Inside Nigeria’s Community Pharmacies: Where Patients Go To Avoid Long Hospital Queues
When many Nigerians face health challenges, they don’t immediately go to the hospital. Instead, they visit a pharmacy or an unofficial health service provider because of the ease of access. For many people, the pharmacy is a welcome option to bypass the stress of the general hospital and the required paperwork, especially amid a global pandemic. However, pharmacists, who are on the receiving end, aren’t all smiles about this new trend. One of our team members, Hassan Yahaya, meets a Nigerian pharmacist, Pelumi Kolawole, to better understand his motivations and challenges.
On the morning of a regular workday for Pelumi, a Nigerian pharmacist, a patient walked into the pharmacy and read from a list of the items she wanted to buy. Pelumi, dressed in his well-laundered white lab coat took one look at this patient from behind the counter and motioned to the sales assistant to attend to her. After which, he returned his attention to the sales book he had been studying before she walked in.
Not many would understand why a pharmacist wouldn’t jump to attend to a patient, but to Pelumi, it made perfect sense. As the superintendent (responsible for both clinical and administrative duties) and the only residing pharmacist in a typical Nigerian community pharmacy, it was the natural thing to do.
In Nigeria, patients looking to escape long wait times and hospital queues turn to pharmacies which are more accessible. Consequently, this means that pharmacists serve as their first point of contact with the health care team. As a result, Nigerian pharmacists, who are already in short supply, tend to conserve their energy for cases that require their skills (e.g. cases like malaria).
In the book, Prosperity Paradox, Clayton Christensen and Efosa Ojomo share that “there are currently fewer than twenty-five pharmacies in Nigeria per million people. This means that in a country with approximately 180 million people, there are fewer than five thousand licensed pharmacies.”
For some perspective, there are five times more Redeemed Christian Church of God parishes (23,880), one of the largest pentecostal churches in Nigeria, than pharmacies (4,500) in Nigeria.
According to the Journal of Pharmaceutical Practice and Policy, “there are 21,892 registered pharmacists in Nigeria. However, the data suggests that only 12,807 (58.5%) are in active professional practise as indicated by the number of licensed pharmacists in 2016. Of this figure, 42% of the licensed workforce are in community practice. This means that there is less than one pharmacist for every 10,000 Nigerians.”
So, in cases where the customer has an idea of what they need, pharmacists delegate to the sales assistant.
Walk into any community pharmacy in Nigeria and you’ll find at least one person looking to talk to a pharmacist. At least three out of five times a week, whenever Pelumi resumes work, there’s usually a patient waiting for him. Patients are drawn because of the ease of access to a pharmacist, customer service, and informal environment. Also, unlike hospitals, there is reduced waiting time.
Most Nigerian community pharmacies have the same layout: there’s usually a prescription-only medication section, an over-the-counter medicines section, and a mini-mart. In certain models, there’s also a beauty/cosmetics section. However, the medicines and mini-mart sections appear to be the most common features because the footfall traffic from the mini-mart drives customer discovery of pharmaceutical services available.
Abiola, 24, only goes to the hospital after being referred by a pharmacist.
“Whenever I have a complaint, I go to the pharmacy first because I can get quick answers without all the paperwork that hospitals require. I only go to the hospital if my pharmacist insists.
I dislike hospitals because pharmacies are affordable and they have good customer service while the hospitals (usually a general hospital) I can afford are the opposite. Growing up, my parents used to take us to the general hospital for any illness, but that place was stressful because of the long waiting time. We would spend the whole day there with overworked and underpaid health workers. The sad part was that the doctors couldn’t spend so much time on one patient because they had a crowd waiting to see them. However, it feels different here. The pharmacists look happy to see us and they take their time to attend to us.”
Patients such as Abiola highlight an interesting trend in the healthcare journey of the Nigerian patient. Patients increasingly visit the pharmacy before anywhere else and only go to the hospital after being referred by their pharmacist. At the height of the COVID-19 pandemic (April, May, June) where patients became increasingly wary of hospitals (for fear of getting infected), community pharmacies experienced an influx of patients. Many pharmacists reported running out of antimalarials, anti-hypertensives, immune supplements, and other medicines. This shows that the pharmacy is an integral part of the Nigerian patient’s health journey. Unlike their counterparts in more developed markets, who mainly check prescriptions, counsel patients, and dispense medicines, Nigerian pharmacists absorb some of the functions of primary health care centres.
However, the pharmacy isn’t the only point patients touch before landing at a hospital. For cases like cleaning of wounds and administration of injection (which are outside the scope of pharmacy practice), auxiliary nurses come into the picture.
Auxiliary nurses undergo a period of apprenticeship understudying a physician or a licensed nurse. Although unrecognized, they are also a part of the Nigerian patient’s health journey. They operate within communities, often the same ones in which they live, making them accessible to patients who would rather skip long waiting lines at the hospital. They mostly administer injections and clean wounds, and their low prices or “pay later” credit model (which leverages interpersonal relationships to extend credit facilities) makes them attractive to low-income patients (the vast majority of the population).
In some low-income neighbourhoods, auxiliary nurses are employed in pharmacies in a bid to capture all this value under one roof. In other parts, pharmacists learn to administer injections themselves to cut costs.
The community pharmacy isn’t only for low-income populations, however — it is increasingly the entry point into the healthcare system for aspirational working-class families, business owners and elderly patients. Pharmacies are adapting their services to offer premium, hands-on features and generate more revenue.
As the workload increases, pharmacists have different opinions on how best to handle it. Some welcome it as an opportunity to help the professional image and are exploring innovations to do more with less. Others see it as thankless work.
Pelumi, our pharmacist, shares:
“Even though it’s challenging dealing with a lot of patients, there are days where it’s worth it. For example, a patient once told me that the antacid I gave him during an ulcer attack helped relieve his symptoms. He also told me about his struggles with the distance to the hospital from his house. I think that he was most grateful that during one of the worst moments of his life, the pharmacy was there to support him. Comments like this are the major reasons I still show up every day.”
Editor’s note: Although there is currently less than one pharmacist per 10,000 Nigerians, there is some progress. During the oil recession of the 1980s, the number was less than one pharmacist per 40,000 Nigerians. With the launch of additional pharmacy schools like the University of Lagos (Unilag), the numbers have gradually improved.
References:
https://joppp.biomedcentral.com/articles/10.1186/s40545-018-0147-9
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