By Fabian Anawo
Community pharmacists have called on President Bola Tinubu to begin immediate reform of the health sector to save it from collapse.
They made the appeal in a letter they wrote to the President dated June 3, 2023.
In the letter, they demanded for full implementation of the National Health Act 2014, revitalisation of the Primary
Healthcare and
administering the National Health Insurance Act in alignment with
due process in the public Interest.
The letter, signed by the National Chairman of the Association of Community Pharmacists of Nigeria, ACPN, Mr. Adewale Oladigbolu says that the Act provides for a Basic National Healthcare Provision Fund, BNHPF, to be financed by one percent of Consolidated Revenue Fund.
The letter says the National Health Act guarantees better funding of the Health Sector if well implemented and will make healthcare more impactful.
It made a case for the appointment of Adviser Pharmaceutical Services and Chairman Reforms on Drug
Distribution to arrest the chaotic drug distribution system.
The letter also solicited for the appointment of a seasoned Health Administrator or Insurer to head the country’s Health Insurance Scheme, which fortune it says has declined.
According to the letter, the BNHPF remains a major tool to drive the actualisation of
Universal Health Coverage, UHC, as it lawfully provides that the
BNHPF should fund Social Health Insurance to the tune of 50% of
dedicated funds, while 30% of the funds be devoted to the
procurement of essential drugs and vaccines, 15% of the funds will
be employed to undertake the training of health personnel and 5%
will be used to cater for National Emergency Health Services.
It says that if experienced and transparent Managers are made to run the MDAs
in the Health Sector, negative indices like high child and maternal mortality would begin to nose dive.
The ACPN said that systemic failure in the country’s health system was due to the relegation of other health professionals by not seeking their contributions before policies are made, the changing of the advisory status of the National Council on Health, NHC, to the Minister of Health to that of a decision making body.
It says that in the last nine years except for doctors, most of the professional bodies were not part
of the NCH meetings.
The letter notes that for a long time, Primary Healthcare Services were negated for pecuniary interests of policy makers saying that the quest for UHC will continue to be a ruse if it is not grounded on a well worked out primary healthcare concept.
It says one of the professional groups that can boost the PHC ideology is Community Pharmacy facilities and
Pharmacists who practice in them saying that surprisingly in
a departure from the status quo, the National Primary Healthcare Development Agency NPHDA in 2021 designated Community Pharmacies as Vaccination Centres for COVID-19 in a bid to promote easy access
to the vaccines, a move which is commendable as events proved it
was a right step in the right direction.
The letter urged that the NPHDA should be empowered to go full throttle as it designates Community Pharmacies as Immunisation Centres for all clinical disease states saying that the move will pave the way for routine immunisation as opposed to the presently imposed National Immunisation Days.
It says that Nigeria can substantially reduce infant and maternal mortality significantly if it encourages the setting-up of Community Pharmacy
based ante-natal clinics like in some climes.
No health professional is in better position to counsel patients on the
essence of drug use in pregnancy and other situations than a
Pharmacist.
The Pharmacist, apart from stressing the compulsion in the usage
of ferrous products, folic-acid and so on in ante-natal care, will highlight all the risk-factors in drug-drug, drug-food and drug-pregnancy interaction profiles.
The letter says that the regulation of the country’s expanding population is germane to the quest for National growth and development and that
Community Pharmacists being certified as Family Planning
experts are able to run good Family Control Clinics at
the Community Pharmacy level.
The roles of Pharmacists in managing other areas like smoking
cessation, diet management and control, prevention of noncommunicable diseases and other wellness strategies needs to be taped as well.
On the National Health Insurance Project it observed that the scheme was well administered in the early years when Health Administrators like Mustapha Sambo and Dr. Mohammed Lecky called the shots with the scheme attaining ten percent coverage only for it to nose dive when Medica doctors began to head it.
The letter points out that the fortune of the scheme began a free fall when Dr. Dogo Mohammed took over as the CEO, pointing out that for over 13 years of the 18 years of the establishment of Social
Health Insurance in Nigeria, it has been anchored by inexperienced Physicians.
The letter says that the failure are hinged on factors including:
Unlawful Payment Mechanism and
indiscriminate Capitation Payment.
It points out that the lawful payment by virtue of the old NHIS Act now amended as the NHIA Act are Capitation Fee for Services, Case Payment and Per Diem. But for administrative convenience, the NHIA Secretariat continues to employ an unlawful payment mechanism
called Global Capitation to compensate providers in Social health insurance. The NHIS pays all compensations for secondary providers who should enjoy fee-for-services to Physicians who are primary
providers and in turn expect these Physicians to pay for these
services. In simple terms, Physicians are paid for drug use service,
laboratory services and related care services in Nigeria’s version of
Social Health Insurance which paves way for unmitigated disaster.
In addition to the above challenge is
the indiscriminate capitation of facilities. Rather than the
norm of capitation to General and Teaching Hospitals which are
tertiary facilities. This constitutes great distraction to teaching and
specialist facilities which are structured to handle referrals, research and specialized care.
It notes that in Nigeria, Social Health Insurance has become a public sector driven concept rather than a private sector oriented agenda which is one of the main reasons it does not inspire confidence in enrolees.
As at 8 years ago, the coverage rate in social health insurance
dropped from almost 10% to 1.72% with a chance that it might drop
even further.
The ACPN pledged to
collaborate with Government as it targets a revival of dead structures across board in all sectors of the economy including Health.