Mazi Sam Ohuabunwa is the President of the Pharmaceutical Society of Nigeria (PSN) and a one-time Chairman of the National Economic Summit Group (NESG). In this interview, he speaks on the challenges of improving local drug manufacturing and the need to cover every Nigerian in the health insurance scheme.
How have you coped with the challenges of your PSN office since you took over?
I came to this office by motivation, because when the idea came to me, I quarrelled with it. I thought I had passed the stage in my life. But God asked me the question, can anybody overgrow his profession? And I couldn’t answer it. So I decided to take up the job. But you will never understand the demand of any office until you come close.
Truly, I had been the Chairman of the National Economic Summit Group (NESG); Nigerian Employers’ Consultative Association (NECA), Nigerian American Chamber of Commerce (NACC), Manufacturers’ Association of Nigeria (MAN). I have held offices in private sector groups, none has been demanding as this. I am virtually here every day because of the way the society is structured and the problems confronting it. There are many things I did not anticipate, that I am going to be the father of all pharmacists; dealing with emotional issues.
In NESG, you come to board meetings, you go and the executive will run the place till the next meeting, but this is more hands-on. So it is taking more time than I had expected. Otherwise the challenges are what we can deal with.
There has been some dilly-dallying on the part of government to implement the National Drug Distribution Guideline (NDDG) which involves the eradication of open market. What is actually delaying this given the urgent need to address the prevalence of drug abuse?
I believe that the reason why it hasn’t taken off is because government wants all the elements involved in NDDG to be in place. As a pharmacist and the President of PSN, I will like NDDG to have been implemented yesterday, but I am also reasonable to appreciate that you can jump into implementing something and then end up in haphazard implementation, and you will not achieve your goal.
So the question is, have we achieved anything by forcing quick response without being prepared? So we are anxious that this NNDG should become operational, but we are also reasonable to appreciate the challenges, especially the involvement of the creation of the Coordinating Wholesale Centre (CWC), which is a major issue to getting NDDG to work. If you don’t get CWC properly established within the framework, we may just not achieve the optimum; that is our understanding of the criticality of CWC in the chain, because one major thing that we must take out from our distribution of pharmaceuticals in Nigeria is to take out the open market. If we don’t take out the open market, we will not solve the problem of haphazard distribution and the danger it causes.
So CWC seems to be the real determining step, because it is essentially a private sector effort. Private sector could have built the CWC, but they are grappling with the problem of getting a land. Even when they have the money, getting approval is an issue, then they go through the process of land approval and all that to start construction. This is taking a little bit more time.
Example, in Lagos here, they suffered the setback after they had paid for a place, the place was taken away from them and it took a long time to get a new place, and now they are sand-filling the whole place.
We have very serious investors led by pharmacists in a number of places to make sure that the CWCs are in place. We are only saying can government help to accelerate this? By the Federal Ministry of Health giving more support, because land ownership is a state thing, but if it is government to government, it is faster or easier done.
We think that the Federal Government (FG) can help. I understand the former minister also tried to intervene in some areas. So we need more of that support.
Secondly, I am determined to have meeting with the promoters of these CWCs in the major sectors, and for us to agree on what irrevocable cutoff date so that one, we are not intermittently waiting for this to happen, then it will serve no purpose. Let us look at what is on ground, appreciate the limitations, and in one or two years we would have reached this level and we will take off, because if not, we will never take off, that is one.
I am also looking at, is there an option that you can call a half-way option? Are there elements of NDDG we can take off with while waiting for the CWC? These are things I am putting together to discuss, because it is a major issue for me and PSN to make sure that NDDG becomes operational. The day it becomes operational and we are able to get enforcement, then I can tell you that we can begin to see the end of the critical challenges that we face in ordering distribution of pharmaceutical products in Nigeria.
On the issue of drug distribution the FG came up with a three-tier classification: society, medicine and vendor, what is exactly the stand of PSN?
The stand of PSN is that we appreciate that there are a couple of people who can play some roles in drug administration and management, and that there can be what they call tax shifting or tax sharing; it happens in many professions. We have said you may not have one category of people in a given stratum, so there may be call for differentiation. But that is the work of the regulatory agency. If you come to register, maybe an outlet, and you are a pharmacist and the regulatory body says, “Ok, this is the list of drugs that you can carry.” Then they see that you are a doctor or somebody who is familiar with medicine, they can say, “Okay, we will allow you to carry this list.” So it is not a question of tier one, tier two or tier three. You cannot franchise the pharmacist’s responsibility. What we are saying in PSN is that even if you are tiering, you must make sure that prescription drugs and ethical products are not in the hand of non-professionals, because the moment you do so, it can expose the Nigerian consumers to danger. Our quarrel was the tiering, and then trying to give ethical products to some tiers that do not fit into law.
The law today only permits pharmacists to handle every aspect of pharmaceutical products, but because of insufficient pharmacists, they allow patent and proprietary vendors’ license, and they are supposed to be stop gaps for managing symptomatic issues, and they refer you to a hospital or to a pharmacist.
We are also reasonable to know that there are places we don’t have pharmacists, especially in some rural areas, and if we say people should not sell drugs in those areas, how will the people survive?
We also have satellite pharmacists to get more pharmacists into the rural areas, because right now, because of the way pharmacists practice, they have made it impossible for any pharmacist to have more than one practice. If you are a retail pharmacy, you are doing only retail pharmacy, if you are academic, you are in academic, unlike doctors. Most of the doctors in the public sector also practice in the private sector; which for me, makes sense because that is the only way you can always be sure that you are current…We are saying, why can’t pharmacists do the same?
What have been the challenges to improving local production of pharmaceutical products?
I am a manufacturer, so I understand the problem, and it is a major issue really. I have a seven-point agenda and one of it is to increase the contribution of local industries to total pharmaceutical consumption in line with the National Health Policy and National Drug Policy that says 70 per cent of locally consumed essential drugs would be made locally. Today, if you ask NAFDAC, they will tell you about 35 per cent, and the manufacturers will tell you about 40 to 50 per cent. My own desire is to raise it.
Except for water, virtually everything we use for manufacturing is imported. Even the ones we buy locally like packaging materials are secondary imports.
Many people believe our health sector is under-performing, where did we get it wrong as a nation?
I believe that the problem firstly is that the country has not gotten the elements of healthcare management right. Healthcare depends on a couple of pillars: health awareness, health insurance, health advocacy and national funding of healthcare. Health awareness is very low. Many Nigerians don’t even value their health.
Number two, health insurance virtually does not exist in our country. 85 to 90 per cent of people pay for their healthcare out-of-pocket. When you are sick, you pay, and it has been proven that when people are sick, that is when they are less able to pay. So that is a problem. No fund in the healthcare. Healthcare is a big business in America and elsewhere in the world. Depending on government budget; it is our problem, and government budget is insufficient. Nigeria said they would budget 15 per cent, UNESCO said 26 per cent. But now Nigeria is budgeting around four per cent because of contending needs, and also low income generating capacity of the country.
There should be a continuous process of deregulation of healthcare so that government can focus its effort on where it has the highest level of impact. We said the FG has tertiary healthcare, state governments have secondary healthcare, local governments have primary healthcare. And what happens at the primary level? Nothing. My proposition is for the FG to run primary health, let secondary health be run by state governments and let tertiary be run by the private sector because that is where you pay more money.
Again, one of the issues is disharmony in the health sector, and this came as a result of selfishness. So we are working together with the other arms, especially the Nigerian Medical Association (NMA), to understand that the health team is a team and a team can only function if all the parts are doing well, and we understand that each person has a role to play; everybody is important.
