Pharmacy as the last step in the healthcare delivery chain plays an important role in the overall well-being of a patient. We speak with Dr. Lucas Nyabero, CEO, Pharmaceutical Society of Kenya on what his profession is doing to ensure everything at this stage of care is patient-centered and absolutely appropriate.

HCA: Give us a brief history of yourself and your organization

Dr. Nyabero:  My name is Dr. Lucas Kimang’a Nyabero. I went to school in Nakuru and then moved to Nyeri and then I moved to Daystar. Then I moved to the US, where I did a couple of schools, and then my graduate school was in Doctor of Pharmacy. I am a holder of a Doctor of Pharmacy from Massachusetts College of Pharmacy and Health Sciences (MCPHS. Before I went to the States, I used to work for AAR, which was in the early 90s. In the U.S., I worked as a clinical pharmacist in a hospital for a long time. I also owned a couple of businesses in the U.S. Then I was faculty in about five universities. My wife and I have a couple of patented products.

HCA: Tell us about the Pharmaceutical Society of Kenya.

Dr. Nyabero: Pharmaceutical Society of Kenya is a professional body for pharmacists established in 1964. Its major mandate is threefold: One is the welfare of pharmacists; Secondly, the advocacy for pharmacy, making sure that the legal system is actually supportive of pharmacy and pharmaceutical care. Number three is the advancement of pharmacy. We have a code of ethics and we make sure that we are also now self-regulating in terms of making sure that the Pharmacy and Poisons Board (PPB), and the government will manage the law. Ethics is typically handled by professional organizations. In the case of pharmacy, we are the ones responsible for it.

HCA: What is the link between a doctor and a pharmacist?

Dr. Nyabero: The link between the doctor and the pharmacist is something that I think is not quite clearly explained and understood. There are two major links. Nexus number one is to make sure that the patient is getting effective, efficient, safe, quality, and affordable pharmaceutical care. Physicians are very good at doing diagnoses. But in terms of which medication works best, that’s the pharmacist’s job.

The second Nexus is after the doctor has already prescribed the medicine, the pharmacist explains to the patients clearly what they are taking, why they are taking it, types of food to avoid, the dosage regimen, and how to deal with adverse effects if there are any. Doctors have knowledge of what a particular medication is intended to do, but pharmacists have a deeper understanding as it is a core part of their daily work. It is essential to consult with the pharmacist when taking medications.

HCA: Is there a way that pharmacists are involved in the manufacture of medicine?

Dr. Nyabero: Yes, they are. Pharmacists are involved in the regulation of packaging to ensure that drugs are not contaminated or damaged, and remain effective when they reach the patient.  Here’s the other one that is very complex that people don’t talk about, disposal. A pharmacist should be involved with all these things from innovation, choice, dispensing, counseling, and disposal. We are putting medications in pit latrines. All it does when it rains is that all that medication goes into the water table, then we drink it. Pharmacists can help in explaining how to deactivate this drug before disposal. That’s the complete continuum of a pharmacist. Pharmacy plays a big role in health care.

HCA: You mentioned regulatory affairs and I came to realize that pharmacists play a bigger role in determining the types of medicines sold in the market. Please expound further.

Dr. Nyabero: They could play a bigger role in getting more involved. However, there is not enough of them in that situation. We can change what we bring into the market. For example, a lot of the drugs we have in this country have been studied in the US and others in the West, and other places. They are perfect drugs for Caucasian males between 18 and 32 years old because those are the ones who do the studies, but not necessarily appropriate for us. Pharmacists can be involved in the actual testing of these medications to make sure that they work with black people.

HCA: Do you have any key numbers like the number of people employed by the society?

Dr. Nyabero: We represent about 4000 pharmacists. Among those ones are some who work in industry, hospital, community pharmacy, academia, and research among other things. Of those ones we have about 40 to 50% who are our members, and among those, we have a bunch of students who just graduated as pharmacists who don’t have jobs. Now, considering what they can do for the economy it’s a little sad.

What I’m trying to suggest is, the U.S. does a study, which they call the economic cost of medication errors, not medical errors, medication errors. In the US, it’s about US$20 to US$40 billion a year. If you extrapolate to Kenya, it’s between US$3 and US$6 billion a year. The cost of providing healthcare in Kenya is about US$6 billion a year. We are suggesting that if we use the medications correctly, hired all those pharmacists who are not hired, and gave them positions where they actually effecting what therapy goes out, the economic output of those people who don’t get harmed by medication can actually pay for healthcare without changing anything else!

HCA: How does PSK generate its revenues?

Dr. Nyabero: Most of our revenues come from memberships and subscriptions from members. We also do events. We have an annual scientific conference. We have a few others like webinars. Every Tuesday and Thursday, we have a webinar, which our partners have actually been able to sponsor, and some of the stuff that we get from that.

HCA: Tell us just a brief profile of the founders and key management staff of the PSK.

Dr. Nyabero: Founders were pharmacists who decided that we need to have a body that’s going to ensure that pharmacy keeps on advancing, ensure that advocacy and the legal system acknowledges and supports the care that we’re offering, the difference we make in healthcare, and also support the members who are pharmacists and ensure ethics are up to date. To that end, we have a code of ethics. As regards management, we have a National Governing Council, which is the supreme body. Under it, there is the National Executive Committee, to which, the CEO reports.

As the CEO, I am in charge of the Secretariat, which runs the programs, communication, finance, and administration. On the other side, we also have standing committees, which include a legal and ethics committee, public relations and advocacy committee. We have an education committee, investment and budget committee, and fellows committee.

Also, our structure includes a president who is elected by the members. We have three vice presidents: The Vice President for advocacy, the vice president for governance, and the vice president for pharmacy practice. They all report to the president of PSK, which is the political arm of what we do. We also have 16 branches nationally and each of them has chairs, vice chairs, treasurers, and secretaries.

HCA: What are some of the key values and strategies that have enabled PSK to succeed?

Dr. Nyabero: I think it’s the passion. The passion to make sure that patients are not harmed. I’ll give you an example. Every time I talk to a patient about any medication, I strive to ensure that they understand it well enough to go and talk to a three-year-old and explain to them what the condition is, what the medication is, what the side effect is, and why they’re taking the medication.

Nearly all medication is actually poison. It is how well you use it. Just like a car, the idea here is how do we operate medication safely. That is the passion that actually has made us develop a love for the common man, to make sure that everyone gets optimum medication care. When you’re putting poison into your system, it has to be the right poison at the right dose, the right time, for the right condition.

We are suggesting that if we use the medications correctly, hired all those pharmacists who are not hired, and gave them positions where they actually effect what therapy goes out, the economic output of those people who don’t get harmed by medication can actually pay for healthcare without changing anything else!

Dr. Lucas Nyabero- CEO, Pharmaceutical Society of Kenya

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HCA: Are there any other services that PSK offers to its members apart from advocacy and welfare?

Dr. Nyabero: Yes, advancement. For example, we do training. We do training on advanced family planning, sanctioned by the Ministry of Health, where a pharmacist will be able to give advanced family planning services including depo shots, and implants, among other things that you can do in family planning.

We also give training on immunization. Every twice a week, we have people coming to talk to us about improving their skills. We are in the process of trying to look for scholarships, and exchange programs to ensure that we grow as a body to make sure that our pharmacists are the best they can be and they can serve the patients as well as they can.

HCA: What are some of the investments around technology that PSK has done?

Dr. Nyabero: We are in the process of doing a couple of things, which we want to do in the next five years. We want to have a robust data setup, which we do have but it’s not as strong as we would like it to be. We want to be the end-all and be-all of all pharmaceutical information in the country. We want to be the first place anyone looking to establish manufacturing operations goes to for information.

Any changes, any policymaking, any political statements that are going to be pharmacy and healthcare in terms of especially pharmaceutical care related, we want to make sure we have that information. We are building a very strong research arm, as I said, a lot of the medicines that we have, have been tested in a different environment. We want to publish our own.

 We also want to innovate. We want to explore innovations like what we call pharmacogenetics, which involves using a person’s genetic information to personalize medication, ensuring that patients receive the right dosage and treatment without the risk of harm or unnecessary spending.

HCA: How is your organization adapting to meet the rising need for more sustainable business operations and a better cleaner planet?

Dr. Nyabero: We’ve engaged UNEP in terms of how to start changing the way we dispose of meds. We’ve had camps and drives where we encourage everybody to bring their expired meds and we collected almost four tons of medications and conducted sessions on how to dispose of them. We’ve been trying to do that, but we’re looking for a more sustainable, continuous way to accomplish this through education.

The other one is also antimicrobial resistance. We are trying to encourage the public to understand the risks of not monitoring the menace before we get to a point where medications that used to treat pneumonia no longer work. To avoid that walk towards infections coming back to be a major part of the cause of death, we have to talk about these things.

HCA: How has PSK contributed to the national and regional economy?

Dr. Naybero: A lot! Let me start with the growth of the economy. If you’ve got the right medication at the right time, in five days, you’re ready to go back to work and build the economy. If you use the wrong medication, because you were not advised appropriately, it takes you maybe 10 or 15 days, those are days that you’ve lost.

The proper use of medication can significantly reduce the duration of illnesses and slows down the progression of diseases. I’ll give you an example of diabetes. If you take your medication for diabetes correctly, you don’t get down the road where you start chopping toes and everything else because of gangrene. That’s a contribution to the public.

The other one is we do free medical camps. We’ve done free medical camps and education for both our members and the public. We have talks in schools. We’ve had talks on pharmacy days and pharmacy weeks. We’ve also had several talks everywhere to sensitize people on the importance of using the meds correctly.

HCA: What are PSK’s priority areasin the next five years?

Dr. Nyabero: One is to build a solid database. We want a solid database for all pharmaceutical-related information. With data we can be able to make informed decisions that are not influenced by emotional bias. 

Number two is to get people to trust that local manufacturing is okay, to just believe that the quality in Kenya is also equally as good and it meets the standards that it’s supposed to meet. We want to ensure that graduate pharmacists are ready to contribute to the healthcare system, and give them the skills and support. As I told you earlier on the nexus of healthcare, the last touch point in the healthcare system is the pharmacy. We want to make sure that it is solid, that the information you get there is accurate. We want to make sure we reduce the economic cost of medication errors.

 There are also a few things we might launch. There are few studies on how to relieve the congestion in public service hospitals. How do we make sure that the people who will get to the hospital level are folks who really need to be at the hospital level? What are some of those services that can be offered at the pharmacy level, to almost ensure that the people who go into the hospital are really sick enough to go to the hospital so that we can use our resources better? With the need and mandate for UHC, nothing is more crucial than resource management.

HCA: Would PSK consider working with other players to advance healthcare

Dr. Nyabero: I think one of the biggest potential sources of funding and support for growth is collaboration with other healthcare cadresFor instance, we engage with oncology doctors to explain our capabilities and demonstrate how we can help. By understanding what we can offer, we can then collaborate on funding and conducting studies to further advance the field.

We also are open to working with pharma companies as well as institutions of higher learning, research centers like KEMRI, hospitals, the Ministry of Health, the Ministry of Education, and other ministries .

We are  open to working with international organizations, the Bill and Melinda Gates, the Tony Blair Foundation, the WHO to ensure that the pharmaceutical care getting to the patients is appropriate and is actually what is needed, not what is available.

HCA: What are some of the opportunities and challenges that PSK sees in the healthcare industry? How do you intend to take advantage of them to enable the pharmaceutical industry and the healthcare industry in general to flourish?

Dr. Nyabero: One of the biggest challenges is medication use, which has costs related to the harm that it will cause. This is a hidden cost. That is a cost that really needs to be looked at.

Many people laying in the hospital today are there because they got the wrong medication. That is a big challenge. Several other people die every year because of a doctor or medications that were mixed up. One of the challenges is obtaining the necessary data in this area. Once we have data, we can compare it, implement appropriate mechanisms, and evaluate their effectiveness in achieving the desired outcome.

The other one is the scope of practice. All the healthcare cadres need to be brought together to ensure that each person’s contribution is felt in the healthcare spectrum of caregiving. The challenge is coordinating all the different aspects of healthcare to provide comprehensive care. One way to address this is through collaboration and cooperation. We are actively working towards building collaborations and highlighting the capabilities of pharmacists as a way of enhancing communication and information sharing.

This is a declaration. Without proper pharmaceutical care, which means the right medication, and people understanding what to do with all that comes with it including interactions and side effects, you will not have UHC. It will not succeed without that.

This feature appeared in the June 2022 issue of Healthcare Middle East & Africa. You can read this and the entire magazine HERE