Why progress in healthcare will be difficult without clinical pharmacists, by Ikeme

Anthony Ikeme, CEO, Clintriad and erstwhile president of the Nigerian Association of Pharmacists and Pharmaceutical Scientists in the Americas (NAPPSA), the foremost Nigerian pharmaceutical organisation in diaspora, in a keynote address at the 2023 Scientific Conference of the Clinical Pharmacists Association of Nigeria (CPAN), held in Uyo, Akwa Ibom State, recently. In this interview with journalists after the event, he spoke extensively on his key points, the ingredients needed to transform Nigeria’s healthcare and the key interventions and contributions of diasporan healthcare professionals in the homeland. Aniefiok Udonquack brings the excerpts:

You were the keynote speaker at the recently concluded conference of CPAN. You have become a regular feature in the Nigerian pharmaceutical scene. What is your motivation for the Nigerian pharmaceutical activities you are involved in and driving?

I am driven by the need to contribute to the transformation of Nigeria and Africa. I am a proud black man, Nigerian and African and I feel that our seeming powerlessness in global affairs is unacceptable. As a nation and as a continent, we seem to be pawns in the hands of other nations who appear to control the world economically, technologically, and politically. Living in the diaspora makes you more conscious that every index of development from Africa seems to be about a marginalised and inconsequential people, who matter little in world affairs. I reject that imagery of Africa.

I refuse to believe that we lack the capacity to be excellent, to be at the forefront, the cutting edge of global development. I believe we just need visionary leaders who are confident and are not afraid to chart a new course for Nigeria and Africa. It is this belief that drives me to do my part. It is always my goal to offer alternative paths and ways of thinking that can lift us and move us away from dependence to self-sufficiency. I am inspired by the examples of countries like Malaysia, India, China, and Israel whose transformation from marginal economies to global biotech powerhouses provide a model for Nigeria and any African country that want to move up the ladder in the global value chain.

The theme of the CPAN conference is ‘Healthcare in the 21st Centiury: Prospects of Clinical Pharmacy Practice in Nigeria.’ What will you say, in your opinion, was the rationale for the theme and its relevance in the current Nigerian society?

While I am neither part of the leadership of CPAN nor a member of the conference’s organizing committee, it is not hard to see why they will seek to discuss the prospects for the Clinical Pharmacists and Clinical Pharmacy profession in the context of the evolution of the global healthcare system and healthcare provision. In the first place, any discussion of how to improve the Nigerian healthcare system should be welcome because healthcare is essential to national development. It is an established fact that good healthcare is essential to the reduction of poverty, meeting the United Nations Sustainable Development Goals, and helping communities prosper.

Particularly for Nigeria, our healthcare system is in shambles and in need of rescue. Available healthcare indices suggest that the Nigerian healthcare system is bedeviled with poor leadership and management, lack of coherence and strategy in healthcare policy, inadequate human resources, inadequate budgetary allocation, low accessibility to health services, and uninformed patients. Secondly, it is important to continually re-examine the contributions of the various healthcare team players: physicians, pharmacists, nurses, etc and ensure that the system is designed in a manner to derive maximum benefits from the disparate skill sets of each healthcare team member, in order to maximise outcomes and benefits to the patients.

The CPAN conference theme suggests a focus on maximising the role of clinical pharmacists. An understanding of these two points alone should make everyone excited about their choice of theme and we look forward to the implementation and infusion of the learnings from the conference into the clinical pharmacy practice and healthcare team dynamics in Nigeria. Kudos to the Chair of CPAN, Dr Joseph Madu, and the PSN President, Prof. Cyril Usifoh, for putting together such an excellent array of speakers to delve into the issues raised by such an ambitious theme.

Your presentation ‘Advancing Healthcare in the 21st Century: Leadership Imperatives for Clinical Pharmacists’ was well received and widely lauded by attendees. What is the main point you were trying to get across?

My main focus was to point pharmacists, especially clinical pharmacists, to a more enduring path to success in their quest to maximise their potential in the Nigerian healthcare system. Amidst all the fights and jostling amongst the healthcare professionals (especially doctors and pharmacists) for position and power within the healthcare system, I challenged clinical pharmacists to seek leadership in ways that shine the light on their value and indispensability within the healthcare team rather than the amplified focus on positioning. If you want to put it succinctly, my point to pharmacists is that “It is not your hierarchical position that matters; it is your value proposition.”

You said in your presentation, ‘There will be no advancement in healthcare without the leadership of the clinical pharmacists.’ Many may consider that statement controversial. What do you think?

Yes, this might initially sound arrogant, but on further reflection, everyone will agree that no statement is truer. You also have to listen to the whole presentation to get the full context.
First, if therapy is critical to the provision of healthcare and we agree that no other professional is more equipped to have a comprehensive knowledge of the therapeutic use of drugs, then everyone will reach the same conclusion.
Secondly, one would see this as arrogant if they are still stuck in the hierarchical idea of leadership that is focused on position and title. But as I shared earlier, the leadership I am talking about here is value-based, hence the conclusion. Clinical pharmacists can provide leadership in therapeutic knowledge, process improvement, quality and system improvement, and innovation.

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Could you please speak generally on your view about healthcare teams in Nigeria?

The Nigerian healthcare system will benefit immensely from the enthronement of true interprofessional healthcare team culture in the management of patients. My favourite definition of an interprofessional team view is when pharmacists, nurses, physicians, and community health workers learn with, from, and about each other to enable effective collaboration to improve patients’ health outcomes.

You stressed the need for collaboration by CPAN, particularly with diasporan healthcare professional bodies like NAPPSA, which you belong to, and others. Can you speak more on this?

Any national, sectoral, or professional development strategy in Nigeria that does not involve the diaspora is akin to development malpractice. It is like fighting with one hand tied behind the back. It is like willfully shooting oneself in the foot before competing in a track and field event. All great countries that have leapfrogged stages along the development curve did so while harnessing the synergy between citizens in the homeland and their diasporan community. It is thus commendable that CPAN already built strong ties with the US-based Nigerian pharmacist group, NAPPSA.

Leadership is critical for change, as you have stressed. Take us through some of the laudable initiatives by yourself or your organisation, NAPPSA, targeted at the homeland?

That is a loaded question. Indeed, NAPPSA has been very committed to the development of the Nigerian pharmaceutical and healthcare sector, starting from the foundational leadership of Nnodum Iheme, the first President of NAPPSA. In 2011, NAPPSA hosted the first ever multi-sectoral Abuja Healthcare Summit to seek a multi-pronged, multi-sectoral collaboration for the transformation of the Nigerian pharmaceutical and healthcare sectors.

This summit included participants from the Ministries of Education, Health, Science and Technology, as well as NAFDAC, NIPRD, NIMR, PMG-MAN, PSN, NMA, ANPA, etc. In 2013, NAPPSA also hosted a Nigerian Pharmaceutical Sector Investment Forum as part of its 2013 NAPPSA Scientific Conference in Philadelphia.
Over the last decade, NAPPSA has supported pharmacy curriculum development in Nigeria, which played a large role in the creation of the PharmD degree in Nigerian Universities, an effort most passionately championed by the current NAPPSA President Teresa Pounds. In 2019, NAPPSA partnered with ANPA to host one of the largest medical missions in Nigeria. At the peak of the COVID-19 pandemic in 2021, NAPPSA not only provided COVID-19 response guidance and intellectual support to Nigerian healthcare institutions and community but also donated COVID-19 diagnostics and PPE to the National Center for Disease Control (NCDC).

At a personal level, I have been actively engaged with pharmaceutical sector capacity building in Nigeria through the African operations of my company, Clintriad. I have been actively engaged in capacity building for clinical trials and the build-up of a database of investigational sites, investigators, and other resources for clinical research in West Africa. As an international faculty and board member of the Association for Good Clinical Practices in Nigeria (AGCPN), I have served in leadership capacities for various AGCPN transformational initiatives over the years.

My current focus is national development through entrepreneurship. I and other like-minded diasporans are looking at ways to increase the participation of Nigerian entrepreneurs in the global pharmaceutical product supply enterprise. A company I co-founded took the lead in importing the first Nigerian-made medical device to be distributed in the USA in 2021 as a demonstration of what is possible and how we should engage the global economy. We are currently putting together an initiative for orchestrating grassroots pharmaceutical sector entrepreneurship and business incubator in Nigeria.