Prince Julius Adelusi-Adeluyi, a former Minister of Health, is currently the President of the Nigeria Academy of Pharmacy, which is at the centre of efforts to mobilise healthcare professionals towards a new culture of mutual respect and collaboration. He spoke to Nosa Alekhuogie on the state of healthcare in Nigeria and the teamwork-building efforts. Excerpts:
Looking at the state of the healthcare industry in Nigeria today, what would be your assessment? Would you say we are making progress or we are retrogressing?
When you examine the human development indices in recent time, for instance life expectancy has risen in Nigeria from about 44 years about three and half decades ago to a little over 54 years today; when you look at our approach to the control of the HIV/AIDS pandemic and the fact that the disease is no longer spreading as fast as it used to; when you look at the concerted effort that was made to rid our country of the Ebola disease a few years ago; when you look at a lot of these things, yes indeed, it would be appropriate to say that Nigeria has made progress over the years in the area of healthcare.
But we could also look at the opposite side. We could look at the issue of infant mortality for instance and discover that there is a lot to be done in that area. How much research is currently ongoing in our universities and research institutes to find solutions to the diseases that afflict us? How supportive have we, as a country, been of research into new drugs and other solutions to these problems? Why is it that sixty one years after the discovery of oil in Nigeria we still do not have a functional petrochemical industry, which could have provided core components for local drug manufacturing and in turn, helped to make medicines more readily affordable by the common man? So you find that currently, because majority of medicines consumed locally are imported, the cost of medicines soars whenever there are shocks in the forex regime. But this needn’t have been so if majority of the drug components were produced locally. Many years after NIPRISAN, a drug for control of sickle cell anaemia was discovered by the NIPRD, why for instance is not being mass-produced in order to make it more widely accessible to people who suffer sickle cell disease?
So there are lots of questions that point to the fact that a lot more still needs to be done, especially in the areas of research and boosting the capacity of the local drug manufacturing companies and healthcare institutions to care for Nigerians. There is a lot that needs to be done as well in the area of fostering preventive healthcare – getting Nigerians to inculcate the habit of regular hand-washing for instance, of keeping their environments clean and devoid of stagnant water for instance. Imbibing good hygiene habits can dramatically minimize many health issues.
And then very importantly, there is the issue of inter-professional rivalry in the sector, which has become so divisive and unhealthy, that it is a huge burden on the entire health sector.
On this issue of rivalry among the professions, is this really a problem? After all, even siblings can be in competition with each other and become rivals, but this does not necessarily mean that they hate or despise each other.
Yes, siblings can be in healthy competition. The important adjective in this instance, is “healthy.” If what was going on in the health sector was healthy competition, nobody would complain. The truth is that there is currently so much divisiveness in the sector, so much mutual distrust and animosity among the various health professionals that it is clear to see that this unfortunate state of affairs can weigh down the entire sector and make it impossible for it to deliver excellent value to Nigerians in need of healthcare.
What, in your view, is responsible for this unhealthy rivalry?
There clearly have been a few developments over the years that have tended to pitch the different professional groups against each other. But the professionals themselves have not managed whatever differences they have, as well as they ought to. So over the years, perceptions of one another by the various professionals appear to have taken a nosedive. Sometimes, you read statements and commentaries by healthcare practitioners and you are shocked beyond belief and alarmed that these professionals are referring to fellow professionals in such unprofessional terms. The negative perceptions have been impacted by all of the anger and divisive statements.
But these are professions – I mean the healthcare professions – which exist solely to give succour to people in society by helping us to overcome pain and disease. As I said earlier, it is not possible that our doctors, pharmacists, nurses, medical laboratory scientists, physiotherapists can do this to the best of their abilities if they all continue to provide service in an environment of rancour and mutual distrust. And this is especially true when you realise that the practise of healthcare is increasingly collaborative and multidisciplinary. In the twenty first century, no one professional can do it all alone. All of the knowledge and expertise that resides in the various scientific disciplines, maybe even non-scientific disciplines as well, must come to play. Collaboration is the key. Team work is vital. Healthcare practitioners must come together and work as a team to provide succour to Nigerians in need.
You mentioned “developments over the years” as being responsible for the rancour in the sector. What are these developments?
There have been many developments locally over the years and it may be impossible to pinpoint any singular development as being responsible for the total near-total breakdown of what ought to be camaraderie among the sundry health disciplines.
Having been involved in quite a few efforts spearheaded by the government to broker peace and harmony in the sector over the years, my understanding is that such issues as remuneration, perquisites and working conditions are some of the problem areas. Then of recent there have been issues of regulatory clarity and regulatory overlap.
Having sat in panels and listened to submissions by medical laboratory scientists, pharmacists, doctors and other professionals, you realise that these are not issues that are insurmountable. Yes, they are problem areas that need to be tackled in such a manner that is transparent and mutually acceptable to all concerned, but there is no way this can happen in the current context of infighting and name-calling. That’s why we emphasise that the first step is to sit together, understand ourselves better and commit to working more collaboratively.
You’ve detailed quite a few problems. What are the solutions? What in your view, needs to be done to bring peace and tranquillity back to the healthcare sector?
There is an ongoing initiative which is being spearheaded by healthcare practitioners themselves, with the objective of gradually breaking down the walls of discord and empowering health practitioners – doctors, pharmacists, nurses and all – to adopt a more collaborative mindset in seeking solutions to health problems of the people.
For instance in May, the Nigeria Academy of Pharmacy will in partnership with the Pharmaceutical Society of Nigeria, organise a symposium that will examine the imperative of collaboration among the healthcare professionals. It is going to be a cross-disciplinary affair and medical doctors, pharmacists, medical laboratory scientists, nurses and midwives, physiotherapists, dieticians and even students of these and other professions will participate. Former minister of Health, Professor Eyitayo Lambo will be delivering the keynote at this symposium at which several other speakers drawn from each of the professions will be participating.
Because it is an initiative of healthcare practitioners on our own volition, we believe that it will be more productive than similar initiatives that have been instituted by government in the past. We expect that professionals will be more open with each other and less combative and that this initiative will kick-start a major shift in mindset among professionals in the sector towards working together rather than practically fighting one another. If the mindset is inclined towards cooperation and teamwork, once team members in the health sector commit to partnering each other in the Herculean task of relieving Nigerians of the burden of ill health and disease, it will be a huge boost for the healthcare industry.
But healthcare practitioners have lamented about inadequate budgetary provision to the health sector, inadequate health facilities, brain drain leading to medical tourism by Nigerians who can afford it, among other problems. How does collaboration affect all of these issues?
I recall my experience in my days as minister. Indeed, one of the first things I did was assemble all staff of the Ministry of Health for a team-building session at Whispering Palm Resort in Badagry. It was a very useful bonding session, but was also very insightful in demonstrating that there is so much that can be achieved by bringing people together, by team work. Indeed a new phrase soon emerged in the ministry: “In the spirit of Whispering Palms.” This was how people now referred to the new general disposition towards teamwork and inclusiveness.
Many of the issues you have listed are best addressed by healthcare operatives agitating in unity. The doctor who is seeking equipment to do his work is not doing so for his own sake. His work is about the patient and making life better for his patient. The pharmacist who is seeking reduced duty on pharmaceutical raw materials or asking for a dedicated forex window for drugs and medical equipment is only doing so in order to make medicines more affordable for Nigerians. Healthcare professionals can get better results from these advocacy efforts if they would, in unison, lend their voices to these issues rather than operate in silos. This is one of the issues that collaboration helps to showcase. If collaboration among health professionals can help enhance budgetary allocation to this critical health sector, enhance the state of facilities in health institutions and enable the different professionals ply their trade in fulfilment locally rather than take their skills and expertise abroad, then it would have been worth the effort. Having more trained professionals working in fulfilment in Nigeria and attending to the needs of Nigerians is preferable to having them provide the same services in the Diaspora.
So collective advocacy for the health sector is one benefit that collaboration can help bring forth and Nigeria’s healthcare will be the beneficiary ultimately.
Given the deep-seated lack of trust and infighting among professionals that has raged for decades in the healthcare sector are you not being overly optimistic about this new campaign for collaboration? Afterall, none of the government interventions seeking harmony in this area seems to have been successful.
As I mentioned earlier, what is unique about this new intervention that is being spearheaded jointly by the Nigeria Academy of Pharmacy and the Pharmaceutical Society of Nigeria is that this time, it is us healthcare practitioners who are on our own volition taking the initiative. And we trust that this aspect of free-will may actually make the difference. It’s like a scenario where you live in a neighbourhood in which you share the same existential problems – electricity, water, security – but instead of forging a united front to tackle these issues, each household keeps to itself or worse still fights the neighbouring household instead. In such a scenario, the problems of that neighbourhood will persist. You will find that the different households in the neighbourhood are likely to come together in unity more effectively, if the effort is originated from within than if the effort were instigated by an external party. The state of the healthcare sector is so similar. Here is a sector that is buffeted right, left and centre by different problems which are best solved by a united front of all the healthcare practitioners acting in concert with each other, for the ultimate benefit of providing better healthcare to the people of Nigeria.
So we are very positive that this initiative will mark a turning point in inter-professional relations in the healthcare industry.
You said that this is an initiative of the Nigeria Academy of Pharmacy. Is this your primary purpose as an academy? What else do you do?
Our primary purpose as a scientific academy is to contribute to raising awareness on the essence of meaningful pharmaceutical research as well as encouraging the prosecution of research that addresses relevant health problems. Of course, “meaningful” in this context implies that such research should be cognizant of the peculiar needs and aspirations of the immediate environment even while it seeks to solve the problems that afflict mankind in general.
Living up to this primary mission means that our approach must be multi-faceted. You will find, for instance, that unless the professional practice is in such a situation in which professionals can fully express themselves intellectually, they cannot get the best results. Whether you are a pharmacist or doctor or medical scientist, the conditions under which you operate must be such as inspire you to excel. An environment of rancour does not do that, which takes us back to one of the reasons why we are driving collaboration amongst health care professionals.
Of course, we are also very concerned about the quality of training which pharmacists receive year-on-year. As an academy we have been involved in curriculum reviews working with the universities on one hand and the Nigerian Universities Commission on the other. The whole idea is to ensure that our universities continue to produce pharmacists whose training is relevant to the rapidly evolving needs and aspirations of people here and elsewhere. Many years ago, this training was primarily drug focussed but over the years, there has been a shift in focus. The patient is now the focus of all training, and that has become reflected in the new pharmacy curriculum. So the focus is now far more clinically-oriented than it used to be and this is in keeping with developments across the world, where all the professions in the healthcare sector are placing the patient at the centre of their universe.
So healthcare advocacy, whether by pharmacists or doctors is ultimately about the patient, about providing better and more affordable healthcare to the people.
You’ve talked quite a bit about research. Can you tell us about any research which any member of your academy is working on currently? Can Nigeria be looking forward to a breakthrough in one of these disease areas like malaria or cancer in the future?
What I can tell you is that even though the circumstances are extremely tough, a number of our colleagues still manage to carry out research especially in the universities and research institutes. Of course, research, as you know is a cost-intensive venture which implies that in the face of economic difficulties, it becomes very difficult to carry out research to a meaningful degree. And this explains why it is important that there is a structured platform for advocacy in this regard, which is also one of the things we do at the Nigeria Academy of Pharmacy. In the face of so many different competing needs, it can actually be difficult for government to find justification for funding research. Academies and research-inclined professional institutes can help to provide this justification to government.
And the truth is that research is the future. It is the one avenue by which we make true progress. If it weren’t for research, mankind would still be a hostage to hundreds of diseases and afflictions.
I was reading a new report by the WHO on neglected tropical diseases, NTDs, a few days ago. These are diseases like guinea worm, African sleeping sickness and many others that either do not exist or have been long wiped out in other parts of the world. Now, even though the world has made some progress in continuing to focus attention on them and the progress made with eliminating them, as scientists, we owe our people a duty not to neglect these conditions, even if the rest of the world tends to have neglected them. We owe the continent a duty to continue to trudge on in our laboratories and seek solutions to these ailments.
The Nigerian Institute for Pharmaceutical Research and Development, NIPRD, made a breakthrough a few years ago in coming up with a drug named NIPRISAN which is very effective at controlling both the outbreaks and severity of crises in sickle cell disease. NIPRISAN is a product of local research and sickle cell disease is a blackman’s disease. So the drug is a reflection of the local relevance in research, that I alluded to earlier. NIPRISAN is at the moment being produced in very small quantities. But if it is to become widely accessible, then it ought to be produced in larger quantities and there’s no better way to do this than for production to be expanded. That is the stage that NIPRD is and we are hoping that relevant organs of government will help to make this happen soon, and in so doing provide succour not only to the hundreds of thousands of people who suffer from sickle cell disease but also their families and loved ones who can only look on while their loved ones suffer excruciating pain during crisis.