wrong is you start conducting a clinic in your pharmacy, start giving injection and whatever. Even in advanced world, in UK now, there is Pharmacist Initiated Medicine (PIM), some medicines that pharmacists can actually prescribe. But it is not absolute. So the problem is with the system we operate in Nigeria. The last thing about prescription; people throw away left over drugs for no reason, is that right, can I throwaway my unused prescription? Well, you are not even supposed to get more than what you need. All these are not signs of things that are not okay with our system. When a doctor writes a prescription, it is for a definite period. Ideally, there is not supposed to be a left over but what are the dangers of having left over? The health sector crisis, is it more of failure of leadership, or a professional rancour? Of course, it is more of a professional rancor. That is where it started from and where it still is. I have interfaced a lot with both my colleague pharmacists, doctors, medical laboratory scientists and others in the health system like administrators and engineers. They are all complaining because their career progressions have been affected by this rancorous relationship between the different professionals in the health sector. Even others that are not trained primarily as healthcare professionals but working in the health team cannot make progress as much as their colleagues who are outside the health system. They are also not happy with the situation. It is based on this situation that I asked what exactly the problem is. My conclusion is that it is about leadership. It cuts also across all sectors, including the educational sector. It is because of the quality of leadership that we find ourselves where we are today. It is totally unlike in developed countries of the world. Fine, I will not in good conscience accept that just because you read pharmacy and you read medicine, that automatically makes me to serve you. No, there should be different cadres of workers for the system to move on. So, this idea that I am this and therefore, I am the head, to me, it doesn’t sound okay. For a very long time, doctors have been leading the health system. The question we are asking is that, what kind of leadership have they provided? If they had provided the right leadership, why are we where we are today? Look, if you say you are my leader, what are you doing that will make me follow you? And can there be leaders without followers? These are the questions we need to ask ourselves and this is what I am trying to say. Who is a leader? A leader is he who mobilises others for the achievement of a common goal to perform a particular task. Therefore, if you are the leader, your job is to mobilise the available resources within the system to achieve the goal. It is not the doctors alone that are available in the system, all other categories of staff including the administrative staff are in the system. It is your job to now bring all these people together to achieve the right goal, which is the health of the patient. I think we are where we are today because of the failure of that leadership. There is true growth actually when we are interdependent. What is the meaning of education? Training of mind and character, that is what education is all about. What is important is that your mind and character have been trained. And once that is done, you are able to actually react or adjust in whatever system you find yourself. I think the doctor should change their position; they need to bring everybody together. Even when you are Chief Medical Director, you are not performing surgery there, neither are you taking delivery. All you do is administration. So, we need to keep the best of our team there. But if it must be the doctor, let the doctor provide the required leadership. How can the government bring everybody together to work as a team? Well, everything starts and ends with the government. The objectives of the team must be defined. In my own concept, I have met many doctors in the hospitals; I don’t like the environment under which they work. But, it is not just the doctors alone. Go and check the laboratory or even the pharmacy, hardly will they find a chair and a table to sit on to do their job. These are the things we need to focus on. How do we make the system work better, how do we ensure that the patient don’t have to spend the whole day to get health services? These are what we should be talking about and let us make the best use of the skill that our people have. Honestly, to run a system, you don’t need to be a doctor. What you need to be a doctor is to be able to see a patient and diagnose what the problem is and make a recommendation for the solution. No doubt we have some doctors with good skill. Governor Mimiko is a medical doctor. Why would I say I don’t want Mimiko to be my leader because he is a doctor? I will look at him as a good leader, and I will want to follow this good leader. That is the point. So, if I have the competence to be a good leader, why would you stop me just because I am a pharmacist? I think these are the things we need to know. But is the problem not that of every profession protecting its territory? This territorial protection is what is disturbing us. It has become an ego. We have to drop it. But is this also not an issue in Pharmacy practice, where they say they don’t want anybody dealing in medicines apart from pharmacists? There is no rule that says you have to be a pharmacist before you can operate in the business of Pharmacy. What the rule says is very clear; for you to have a pharmaceutical organisation, you must be registered with the Pharmacy Council of Nigeria (PCN). And to register with the PCN, you need a superintendent pharmacist. Now, complaints are on those not operating under any regulatory control. For instance, Onitsha and Idumota markets have tolerated illegality. The rules are there, you cannot operate a pharmaceutical premise, unless you are registered with PCN. The superintendent pharmacist is to oversee activities in the premises. Drug is not just an article of trade. Given the situation of pharmacist and Pharmacy practice in Nigeria, how is the profession surviving? Well, the fact that we are surviving is why you met me in my office today. But the truth of the matter is that, government has not really pay much attention to pharmacy and it is unfortunate. The pharmaceutical industry has the potentials to contribute substantially to the national GDP. What we are contributing to the GDP is less than one per cent. We do not even exist in the world pharmaceutical map. Why is this so? 70 per cent of our products are imported. We are not producing to meet our national needs, talk less of being able to export to others. Why do you think the Indians are here, why are the Chinese here? It is because the opportunities are here. To me, what is happening borders on leadership. President Goodluck Jonathan cannot do everything; I want to plead with those that are giving the responsibility, particularly policy makers in health, to think out a solution to this problem. Why are Indians making it? They have a group in India called the Pharmaceutical Export Promotion Council whose goals is ensuring expansion of the pharmaceutical industry. The group organises exhibition everywhere. Also Indian government supports them in this business. They get loans at between four to six per cent whereas Nigerians get loans at about 25 to 30 per cent. There is also the challenge of multiple taxation in Nigeria. The theme of the Worlds’ Pharmacy Day; access to Pharmacy is access to health, how is this achievable? Pharmacist is one of the accessible professionals all over the world. You just walk into the chemist; you ask if the pharmacist is around and you just see him. In fact, you don’t pay consultation to see him. You tell him about your health problems, the one that he can manage he attends, the ones that he cannot manage, he refer you. That is why we say access to pharmacist is access to health.