By Enyeribe Ejiogu
President of the Pharmaceutical Society of Nigeria, PSN, Pharm Ayuba Tanko Ibrahim, has reiterated that the decision taken by the regime of former military president, General Ibrahim Badamasi Babangida, to make doctors head health facilities nationwide has continued to hobble the healthcare system, making Nigerians the ultimate losers.
Squarely, he laid the blame on late Professor Olikoye Ransome-Kuti, who as Health minister advised the IBB-led Federal Government to abrogate the age-long British and global practice of hospitals being headed by seasoned, non-partisan administrators, who were not doctors or other health professionals.
During the pre-and-post Independence era, the PSN President stated that hospitals ran smoothly and all healthcare professionals enjoyed non-discriminatory career progression until doctors began to skew everything to favour their profession only.
He also kicked against the seeming tendency of doctors that are heading health facilities to take too much leeway and unduly abuse the privilege given to them – even to the point challenging the government in the matter of Pharmacy Consultant status granted to pharmacists by the Federal Executive Council, which chief medical directors of tertiary hospitals have refused to implement. In this interview, he speaks further these issues.
Prior to becoming the President of the Pharmaceutical Society of Nigeria, PSN, what were you doing? Were you running a business or something?
I was a public servant. After my graduation, I did my internship in a General Hospital. After that, I was called up for the mandatory one year service under the National Youth Service Scheme, NYSC. I started my service in the health clinic at the orientation camp. After the orientation I was deployed to Nigerian National Petroleum Corporation, NNPC, for my primary assignment. Those were the days when Nigeria was good. When I finished the youth service, I was employed by NNPC. I worked there until 2021, when I retired peacefully. So, I’ve been a public servant all my adult life.
After you retired, did you set up any business?
You know, regarding business ventures, when you start it late, and you don’t have the entrepreneurial know-how, you are likely to be fleeced. So I’m taking my time. I’m studying the terrain. I am understudying some people, to learn how they do it, so that I will take the right steps in running the enterprise when I decide to set up my own.
However, I became the PSN President about six months ago. Running a pharmacy requires you to be there regularly. Nowadays, the PSN presidency is not a job you can do alongside anything else. It takes a lot of time. It means that if I set up a business, I won’t have time for that business. So, I decided to finish the presidency first. God being so kind, NNPC still pays me a pension. So I’m surviving.
How long is your presidency?
It will last for three years. And by the grace of God I will make impact during the three years of my tenure.
Would you say that the nation is getting the full value of the capacity and capability of pharmacists? And if it is not, what exactly is the problem?
I would say no. And the reason is that the government, which is the largest employer of pharmacists, does not accord pharmacists their due in the scheme of things. We are highly, highly trained professionals, but we are under-utilised.
So, if the government would recognise the value of pharmacists and utilise their capacity, and extract the full value of what they can offer, it would be El Dorado for the health sector in Nigeria. But I would not blame the government very much because in the healthcare sector, we are supposed to work as a team with each professional complementing the other professionals.
But unfortunately in Nigeria, we find ourselves in a situation whereby one professional group wants to dominate everybody and lord it over everybody, instead of considering the others as partners. So that’s why other professionals, not only pharmacists, are not giving their full complement of what they can offer. So, in a sense, that is a policy issue that ought to come from the government.
If one profession is being allowed to lord it over the other professions in the healthcare system, isn’t that a failing on the part of the government?
What is happening has historical antecedents. When I was in school, I remember hospitals, especially federal government hospitals, were headed by hospital administrators.
How far back are we talking about?
In the mid-80s during the regime of former Military President, General Ibrahim Badamasi Babangida who appointed late Professor Olikoye Ransome-Kuti as the Minister of Health. Prof Olikoye changed almost all the laws in the health sector to make doctors head of everything. And that was the beginning of the problem of the healthcare system in Nigeria.
The simple fact is that where the hospital is run by an administrator, the doctors, pharmacists, medical laboratory scientists as well as the nurses will do their jobs. Even physiotherapists will do their job. There will be no discriminatory practices. But the moment they found themselves in the position of being heads, they began to implement discriminatory policies against others in favour of themselves. That is not what a leader is supposed to do. You can’t be a leader and then be discriminating against other professionals. It doesn’t work. And that’s why we have a lot of disharmony in the health sector. And since then, things have never been the same. There has always been one fight or the other between doctors and the other professions in the healthcare system.
Let me present the perspective with the most recent one. The Federal Government approved the consultant cadre for pharmacists who have the qualification of the West African Postgraduate College of Pharmacy.
It was approved through stages by the federal government until the final document signed by the Minister of Health for implementation. Doctors said they would not implement. I am talking about doctors who are heading tertiary hospitals as chief medical directors. In fact, last month, the Lagos State branch of Nigeria Medical Association even warned the government. Can you imagine a situation where doctors, who are employees, warned the government that they would go on strike if the government took any step to implement the new policy? In which other country can this happen?
Two groups of professionals working for the government, and one group warns that if the employer (the government) pays members of the other group certain entitlements, they would go on strike. Can you imagine that? Doctors have been given too much leeway. And they have abused it.
Are there legal steps that can be taken to challenge non-implementation of the policy?
Yes, this can be challenged in court because there are laws governing these things. The Federal Executive Council has approved the policy. So, CMDs that refuse to obey or implement the policy should be regarded as being insubordinate. The laws in favour of pharmacy or laws governing pharmacy are against it. These things are in the Pharmacy Act but they violate them with impunity. The simple reason is that somebody has not challenged them.
Under my tenure, we will challenge those things through advocacy and enlightenment. We will meet the people involved and urge them to do what is needed. And then if possible, we take them on.
You know, there was a decision taken by the government to create the Coordinated Wholesale Centres. The one for Kano was built and it is working. Why has it been difficult, almost impossible to build the one for Lagos and Oba (Anambra State)?
You have asked a very beautiful question. About two months ago, the National Agency for Food and Drugs Administration and Control, NAFDAC, went into action and closed down the open drug markets in Onitsha and some parts of Idumota, Lagos and the rest. It sent shockwaves around the country. Let me tell you, unless we have those Coordinated Wholesale Centres, we will not have sanity in the distribution of drugs and thereby be able to stamp out the menace of fake, substandard and adulterated drugs.
To tell you the truth, the people who are doing this are very rich and powerful people. And they make a lot of money from this, and to fight them would take a lot of courage. NAFDAC did very well by taking them on. But we have gone back to square one because the markets have been re-opened and the people who operate there have been given some conditions and told what to do. Like we have said, the CWCs initiative is the ultimate endgame. They have been given some time to complete their CWCs.
We shall monitor and make sure that they abide by the time they have been given to complete their movement. If the nation is not able to sanitise the drug distribution system, then you can be sure that we will continue to have fake and adulterated drugs in the system.
You have to sanitise the drug distribution system, such that when a drug leaves the warehouse, it can be traced to the final consumer, that’s where you can have sanity. For example in developed countries that are serious, you can’t just walk into any shop and buy drugs. That is the way it is supposed to be in Nigeria. But that’s not how we operate at all. The problem we have in country is the Nigerian Factor. I find that hard to accept. I’d like things to be done correctly and rightly. So we, the stakeholders in the health sector, should put our heads together, work together and ensure that we sanitise the health system. So that we would have no fake doctors, no fake pharmacists, no fake drugs. But instead of coming together to work for the good of the country and for the patients, we are busy fighting for supremacy and to control the other professions. It’s unfortunate.