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Pharmacy Leadership in Nigerian Administrative
Structures
The Ministry of Health is in charge of the health sector in
Nigeria and it regulates all heath-related concerns in the
country. The Chief Medical Director of each federal owned
government hospital is controlled by the Health Minister. The
Chief Medical Director, a physician, supervises the activities
of other departmental directors and administrative heads of
which the Head of Pharmacy is one. At the University of
Nigeria Teaching Hospital, a 500-bed tertiary hospital, an
Assistant Director of Pharmacy heads the pharmacy department. The Assistant Director (the Director is at Ministry of
Health) regulates and supervises all pharmacy activities in the
hospital ranging from administrative, procurement, quality
assurance, storage, pricing, and distribution of medicines in
the hospital. The Deputy Directors of pharmacy who are
under the auspices of the Assistant Director heads each of the
units highlighted above. They also directly supervise other
pharmacists in the hospital, which follows a hierarchical
cadre decent from chief pharmacist to principal pharmacist to
junior pharmacist to intern pharmacists.
At The Ohio State University Wexner Medical Center
(OSUWMC), the Administrator of Pharmacy Services leads
the administrative structure of the 1400-bed health-system's
Department of Pharmacy. Similar institutions may have
varying titles such as Chief Pharmacy Officer or Director of
Pharmacy, but the responsibilities include oversight of all
legal liability, compliance, safety, operations, and finance of
the medical center's pharmacies. There is a tiered system of
Associate and Assistant Directors who hold responsibility
for the day-to-day functions over specific service lines within
the department. Last, there are managers and team leads who
are the change drivers for implementing new pharmacy services and facilitating transitions both internal and external to
the department.
Drug Purchasing and Supply Chain Logistics
The importation, manufacture, sale, and distribution of medicines in Nigeria are a very chaotic system that has been
abused and severely exploited. The exploitation of the medicines supply chain has given nonpharmacists an opportunity
to enter and control the drug market freely, and thus the system has been riddled with counterfeit, fake, and substandard
medicines.4 The morbidity or mortality consequences of
these poisons have rarely been quantified, as there is a paucity of reliable data. One example includes the "MYPICKIN®
saga" of 1990. This poorly constituted branded paracetamol
killed 109 children before it was identified to contain poisonous ethylene glycol and withdrawn from the market.5
There are laws that regulate the medicines supply chain
in Nigeria and were summarized by a study attempting to
evaluate the reasons for the preponderance of fake medicines in Nigeria.6 These laws though old are still clear as
Hospital Pharmacy 52(7)
regard the sacrosanct role of the pharmacist as the only custodian of medicines throughout the supply chain. Some of
the laws such as the Poisons and Pharmacy Act, Cap 366 of
1990 regulates the compounding, sale, distribution, supply,
and dispensing of drugs and also provides the level of control for different categories of drugs and poisons. The
Counterfeit and Fake Drugs Act, Cap 73 of 1990 was also
enacted into law to stem the rising tide of counterfeit,
banned, or fake drugs. The act prohibits the sale of any drug
in an open market without permission from the proper
authority. There are also other laws that further expand the
regulation of drug supply and use with the inclusion of food
and food products. There are no indications yet that these
laws would be reviewed or reenacted to address some
"gray" areas, which have also allowed "charlatans" to
exploit. Despite the availability of these laws, poor enforcement has been the bane of its effective implementation. In
Nigeria today, physicians, medicine vendors, and even
apprentice-trained persons can supply and distribute medicines with very little difficulty. It is widely believed in the
pharmaceutical sector that the recent boost in indigenous
production of medicines (especially essential medicines)
could further foster a reduction in the volume of imported
substandard and fake medicines.
The drug supply chain in the United States has remained
relatively safe, though the complexity of the process has had
its faults leading to patient harm. Threats similar to those in
Nigeria have also made their way into the United States'
marketplace including counterfeiting, importation of substandard, counterfeit drugs, and gray markets.7 These issues
impact the authenticity and credibility of the supply chain,
ultimately leading to ineffective or potentially harmful medications. The US government is confronting the issue of counterfeit and falsified medications by implementing the Drug
Supply Chain Security Act (DSCSA). In 2013, President
Obama signed into law the DSCSA, which ultimately implements a fully interoperable, electronic system for the tracking and tracing of products throughout the supply chain. To
achieve this feat, the DSCSA addresses several major components including product tracking and tracing, serialization,
verification, detection and response to a suspect product, and
wholesaler licensing and reporting.8
Nigerian Vision for the Future of Pharmacy
Practice
Studies conducted in Nigeria, however, have shown good
indices for further growth of clinical pharmacy and pharmaceutical care. There has been an evident improvement in attitudes toward pharmaceutical care provision by pharmacy
students and pharmacists in Nigeria and increased preference
for patient-oriented practice as career options for graduating
pharmacy students.9,10
To be regarded as a clinical pharmacist in Nigeria, upon
graduation or after some years of practice, one can either
Table of Contents for the Digital Edition of Hospital Pharmacy - July/August 2017
The Evolution of Drug Information Centers and Specialists
Letter: Sodium Phosphates Injection—Osmolarity Labeling Correction
ISMP Adverse Drug Reactions
Drug Monographs: Avelumab and Ribociclib
Formulary Drug Review: Naldemedine
Chimeric Antigen Receptor T-Cell Therapy for Lymphomas: A Review of a Drug Class or Therapeutic Class in a Late Stage of Clinical Development
International Mentoring Programs: Leadership Opportunities to Enhance Worldwide Pharmacy Practice
Compounded Apixaban Suspensions for Enteral Feeding Tubes
Impact of Developing Adult Ketamine Order Panels for the Emergency Department
Critical Appraisal of Biomedical Literature With a Succinct Journal Club Template: The ROOTs Format
Effect of a Rivaroxaban Patient Assistance Kit (R-PAK) for Patients Discharged With Rivaroxaban: A Randomized Controlled Trial
Examining the Use of Sodium Nitroprusside in Coronary Artery Bypass Grafting: Is the Benefit Worth the Cost?
Successful Implementation of an Antimicrobial Stewardship Program at an Academic Medical Center
Hospital Pharmacy - July/August 2017 - 445
Hospital Pharmacy - July/August 2017 - 446
Hospital Pharmacy - July/August 2017 - 447
Hospital Pharmacy - July/August 2017 - 448
Hospital Pharmacy - July/August 2017 - 449
Hospital Pharmacy - July/August 2017 - 450
Hospital Pharmacy - July/August 2017 - 451
Hospital Pharmacy - July/August 2017 - The Evolution of Drug Information Centers and Specialists
Hospital Pharmacy - July/August 2017 - 453
Hospital Pharmacy - July/August 2017 - Letter: Sodium Phosphates Injection—Osmolarity Labeling Correction
Hospital Pharmacy - July/August 2017 - ISMP Adverse Drug Reactions
Hospital Pharmacy - July/August 2017 - 456
Hospital Pharmacy - July/August 2017 - 457
Hospital Pharmacy - July/August 2017 - 458
Hospital Pharmacy - July/August 2017 - Drug Monographs: Avelumab and Ribociclib
Hospital Pharmacy - July/August 2017 - 460
Hospital Pharmacy - July/August 2017 - 461
Hospital Pharmacy - July/August 2017 - 462
Hospital Pharmacy - July/August 2017 - 463
Hospital Pharmacy - July/August 2017 - Formulary Drug Review: Naldemedine
Hospital Pharmacy - July/August 2017 - 465
Hospital Pharmacy - July/August 2017 - 466
Hospital Pharmacy - July/August 2017 - 467
Hospital Pharmacy - July/August 2017 - 468
Hospital Pharmacy - July/August 2017 - Chimeric Antigen Receptor T-Cell Therapy for Lymphomas: A Review of a Drug Class or Therapeutic Class in a Late Stage of Clinical Development
Hospital Pharmacy - July/August 2017 - 470
Hospital Pharmacy - July/August 2017 - International Mentoring Programs: Leadership Opportunities to Enhance Worldwide Pharmacy Practice
Hospital Pharmacy - July/August 2017 - 472
Hospital Pharmacy - July/August 2017 - 473
Hospital Pharmacy - July/August 2017 - 474
Hospital Pharmacy - July/August 2017 - 475
Hospital Pharmacy - July/August 2017 - 476
Hospital Pharmacy - July/August 2017 - 477
Hospital Pharmacy - July/August 2017 - Compounded Apixaban Suspensions for Enteral Feeding Tubes
Hospital Pharmacy - July/August 2017 - 479
Hospital Pharmacy - July/August 2017 - 480
Hospital Pharmacy - July/August 2017 - 481
Hospital Pharmacy - July/August 2017 - 482
Hospital Pharmacy - July/August 2017 - Impact of Developing Adult Ketamine Order Panels for the Emergency Department
Hospital Pharmacy - July/August 2017 - 484
Hospital Pharmacy - July/August 2017 - 485
Hospital Pharmacy - July/August 2017 - 486
Hospital Pharmacy - July/August 2017 - 487
Hospital Pharmacy - July/August 2017 - Critical Appraisal of Biomedical Literature With a Succinct Journal Club Template: The ROOTs Format
Hospital Pharmacy - July/August 2017 - 489
Hospital Pharmacy - July/August 2017 - 490
Hospital Pharmacy - July/August 2017 - 491
Hospital Pharmacy - July/August 2017 - 492
Hospital Pharmacy - July/August 2017 - 493
Hospital Pharmacy - July/August 2017 - 494
Hospital Pharmacy - July/August 2017 - 495
Hospital Pharmacy - July/August 2017 - Effect of a Rivaroxaban Patient Assistance Kit (R-PAK) for Patients Discharged With Rivaroxaban: A Randomized Controlled Trial
Hospital Pharmacy - July/August 2017 - 497
Hospital Pharmacy - July/August 2017 - 498
Hospital Pharmacy - July/August 2017 - 499
Hospital Pharmacy - July/August 2017 - 500
Hospital Pharmacy - July/August 2017 - 501
Hospital Pharmacy - July/August 2017 - Examining the Use of Sodium Nitroprusside in Coronary Artery Bypass Grafting: Is the Benefit Worth the Cost?
Hospital Pharmacy - July/August 2017 - 503
Hospital Pharmacy - July/August 2017 - 504
Hospital Pharmacy - July/August 2017 - 505
Hospital Pharmacy - July/August 2017 - 506
Hospital Pharmacy - July/August 2017 - 507
Hospital Pharmacy - July/August 2017 - Successful Implementation of an Antimicrobial Stewardship Program at an Academic Medical Center
Hospital Pharmacy - July/August 2017 - 509
Hospital Pharmacy - July/August 2017 - 510
Hospital Pharmacy - July/August 2017 - 511
Hospital Pharmacy - July/August 2017 - 512
Hospital Pharmacy - July/August 2017 - 513
Hospital Pharmacy - July/August 2017 - 514
Hospital Pharmacy - July/August 2017 - 515
Hospital Pharmacy - July/August 2017 - 516
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