PPMVs - What do you think?

Truly, the proliferation and even the very presence of PPMVs (Proprietary Patent Medicine Vendors) is an indication of what some would refer to as "a tendency for double-speak in the practice of pharmacy in Nigeria".

The noble ideas behind the PPMVs ought to be commended. What, with the then scarcity of qualified pharmacists and pharmacies across this vast land, the difficulties in sourcing funds to start a standard pharmacy and the increasing awareness to ensure coverage in the underserved, often, far-flung regions of the country needed to be dealt with. Yes, PPMVs worked then.

However, I argue, they have become a stop-gap that has overstayed its welcome. Yes, there are people and businesses involved, however, discarding PPMV healthcare model does not mean there will be no substitute channels for these affected lives and businesses to find expression in. Why must we hinge a detrimental model’s perpetuation on “sentiments”?

The business world is made up of dynamic models. Dynamic, meaning they are changing and being "amended" to suit the reality to which these models are being applied.

Today, young pharmacists are all over the country, many under-paid and under-employed and doing jobs that can be easily carried out by non-pharmacists (they are given lofty names and titles like Medical Reps when in reality they are glorified (if lucky) sales representatives)! Or, serving within small corners in hospitals that gag them and hardly recognize the need for their input in ensuring true clinical practice in patient care and health prevention/management. Or running pharmacies in a lackluster manner that neither encouragesd them nor the investor who is looking for good returns. It’s quite drab, but many say that’s just a tip of the iceberg.

Sometimes, they even venture out to the communities where their expertise is highly valued, and they become blind-sided by the day to day operations of running a small business...soon, the essence of being a professional with the right knowledge - who ought to pay attention to the latest updates in healthcare as relates to medicines and operate with the right amount of innovation required to direct the attention of the populace from readily available alternatives that might not serve them well in the mid- to long term; that very essence that drives entrepreneurship IS SACRIFICED.

No rational person sets out to establish a business and render sub-standard service. However, it happens...but, I digress...what do I think about PPMVs and the practice of pharmacy in Nigeria?

Community pharmacy is inconveniently struggling to establish good practice in the midst of several challenges.

Some of these can be managed, some are common to all other Small and Medium Scales enterprises (SMEs) while some, these ones trouble my heart everyday, are self-inflicted and make one wonder "WHY DONT WE DO SOMETHING ABOUT IT??"

That is where my discussion today dwells.

The presence, licensing, proliferation and oversight of PPMVs need to be examined thoroughly. Why? It poses a real irony that we want to be taken seriously within the healthcare as professionals' whose contribution is valuable and vital to the total delivery of quality services, yet, we support (often) uneducated men and women to practice our profession and see nothing wrong with it.

Some will say, "Oh, it’s not causing any harm to our profession, they are only allowed to deal with the simple medicines" and I wonder who is kidding who?

What is simple about Acetaminophen (Paracetamol) and its overuse resulting in liver failure...what is simple about Ascorbic Acid ad other Anti-oxidants present in "simple" multivitamins and their interaction with components of ACTs which leads to malaria treatment failure and all the attendant reverse pharmaco-economics! Or what is simple about "Tetracycline" and its use in children or even Aspirin and this same vulnerable group in our society?

Who is informing the citizens that these so-called simple drugs, some permitted and some not permitted in PPMVs, come with special instructions that if neglected, may result in severe side-effects that may be detected or undetected?

Who can justify that the PPMVs are filled with many "un-simple" medicines, bought everyday over the counter with or without prescriptions to unsuspecting public, yet we go about seemingly unconcerned. We turn the blind eye, because, “to do something about it will disrupt the status quo”.

Why don’t we explore alternatives? Why do we resist change and risk the possibility of become dinosaurs in a profession that is metamorphosising in so many many ways?

Why don’t we try to tweak our "rules" in order to address the matters affecting us, but this time, casting our minds into four, six, or ten decades from now; anticipate if these solutions will stand the test of times to come before institutionalizing them or not? Why not open ourselves up to practical expertise found in those who have views beyond what we have; views into other sectors and how they have dealt with some of the issues we are facing, without reinventing the wheel?

Let's explore the "one pharmacist, one pharmacy" rule and see if its about time it is revised especially in a manner that supports establishment of well managed and well financed chains of pharmacies that will ensure standards and quality are established across their outlets and that will attract the attention of strong partners locally and internationally…

... let's find another way to support drug distribution across the six geopolitical zones so as to ease the pressure on manufacturers (I am yet to hear of a manufacturer without debtors owing 7 or 8 figures) as well as ease the burden of sourcing genuine medicines which our pharmacies face daily...

…why don’t we have a concerted effort in addressing business financing and back-end management as other sectors have and continue to address...

…why don’t we encourage the older pharmacists to continue to contribute to the profession even when they have "retired", build work systems that still allow them flexible work hours and knowledge sharing pools that tap into their expertise and wisdom without being hectic...

…why don’t we engage pharmacists who have retired as inspectors, equip them with up-to-date know how in monitoring and evaluation and ensure they remain unbiased and uncompromised using simple tools and methods...

…why don’t we explore use of technology in a manner that simplifies procurement and other aspects of supply chain management, but ensuring that individual businesses do not bear huge overheads to set up infrastructure and operations...

So many thoughts... but then, when these are in place begin a phased extinction of PPMVs so that medicines can only be obtained under the right conditions and we stop short-changing the citizens we promised to serve. This should be done in a phased manner, and not in haste, as you need sustainable alternatives to be inplace before you jettison an existing solution, no matter how bad, otherwise, you risk collapse and pre-mature abortion of the “good” idea.

Let's not allow sentiments sway us, the times past when we thought we were weak and could not achieve much are just that - PAST! Now, its as much as we can imagine that we can achieve. This profession is real and too many have encroached into it. Let us join hands, as men of honour, to truly get things going!

We will continue this discussion.

Exciting times indeed

I have come across some interesting information in recent times, some good, some not-so-good and some, downright discouraging. However, I hope to share only good stuff with you on this blog.

Why? We all need encouragement! And I have come to understand that good examples are able to lift one up and give you hope to take a positive step in your own personal circumstances.

Advantage Health (www.advantage-ng.com) has started. This idea/project/platform has been coming slowly but surely over the past three years! We conducted surveys, discussed with colleagues, tried to implement in a "big way" ... and finally, we have started.

No good in boring you with what has delayed the commencement, you can visit the site and register if you have a community pharmacy practice, or you have a primary healthcare clinic/centre which is a provider to one or more HMOs. Even HMOs can register and we will contact you soon.

What really are we about? A collaborative platform? A much needed business club? A group of enthusiatic, naive, idealistic profefssionals? A team of hands-on supply chain experts? Expert back-end services provider? Group Discount purchase team? Healthcare support providers? YES YES YES!!! These and more.

You will learn more about who we are in the coming days, months and years. We plan to be here for a long time (at least 10 years) to improve the standard of living of the majority of Nigerians. HOW?

Be on the look out for postings on how, what, who, where, when and much more on Advantage Health!

Get the advantage...feel the advantage...be the Advantage!