By Henry Uche
The Association of Community Pharmacists of Nigeria (ACPN) has faulted pharmaceutical laws in Nigeria, saying that there are myriads of loopholes and defects, even as it reviewed the operations of the National Health Insurance Authority (as amended by NHIS amendment Act 2022) and tagged it an “abysmal failure.”
In a communique issued at the end of a summit by the group in Edo State, the state chapter chairman of ACPN, Duke Otite, lamented that there were series of violations in the existing pharmacy laws, which encourage unauthorised personnel to dabble into drug dispensing.
From the communique, the group recommended the incorporation of mobile health technology (m-Health) because of the prospective benefits for achieving universal health coverage (UHC) by improving access to health services, particularly for those in the hinterland, enhancing knowledge and access to health information for all providers.
From the summit, they made the following submissions: “The purpose of any health insurance programme was to provide of affordable and cost-effective access to quality healthcare to enrollees, which ultimately eliminates out-of-pocket expenses, which comes with financial hardship.
“We have reviewed the operations of the National Health Insurance Authority (as amended by NHIS amendment Act 2022) and concluded that it was an abysmal failure as the emphasis was on only the formal l sector which accounts for less than 15 per cent of the population of Nigeria.
“We are not satisfied at the modus operandi of the current NHIA, which empowers the physician to be prescriber and dispenser of drugs at the same time contrary to global best practices, which forbids a prescriber or dispenser to derive undue economic advantage in the totality of drug management mechanisms.”
The group lamented that the FG, FMOH and NHIA had continued to encourage unethical and unlawful acts by tolerating unacceptable status quo in the health system.
They also bemoaned the unlawful payment mechanism of global capitation, which, according to them, was structured to merge capitation fees for General Practice Physicians (primary providers) and fee for service for secondary providers and tertiary providers as brazenly negating the lawful payment mechanisms to all other non-physician Health workers including Pharmacists who are prevented from carrying out their professional duties of drug dispensing and counselling contrary to law. (PPA Cap 535 LFN 1990).
“We condemned the indiscriminate capitating of facilities in the Secondary and Tertiary bracket which is a violation of the norm that places capitation payment on only primary care facilities. This would undermine the capacities of private sector players in a conundrum that limits the growth of the Nigerian Health System in all ramifications.
“The aberration of indiscriminate capitation has caused a distraction from the core statutory responsibilities of training, research and specialised care in the teaching hospitals which are forced to manage clinical disease like malaria, which accounts for over 65 per cent of all clinical visitations in Nigeria.
“We call on Federal and State authorities to automatically bar HMOs with service provider networks to desist from utilising those provider networks for service rendition in the NHIS.
“We are concerned about the modus operandi of the NHIS secretariat and HMOs, which rely on branded drug products in the running of Nigeria’s version of social health insurance programme. From the foregoing, Nigeria’s healthcare system has been bleeding and is currently the 5th worst in the world.”
ACPN recommended that the government should immediately start the process of accrediting community pharmacies into the Edo State Health Insurance Scheme to provide primary health care services and offer pharmaceutical health care services to patients under the scheme that do not patronise government institutions.
They suggested the use of Unstructured Supplementary Service Data (USSD) code since they are often simple, cheap and have wider coverage. More so, Mobile Apps can be made to be free, simple, visual and functional without internet connectivity.
“NHIA Act 2022 is a template to avail about 100 million under privileged Nigerians access to the Basic Healthcare Provision Fund (BHCPF) provided for in the NH-2014 Act. This will guarantee that Community Pharmacies through an extended scope of practice will be able to provide basic care fully funded by the vulnerable group fund.”
They counselled the ACPN Edo state and national to consider exploring judicial interpretation of relevant aspects of the various acts of parliament to permanently redress the misnomer (non-pharmacists involvement in dispensing of drugs), an act that compromises patient lives and safety.
“Pharmacists play a major primary care role that is enhanced by their accessibility and can be further amplified with a broader scope of practice, technology integration, Health Insurance and remuneration commensurate with this role,” they affirmed.