Patent Medicine Vendors And The Roles Of Pharmacists in Nigeria

They are everywhere, at the street corners, in the markets, etc. Try counting five (5) electric poles in your hood, and I can bet you would find at least one. They are scattered all across. It is business as usual, and many provision stores or better still, daily needs stores would usually at some point, start stacking bottles of paracetamol, tablets of vitamin C, antibiotics (Even though many do not know their uses, and would randomly combine it for those who are fortunate enough to seek for their counsel), cough syrups, etc. It is common to see packs of sugar, bottles of groundnut, with the items earlier mentioned. 

For many, it is just business, nothing special. Here in Nigeria, you can make money from anything; even if they are medications with the ability to alter your mental state. No one cares; if these medications are stacked up, with no care for their shelf life, till the next person comes to buy them. The open drug markets further contribute to this menace. Take a trip to Ibadan, Go to Onitsha, and you would see folks stacking drugs in bundles to be delivered to different parts of the country. How did it get to this? Where are the regulations? Anyone can today, pull some funds together, grease the right palms and start a patent medicine store before next week. It is that easy. 

Growing up, I had no idea how these things worked (I still do not have the idea of how many things worked), But I always thought these folks made medication easily accessible, and I don't have to take a bike to our junction before I could find a pharmacy to get my meds. I always wondered why mum would not stop telling me not to go to any of those surrounding us. She would always harp on this and sometimes shout at me to go to a pharmacy. Telling me not to waste her money. 

Sooner than later, and graduating as a pharmacist, I can understand why she always told us to get our meds in a pharmacy. Now here comes the sad thing, a lot of Nigerians like me back then, are still stuck and believe it is also the same drug isn't it? If I can get it around, why do I have to waste my time? Many still consider patent medicine stores as small-scale pharmacies and this is so wrong.  I have lost count of the number of times, I have overheard my neighbors sending their wards to quickly dash across the street and get them one medicine or the other. "Her drugs are good, don't worry," people say when I scoff at statements like this. 

When it comes to the Nigerian situation, It is like the patent medicine vendors get most of the advantages and none of the drawbacks of the system. Many Nigerians do not even know the difference between a Pharmacy and a patent medicine store. A lot of times, I have had to drum it into the ears of my patients; "Get these meds in a pharmacy" and not a random drug store on the street. A lot of Nigerians abuse this process and come on later to slander pharmacists. Wrong! Pharmacists are professionals, they know all about drug interactions, drug quality, and everything related to rational drug use. 

Pharmacists are solely concerned about your health. They are the custodians of community pharmacies and they are trained as first responders for any community health engagements. Pharmacists are trained to cater to minor ailments, interpret prescriptions, give you the best suggestions concerning the proper use of medications, and follow up appropriately.  They are professionals waiting for you to come around.  Pharmacists have been underutilized within the healthcare space, a sad thing; but without appropriate investments in boosting the capacity of these professionals, Nigerians will keep bearing the brunt. Although, this is a discussion for another day. 

One of the best feelings for a pharmacist is when he gets positive feedback from his patients. He is fulfilled whenever this happens. So why are a lot of Nigerians bent on getting their meds from unverified sources, with no proven track record? How did we end up here in the first place? Patent and proprietary medicine vendors form a large proportion of the informal healthcare sector in Nigeria. Their practice environment is largely unregulated, and they supply a large portion of drugs used by the public. In a way, this translates to the prevalence of fake medicines in the country. 

When it comes to the patent medicine vendors; as the name suggests, Profit is the focus here; No one gives a hoot about rational drug use, efficacy, or feedback. It's all an exchange of goods and services. But should it be this way, when sensitive medications are involved? This is one of the questions which should be asked in this context. Stakeholders can debate the menace of fake drugs, improving the capacity of pharmacists, and pharmaceutical care all day, but who gives practicing licenses to patent medicine vendors? What is the business environment like? How are they regulated, and who enforces sanctions? What are the literacy requirements for practice? What is the scope of action? and how can pharmacists come in to fill the gaps that are currently being exploited? 

On the Pharmacist's council website, Patent medicine vendors are described as persons without formal training but engage in the sale of orthodox medicines on a retail basis. According to research carried out by William R, et al, of the Bloomberg school of public health; on the manner of interaction between patent medicine stores and consumers, the conclusion was based on the fact that the nature of patent stores leads to an impersonal relationship. After the sale, no other service is rendered. No one would listen to your complaints. Hence it is common to see medications sharing the shelf with items like bread, Packets of sugar, chinchin, and many other commonly consumed items. 

There are legal and functional dimensions to the services of medicine stores. Functional as in the sale of the products, and legal in terms of the types of products they can sell. Patent medicine vendors should sell medications for minor ailments at best, but in recent times, and in a bid to meet customer demands, psychotropic substances, antibiotics, etc, are sold. Amidst all these, what can be done to remedy the situation and ensure that interventions have patients at the core. It is bad enough that many Nigerians do not know the functional difference between these patent stores and real pharmacies. 

Seeking to address this situation requires attention from relevant stakeholders, and everyone interested in seeing pharmacists own their space in the provision of good, quality drugs to the teeming populace. Patent medicine vendors supply a bulk of these drugs, but what would you expect in a country with its population growing at an alarming rate, and a space bereft of proper regulations. Pharmacists have been doing the same thing, the same way over time. Maybe it is time to try something different, as all hands need to be on deck.   

With the prevalence of patent medicine stores, it is obvious they are not going away any time soon. Hence, it is time to sensitize and strictly regulate their activities, in line with selling good, quality drugs. Patent medicine vendors have strong community-based associations that seek to protect their interests; this they do very efficiently. Only a primary school leaving certificate is required to set up a patent medicine store, and most folks in the field started their own medicine stores after undergoing an apprenticeship under older colleagues. How can the council come into this space, and champion the cause of pharmacists who are professionals in the field? The PCN awards the license for the practice of patent medicine vendors and more can be done in ensuring the legal and functional requirements are fulfilled before awarding licenses. 

On interaction with senior professionals, many suspect that there are a lot of sharp practices going on in the different council secretariats in interacting with patent medicine vendors before licenses are awarded. It is said that precedence is given to the individual with the money, and a lot of palms are greased in that manner. Young pharmacists seeking to get into community pharmacy practice should be encouraged and not frustrated with the many blocks on the path of getting their premises registered. When it comes to regulating patent medicine stores, stricter sanctions should be enforced, in the hope that this will curb the practice of selling substandard products. 

In order to boost the participation of pharmacists in the community, there is a need to tap into their multidimensional training. There is no reason to restrict pharmacists to only using their license for just one facet of the profession. If professionals have the capability, hospital pharmacists, for example, should be allowed to own premises and provide pharmaceutical care for members of the community. The open drug market is a big menace that should be curbed. It is a major source of drug supply for many patent medicine vendors, hence there is a need for monitoring agencies like NAFDAC to work with the pharmacist's Council of Nigeria, to stem this growing tide. 

Finally, there is the need for pharmacists to speak with one strong voice and demand a place and better participation in community health. There are a lot of allied and technical bodies with different objectives. These voices should be harmonized, as there is strength in unity. Pharmacists can be more, they should be allowed to explore, till they find their strong points of practice; enough with the restrictions, it is not helping in any way. 

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