By Chioma Obinna
Edo Community Pharmacists have bemoaned the credibility and integrity issues surrounding the Nigeria Health Insurance which excluded the Community Pharmacies even as they demanded immediate accreditation of Pharmacies into the State Health Insurance Scheme in order to provide primary health care and pharmaceutical services to patients under the scheme that do not patronise Government institutions.
The Community Pharmacists under the auspices of the Association of Community Pharmacists of Nigeria, ACPN, in a communiqué it issued after summit in Edo State recently, declared that the operations of the scheme lacks credibility and integrity as Community Pharmacies are the most accessible and affordable link in the value chain of healthcare.
They insisted that the aim of the NHIS Act was to provide affordable and cost-effective healthcare to Nigerians.
The Communiqué also faulted what it described as unlawful payment mechanism of global capitation. According to the pharmacists, the payment is structured to merge capitation fees for General Practice Physicians (Primary Providers) and fee for service for secondary providers and tertiary providers as effectively 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.
The communiqué reads in parts, “We 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 sector which accounts for less than 15 percent of the population of Nigeria.
“Summit identified the four major services covered by Health Insurance as including diagnosis, investigation (laboratory) procedures (surgery) and pharmaceutical care.
“Community Pharmacists under the aegis of the ACPN (Edo State) declared that the major credibility and integrity issues arising from Nigeria’s brand of Health Insurance is grounded on the non-incorporation of Community Pharmacies which are the most accessible and affordable link in the value chain of healthcare,” it added.
ACPN called for the scale up of community pharmacists’ involvement with health promotion activities for the sake of effective Universal Health Coverage (UCH).
The pharmacists claimed that using pharmacists who are properly prepared to instruct or train the population toward a particular objective and achieving set goals could help alleviate the scarcity of healthcare providers in public health institutions, particularly in rural areas.
“Summit expressed the need to scale up community pharmacists involvement with health promotion activities which will help to accelerate Universal Health Coverage while maintaining access to many public health services in the communities through the over 6,000 registered community pharmacies.
“The shortage of healthcare providers in public health facilities, especially in rural areas, could be leveraged by Pharmacists who are adequately trained to educate or train the community towards a particular end or attaining set goals.
“Thus, Summit canvassed exploration of the extended scope of practice for community pharmacies in the following areas: Prevention and control of locally endemic diseases; Immunisation services; Treatment of communicable and non-communicable diseases; Health Education; Maternal Child Health/Family Planning, and Supply of essential medicines and basic nutritional supplements.”
ACPN also frowned at the operations of the current NHIA, alleging that it empowered doctors to be both prescribers and dispensers of drugs, contrary to the global best practice. It further regretted that the Federal Government, as well as the Federal Ministry of Health (FMOH) and NHIA, had encouraged such and other unethical practices.
It noted that the drug value chain has remained endangered in National Health Insurance Act (NHIA) operations, alleging that the doctors who prescribe and dispense drugs do so with drugs from their own clinics.
“Summit frowned at the modus operandi of the current NHIA which empowers the physician to be prescriber and dispenser of drugs at the same time. This is contrary to global best practices which forbid a prescriber or dispenser to derive undue economic advantage in the totality of drug management mechanisms.
“Summit clarified that value addition remains jeopardised in NHIA operations till date because what obtains presently is that the Physicians who prescribe and dispense only give out drugs in the stock of their clinics which often times is not the best drug of choice from a clinical perspective.
“Summit inferred with a sense of responsibility that the Federal Government, FMOH and NHIA had continued to encourage unethical and unlawful acts by tolerating this status quo.
“Summit identified the unlawful payment mechanism of global capitation which is structured to merge capitation fees for General Practice Physicians (Primary Providers) and fee for service for secondary providers and tertiary providers as effectively negating the lawful payment mechanisms to all other non-physician.”
ACPN regretted that the Act has prevented health workers, including pharmacists, from carrying out their duties of drug dispensation and counseling, saying the development impedes the growth of the Nigeria’s health sector.
They further lamented the indiscriminate payment mechanism in the Secondary and Tertiary bracket, adding that it is a violation of the norm that places capitation payment on only primary care facilities.
“What this does is to undermine the capacities of Private Sector players in a conundrum that limits the growth of the Nigerian Health System in all ramifications.”
“Summit drew attention of the Federal Government and state governments to the tendencies of HMOs which have service provider network to expressly handover strategic opportunities to cater for enrollees to their own provider networks as hospitals with a full complement of all professional services including pharmacy, medical laboratory, radiography, physiotherapy and others.
“We critically evaluated the practice and call on the 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.”
They further challenged the NHIA to collaborate with Pharmaceutical Manufacturers Group of Manufacturers Association of Nigeria (PMG-MAN) and Association of Pharmaceutical Importers of Nigeria (APIN) to ensure mass production of generic packs of drugs for Edo residents and the country.
“Summit counselled the NHIA to collaborate with PMG-MAN and APIN in a larger bid to produce bulk generic packs of drugs which will be negotiated to make the totality of service more affordable and accessible to consumers of Health in Edo State and Nigeria in general.”
The summit also strongly advised the Federal Government to leverage on findings in new studies by Columbia’s Mailman School of Public Health which confirms pharmacists are stepping into roles previously held by primary care physicians and other healthcare providers.
It reinforced this position by referring to research done by Express Scripts Pharmacy which shows that there’s a link to better health outcome when pharmacists get involved with patient counselling, intervene with chronic disease management and care, canvassing for a need for alignment of these recent advances to harness the potentials of community pharmacies in health insurance.
It thus recommended the incorporation of Mobile Health Technology (M- Health) because of the prospective benefits for achieving UHC by improving access to health services particularly for those in hard-to-reach communities, enhancing knowledge and access to health information for all providers.
The ACPN members suggested the use of Unstructured Supplementary Service Data (USSD) codes, noting that “They are often simple, cheap and have wider coverage and mobile apps which are already being deployed by a few of the HMOs with considerable success
“Mobile Apps can be made to be free, simple, visual and functional without internet connectivity.”
They admonished the state government Health Insurance Schemes, NHIA and FMOH to take maximal advantage of collaboration to accredit primary and secondary health facilities, saying community pharmacies will be instrumental towards effective enrollment of Nigerians into the scheme.
“Community pharmacies, due to accessibility in rural areas, will be instrumental to enrolling Nigerians into the scheme. The 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 cited the South Africa National Health Insurance where widespread collaboration and re-assessment of roles and practices of pharmacists by focusing their skills on Primary Health Care (PHC).
“The South Africa National Health Insurance turned out to improve accessibility, affordability and availability of drugs and health services to all South African citizens.
“In Nigeria, the inculcation of community pharmacists into COVID-19 vaccination remains a critical defining moment bound to improve access to vaccines given the proven accessibility of community pharmacists. Vaccine coverage through the strong over 6,000 community pharmacy value chain will ultimately promote UHC and strengthen our waning health system which is on the verge of total collapse.”
They lamented the serial violation of existing pharmacy laws which encourages unauthorised personnel to dabble into drug dispensing over the years, counseling the ACPN, Edo State, and the national body 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.