Pharmacists to Nigerian Doctors: Your Position on Consultancy is a Manifestation of Crass Ignorance, Wickedness


Posted on: Thu 24-12-2020

Our attention has been drawn to an unfortunate petition, containing deliberately distorted information put together by the leadership of the Nigerian Medical Association (NMA). In the petition, NMA called for the withdrawal of the circular on Consultant Pharmacist cadre released by the Head of Civil Service of the Federation. It has become necessary to put up this rejoinder for the purposes of correcting the distortions as contained in the petition by NMA. 

  1. The release of the circular on consultant pharmacist cadre followed due process and fulfilled all the requirements as stipulated by the National Council on Establishment (NCE). Sir, it is appropriate to inform you that the NCE had in August 2011 given approval for the creation of the Pharmacist Consultant Cadre (See Annexure 1). This approval followed the receipt and adoption of the recommendations contained in a report of its technical committee on the review of the Scheme of Service and Creation of Consultant Pharmacists Cadre in the Public Service. However, owing to reasons beyond our comprehension, the follow-up circular was not released.  In 2015, in an apparent attempt at releasing the circular, the Office of Head of Civil Service of the Federation (OHCSF)  dispatched a letter  dated 28 July  2015 (reference no: HCSF/EPO/EIR/NCE/100/S.6/T/56) to the Permanent Secretary, Federal Ministry of Health (FMoH) requesting for his views/comments and inputs before the release of the circular as approved by the NCE in 2011. (See Annexure 2). The FMoH responded via a letter dated 5th October 2015 (reference no: C4007/T4/315) in which the ministry reaffirmed its full support for the creation of the Consultant Cadre for Pharmacists.
  2. One of the paragraphs in their response stated as follows “I, therefore, wish to assure you that the Federal Ministry of Health is in full support of the creation of the Consultant Cadre and look forward to the release of its Scheme of Service.” (See Annexure 3). Again, the release of the circular was stalled for reasons we are yet to understand. In furtherance of its support for the Fellowship training program, the FMoH on 15th September 2015 sent out a circular (Ref no FDS/231/04/II/68) where it conveyed the approval of the ministry for the “use of facilities/departments under the Federal Ministry of Health as training sites for the residency program of students of West African Postgraduate College of Pharmacists.” (See annexure 4)
  3. Finally in 2019 the matter of Consultant Pharmacist cadre was presented to the NCE for a second time for its consideration during her 41st meeting held in Asaba, Delta State from 4th- 8th November 2019. The NCE, in its wisdom, ratified its earlier approval (made in 2011) for the creation of the Consultant Pharmacist Cadre structured from SGL. 15 – SGL.17 in the Schemes of Service for use in the Public Service of Nigeria. After this second approval, another letter dated 6th March 2020 was sent from OHSCF to FMoH (ref no: HCSF/SPSO/ODD/NCE/CND.100/S.8/39) (See Annexure 5) to FMoH informing the ministry about the ratification of its earlier approval for pharmacists consultant cadre and requested that the FMoH should liaise with the National Salaries, Income and Wages Commission to develop the appropriate salary structure for the new cadre to enable the OHCSF issue the appropriate circular for the implementation of the Council’s approval. The FMoH referred the request from the OHSCF to National Salaries, Income and Wages Commission via a letter dated 13th May 2020 (ref no: C.4007/II/217/T/21) (see annexure 6) to develop the appropriate salary structure. The National Salaries, Income and Wages Commission responded to the request from FMoH via a letter dated 17th June 2020 (reference no: SWC/S/04/S.218/T1/97) (see annexure 7). In the letter, the Salaries and Wages Commission stated that “the salary structure of medical professionals including consultant pharmacists have since been developed.” It went further to add that the salary structure for pharmacists is the Consolidated Health Salary Structure (CONHESS). Accordingly, Consultant Pharmacists should be placed on CONHESS 13 – 15 which is equivalent to SGL 15 – 17 as shown in the consultant pharmacists’ cadre.” It concluded its submission by stating that “the consultant pharmacists are entitled to be paid relevant allowances including specialist allowance as contained in circular No. SWC/S/04/S,410/Vol. II/349 dated 8th December 2009” a copy of which it attached to their response. Upon receipt of this letter from National Salaries, Income and Wages Commission, the FMoH sent a reply to OHCSF via a letter dated 28th July 2020 (reference no: C.4007/II/217/T) (see annexure 8).
  4. Based on these clarifications and having met all the statutory requirements, the OHCSF on 13th of September 2020, finally released the circular (reference no: HCSF/CSO/HRM/1274/T3) for the Cadre. The circular was signed by the Head of Civil Service of the Federation, Dr Folasade Yemi-Esan, who is a dental surgeon by Profession. (See Annexure 9). To the best of our knowledge, this process and procedure for the approval and release of the circular for the Consultant Pharmacist Cadre is perhaps the most thorough in recent history.
  5. NMA's petition has brought to the fore its predilection to unnecessary bellicosity in the Nigerian healthcare space and a manifestation of crass ignorance by the NMA's leadership on contemporary trends in the practice of healthcare across the globe. It is a well-known fact that the provision of healthcare in the modern era is built around teamwork of all healthcare professionals with the patient at the centre of all care endeavours. The delivery of healthcare is evolving on daily basis with new emerging diseases. Also, management of diseases - which significantly revolve around drugs – is becoming more complicated necessitating the new focus in the area of pharmaceutical care vis-à-vis the identification and resolution of drug therapy problems. In order to optimize therapeutic outcomes in patient care in an ever-changing 21st-century world, a Pharmacist needs the right advanced knowledge to support the expert care of patients both in the hospital and community settings. There is no gainsaying the fact that drugs are the fulcrum around which an effective healthcare delivery revolves. With the advancement in technology, the process of formulation and manufacture of drugs have become complicated and as such require specialized knowledge and skills. Also, in the area of public health, drugs have a critical role to play. For instance, drugs (vaccines) are the hinges around which immunization (a major public health activity) revolves. The process of handling and logistics associated with drugs in public health is complicated. It requires advanced/expert knowledge in the area of logistics and supply chain management. The above specialised skills and knowledge are what a Fellowship of the West African Postgraduate College of Pharmacists confers on Pharmacists in the West African sub-region who pass through College.
  6. Furthermore, sir, we wish to state that there is no ambiguity in the provisions of the circular which clearly states that the cadre is for Pharmacist Consultants. We are therefore at a loss how a cadre for Pharmacy Practice will conflict with a cadre in medicine. The leadership of NMA needs to appreciate the fact that modern healthcare delivery is not indigenous to Nigeria but was imported from the developed world where the roles and responsibilities of each healthcare professional are well defined within the framework of its acquired competencies. IT IS PERTINENT TO STATE THAT THE PHARMACIST CONSULTANTS CADRE IN NIGERIA IS IN TANDEM WITH INTERNATIONAL BEST PRACTICES FROM UNITED KINGDOM, UNITED STATES OF AMERICA, FRANCE AND AUSTRALIA TO SOME AFRICAN COUNTRIES LIKE GHANA AND SIERRA LEONE. In all these aforementioned countries, Consultant Pharmacists practice peacefully, harmoniously and side-by-side with Physicians in the hospitals for the ultimate benefit of patients. Perhaps, it is relevant to refer the leadership of NMA to undertake a tour of these countries to understudy how Consultant Physicians and Consultant Pharmacists conduct their practices in an atmosphere of harmony along with Consultant Nurses, Dieticians etc. to the benefit of the patient. It is important, sir, to posit here that the healthcare delivery in Nigeria should not continue to be driven by the myopic perspective of the NMA leadership who only seek to enthrone a skewed model of practice, where the medical doctors maintain an unwholesome dominion over the health sector, unique to only Nigeria and unknown to any other clime around the globe. It is ironic that NMA leadership is usually quick to proclaim global best practices selectively where it suits and serves their interests but foot- drag in embracing the culture in totality where it provides for an improvement in the practice of other players in the healthcare team. It is clear that this rather repressive disposition of the NMA is not peculiar to Pharmacists as NMA has repeatedly shown its desire to keep all other healthcare professionals in subjugation. To illustrate this, sir, kindly refer to the case of Enugu State University Teaching Hospital (ESUTH) vs Association of Medical Laboratory Science of Nigeria (AMLSN) (2020) where the learned judge in an obvious attempt to free the Medical Laboratory Scientists from the shackles of bondage by Medical doctors stated that ‘it is clear that the Medical Laboratory Scientists are professionals in their own right in the societies (USA and UK) from which Nigeria borrowed the tradition of the practice of modern medicine’.
  7. The assertion that the release of the circular was hastily done in anticipation that the scheme of service would be produced is a deliberate falsehood designed to hoodwink the uninformed, which only exposes the inherent mischief of the NMA leadership. How on earth can a process of review of the scheme of service which started with the submission of a memorandum to NCE in 2007 culminating in the release of the circular in 2020, thirteen (13) years down the line be said to be hastily done. It gives away the bad faith of the NMA and the infantile disposition of her leadership to serious issues of state bureaucracy that is at stake in this instance. Perhaps, by the above assertion, NMA insinuates that the Office of the Head of Civil Service of the Federation – which is headed by one of their illustrious colleagues - is bereft of the services of quality bureaucrats or that the bureaucrats in the office lack the competence for their job. For the umpteenth time, NMA has taken its know-it-all attitude to a ridiculous dimension.

Sir, from the detailed explanation above, in which we highlighted the tortuous journey that led to the release of the circular, you can clearly now appreciate the fact that this petition from NMA is fraught with falsehood and deception.   

  1. At this juncture, sir, it is pertinent to give you some background about West African Postgraduate College of Pharmacists (WAPCP). WAPCP is one of the four constituent colleges of the West African Health Organization (WAHO). Other constituent Health Colleges are the West African College of Surgeons, West African College of Physicians and West African College of Nurses. These four Colleges share the Secretariat provided by the Nigerian Government at No. 6 Taylor Drive, Medical Compound, Yaba, Lagos. WAPCP has been responsible for postgraduate training of pharmacists in the ECOWAS sub-region since 1991. The first batch of Fellows by examination graduated in 1997.  To qualify as a Fellow of the College, a pharmacist requires a minimum of 8 years spent as follows: three years post-graduation work experience, one year in Primary (didactic learning); two years in Part One (also didactic learning); two years in Part Two (didactic learning plus residency and successful defense of dissertation). There are five Faculties with areas of sub-specialisation in the College namely: Faculty of Clinical Pharmacy, Faculty of Community Pharmacy, Faculty of Drug Production & Quality Assurance, Faculty of Public Health Pharmacy and Faculty of Social & Administrative Pharmacy. Sir, you may be shocked to know that the medical doctors who graduate from the other sister Colleges (in the same West African Health Community with West African Postgraduate College of Pharmacists) are qualified to be appointed as consultants upon graduation. Meanwhile, the same medical doctors (represented by NMA) are not happy that pharmacists who have also gone through similar specialised postgraduate training like themselves should be appointed as consultants in their specialty areas. If this disposition does not pass for wickedness, we wonder what else will.
  2. It is indeed regrettable that government at different levels continue to pander to the dictates, wishes and fancies of Nigerian doctors under the auspices of NMA. NMA has continued to carry on in Nigeria as though it were an employer of labour that should prescribe the conditions of service for its employees, whereas it is just a group of employees. We are therefore compelled to put forward this poser: in which part of the world does a group of employees dictate its terms of employment and also dictate the conditions of service of another group of professionals to its employer? The locus classicus of Suit No NICN/EN/53/2017, where His Lordship, Hon Justice O.O. Arowosegbe said ‘I venture to say that, totally subjecting members of a different profession to the whims and caprices of another, is a classical form of unfair labour practice and modern slavery, which cannot produce industrial harmony in any place of work in this modern time’  It has become germane to inform Your Excellency that the government of Niger state has been implementing the Consultant Pharmacist cadre for Pharmacists in their public service since its approval in 2011; ditto for the Edo State Government which approved its implementation in 2019. (See annexure 10)
  3. It is important to further posit that the implementation of Pharmacist Consultant cadre in public service in other countries has continued to create added value to the healthcare system for the benefit of the patients and other healthcare professionals. This was affirmed by a publication titled “Nigerian Medical Doctor in Diaspora Says NMA’s Letter against Consultant Pharmacist Cadre is Shameful.” (See annexure 11) We want to clearly state that there is no chaos or confusion as posited by NMA. To buttress this position, in Niger State and Edo State where Fellows in the state employment are working as Consultant Pharmacists, there is no report of chaos or confusion between them and their medical doctor colleagues. If they have worked harmoniously over the years why does NMA want to hoodwink the public into believing that if the pharmacist's consultant cadre is implemented across the country, it will lead to chaos and confusion in our healthcare system? Same harmony and mutual respect exist in other countries where pharmacists are appointed as consultants.
  4. It is curious that NMA arrogates to itself the sole responsibility of protecting the health of citizens. All over the world, the provision of healthcare requires teamwork with each professional playing his/her part and handing over the baton to the next professional. It remains a collective responsibility. We find it difficult to comprehend how the implementation of Consultant Pharmacist cadre in Nigeria poses a danger to the health system and has damaging effects on the patients. The fragility of the Nigerian health system is a manifestation of the failure of leadership of the health sector which has remained in the hands of medical doctors. The Pharmacist Consultant cadre will clearly add value and strengthen healthcare delivery for the benefits of other caregivers and patients. The NMA should show Nigerians the damaging effects the implementation of this cadre have done to patients in Niger and the Edo States and other countries like Ghana and Sierra Leone, ditto for the United Kingdom, USA and other countries where this cadre and model of practice have been firmly entrenched.
  5. NMA's offer of unsolicited advice to Government to build public Pharmaceutical companies, where Pharmacists could apply their skills and potentials because drug production and formulation constitute the primary competence of the Pharmacist only exposes their ignorance and lack of understanding of the various areas of practice of Pharmacy.

NMA deserves to be educated that Professions exist to save and serve humanity. As such, all Professions, Medicine and Pharmacy inclusive, are continuously evolving in response to the changing realities and activities of human existence. Pharmacy practice has thus, evolved over the years from the apothecary model through to the formulation and production era and now to a more patient-centred practice wherein the Pharmacist plays a vital role in patient care in a collaborative manner with Physicians and other caregivers. This practice model remains a minimum condition of practice in many countries. In the UK and some other countries, some category of Pharmacists with expert skills are even being designated beyond Consultants to Pharmacist Independent Prescribers. 

In conclusion, sir, the changing role of the Pharmacist in the hospitals from traditional compounding and dispensing have evolved to offer a more comprehensive Pharmaceutical Care consisting of Rational Drug Use, Therapeutic Drug Monitoring, Drug Information Services, Pharmacovigilance etc. Furthermore, Pharmacy practice has also evolved into advanced specialist areas of practice in other segments of pharmacy practice viz: drug production and quality assurance, public health pharmacy, Community Pharmacy and Social and Administrative Pharmacy. Nigeria Pharmaceutical needs today are significantly in the hands of foreign countries partly because of the paucity of specialised skill, a yawning gap that West African Postgraduate College of Pharmacists is trying to bridge. 

In the light of the foregoing, in line with global best practices and given the immense benefits of the Consultant Pharmacist cadre to the healthcare system of our dear country we urge Your Excellency, to ignore the petition of the leadership of NMA and appropriately disregard their call for the withdrawal of the circular of the Consultant Pharmacist cadre in Nigeria. Nigeria's health system shall be better off with this cadre. NMA's position is purely egoistic rather than altruistic. Permit us also to add that this growing penchant of the NMA to often challenge decisions of government and impose its self-centered wishes through blackmail (strike action) must be strongly reprimanded. Otherwise, it might create so much dissonance and entropy where every other professional group would dictate to government not only what it wants but also what it approves for other professional groups.   

Yours faithfully,   

Pharm. (Mazi) Sam Ohuabunwa FPSN PSN President

Pharm. Gbenga Falabi FPSN PSN National Secretary