Sibling rivalry is a common phenomenon in professional
practice as is in families. For years, pharmacy professionals in Kenya were entangled
in a tag of professional war. This year,
it escalated not only to confrontational outbursts but public altercations and
total dress down in social and traditional media - So much for professionalism.
The war is between two professional pharmacy advocacy groups.
One group, Pharmaceutical Society of Kenya (PSK) represents
Pharmacy practitioners with Bachelor of Pharmacy degree. The second group,
Kenya Pharmaceutical Association (KPA), represents Pharmacy practitioners with Pharmacy
Diploma. But one clarification must be made.
Ostensibly, the term pharmacy practitioner is used to
describe both groups in full recognition that one group or the other might find
it offensive at least in the Kenyan context. However, it should be on record
that the use of the term Pharmacy practitioner doesn’t dilute the authenticity
of any of the group’s academic qualifications. That set aside, then what provokes the intractable
disaffection between the two advocacy groups?
Behind the white-coat facade is insecurity, superiority
contest, commercial interests and greed all coalesced into one improvised
explosive that detonates right in the middle of the Pharmacy profession. That
leaves behind a trail of shuttered profession that in many ways doesn’t
contribute to the wellbeing of patients and to the populace.
The recent duel was provoked by the proposed amendments to
the Pharmacy and Poisons Act, Cap 244 - National assembly bill no.14 of 2018. The
Bill is neither ominous nor ambiguous.
It doesn’t restrict or offer any privilege to any of the practitioners.
It reaffirms the difference between a Diploma practitioner and a Degree
Practitioner. Arguably, its weakness is in its failure to capture the
contemporary global practice standards. And that is because the legislative
process was neither comprehensively engaging nor exhaustively consultative in
seeking professional perspectives. A short background on the History of Pharmacy
in Kenya will go along way.
The first semblance of Pharmacy practice came in the form of Compounders in 1926. As has been the case
under British colonial dominance across the Globe, this was a copy-paste
professional practice. By 1971, the increasing demand for skilled practitioners
forced the upgrade of Compounders to a more rigorous formal course work and
externship. The completion of the new curricula offered Pharmacy Diploma.
Though the Diploma College started churning out a good number of skilled graduates,
it was not near enough for the market demand.
The Diploma graduates are recognized and adopted as
Pharmaceutical Technologists in Chapter 244 of the Constitution of Kenya under
the Pharmacy and Poisons Act. By 1978,
the University of Nairobi introduced Faculty of Pharmacy and has earnestly
begun training Pharmacy Professionals with Bachelors degree.
Great majority of Pharmacists from the University of Nairobi
were absorbed into the job market by Pharmaceutical manufactures and distributors.
However, a few do practice behind the Pharmacy counter and have direct patient
interaction.
Fast forward. In Kenya, Today, there are myriads of Colleges
and Universities offering both Bachelors Degree and Diploma in Pharmacy. At
least six Universities are offering degree in pharmacy most of whose curricula
is essentially the mirror image of Nairobi University’s curricula. The
formidable question of quality against quantity arises when one considers the
increase in number of Universities and colleges in such very short period.
Members of PSK claim right to privileges in accordance to
their lengthy training. While that argument can be lent some credence, it subordinates
members of KPA and that could be one of the unsettling discomforts between the
two sides.
For instance, importation, wholesale and manufacturing of
pharmaceutical products is an exclusive affair to Degree Pharmacist. Retail ownership
is the only level-playing field for both groups. By pursing these exclusive
privileges, PSK has in effect drawn a line between their members and those of KPA.
KPA members on their part remain belligerent against been
treated as the professional underdogs while PSK leadership argues their attitude
toward KPA is nothing more than perception.
PSK membership is 4,000 while KPA membership is a dwarfing
10,000. Combined, they are a total of 14,000 Pharmacy practitioners. Put in
perspective, for every 3,500 Kenyans, there is only one Pharmacy practitioner. Even when both groups are combined, the
ratios remain ludicrously below the World Health Organization’s
recommendations.
The entry of PSK and its members into a profession dominated
by Pharmaceutical Technologists was a potent threat and insecurity. Like the old lion King who must cede territory
to the younger energetic male lion, PSK has portrayed the mucho man entitlement
by pushing out the old privileged diploma folks. It is the norm that the old
lion, though not a pushover, cedes ground in the end. That is not to suggest
that any group must cede ground because the reality remains - KPA is determined
to pushback on every inch against PSK.
At the backdrop of this seismic battle, could there be a
third and better alternative that works for everyone - a win-win-win situation?
A win for KPA, a win for PSK and a win for the patients. It’s prudent to step out on the balcony and
consider the current global trend in Pharmacy profession. The global trend is
neither within the purview of KPA nor PSK. It is a complete departure from the
two competing narratives.
The profession can be considered as spectrum where one end
is Compounding drugs as it was in early 1900s and the other end is patient-centered-care
as it is today. Everything else such as supplier, wholesaler, importer,
entrepreneur pharmacist is in the middle and is only evolutionary toward
today’s needs of Patient-centered-care. Both PSK and KPA are somewhere in the
middle of the spectrum. There is a compelling need to move toward today’s end
of the spectrum in the context of the profession. That is the reality that
every Pharmacy practitioner in Kenya and elsewhere in the world must come to
understand and begin to embrace.
Patient-Centered-Care popularly known as Pharmaceutical Care
means the pharmacist is now taking on direct responsibility for the patient.
According to the World Health Organization (WHO), by reorienting the Pharmacy
Profession around Pharmaceutical Care, it means the pharmacist’s new task is to
ensure patient’s drug therapy is appropriately indicated, the most effective
available, safest possible and convenient for the patient (WHO). Ideally, this
approach is self-evident in that the pharmacist’s new responsibility will
immensely contribute toward the patient’s overall outcome and quality of life.
In its quest to increasingly improve Health care, WHO has
introduced the concept of seven-star pharmacist, adopted by International
Pharmaceutical Federation (FIP) in 2000, in its policy statement on Good
Pharmacy Education Practice. Accordingly, the pharmacist is a caregiver,
communicator, decision maker, teacher, life-long learner, leader and manager.
Unfortunately, in most countries, Pharmacy education of
current pharmacists was based on the old skill-set of pharmaceutical product
focus.
Then where should the discourse begin? If the Pharmacists
are to contribute effectively to the new patient centered Pharmaceutical care
practice, The Knowledge base of pharmacy graduates must be reoriented to
reflect this new focus. The
reorientation process must include providing an opportunity to old pharmacy
practitioners in all cadres. Progressively, then it becomes obvious that the
profession will refit itself within the definitions of pharmaceutical care. And
everyone will have won.
In its aspirations to
embrace the changing needs of the pharmacy profession, United Kingdom has recently
started stakeholder’s consultative engagement. It concludes that both Bachelor
of Pharmacy (Bpharm) and Master of Pharmacy (Mpharm) training is neither
effective nor efficient in the delivery of care needed by patients today. It
finds the United States terminal Doctor of Pharmacy (PharmD) as the most
appropriately oriented Patient centered program that can deliver to the
clinical focus required.
Subsequently, many countries in pursuit of Pharmaceutical care
adopted the Doctor of Pharmacy (PharmD)
Program. These new paradigm is sweeping across the globe - Canada, many
Eurozone nations, Sub-Saharan Africa and Asia have adopted the Doctor of
Pharmacy (PharmD). Consequently, it
becomes axiomatic that the global standard for Pharmacy Education is headed in
one common direction; The Doctor of Pharmacy Education Program.
Dr. Ali M. Mahmud,
PharmD, MBA
Member, International
Pharmacetical Federation (FIP)
alimaly@gmail.com
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