JUNE PRIME PARAGON: PHARM ADAKU EFURIBE

Pharm Adaku Efuribe is a clinical pharmacist with over 15 years experience in medicines management, health promotion, chronic disease management, independent prescribing and integrated healthcare. A UN SDG Campaign Action Partner and 2019 ONE Youth Ambassador, Pharm Efuribe continues to advocate universal healthcare coverage (UHC). Her health articles have been published in notable newspapers and she has been featured as a guest clinician on international TV stations. In this interview, Pharm Efuribe shares her thoughts on SDG actualisation in Nigeria, interprofessional collaboration, disease outbreak management and more. Enjoy!

LinkedIn: Adaku Efuribe

Twitter: @AskyourpharmAda

PSN-YPG Lagos: Good day, please tell us about yourself, your interests and your work.
Pharm Efuribe: My name is Adaku Ann Efuribe. I am a Clinical Pharmacist and Independent Prescriber (specializing in pain management and general medicine). I am a Sustainable Development Goals (SDGs) Advocate. My main focus is Goal 3: Ensure healthy lives and promote well-being for all at all ages. I have experience working with the private and public health sectors in Nigeria and the United Kingdom. I am passionate about achieving the United Nations SDGs and committed to advancing health promotion and integrated healthcare.

PSN-YPG Lagos: What was growing up like, family, education, influences that have shaped you?
Pharm Efuribe: I grew up in a close-knit family with mum and dad always around. I was nurtured within a university environment, University of Nigeria Nsukka (UNN). I attended the university staff school and University of Nigeria Secondary School. I studied pharmacy in UNN. I also have a PGD in Pharmaceutical Sciences from the University of Sunderland and a Certificate for Non-Medical Prescribing- Pharmacist Independent prescriber from the University of Leeds. My greatest role model is my dad. My dad played a fantastic role towards my personal development from a very young age and he encouraged me to go into full scale health promotion and public health media campaign in 2016.

PSN-YPG Lagos: Who/What influenced your choice to become a pharmacist? How has the journey been so far?
Pharm Efuribe: My dad encouraged me to study a professional course, and being a science student, I chose pharmacy because I could appreciate the prospects and roles of a pharmacist. My pharmacy journey has been great. I am a work in progress and I learn every day. My experience in pharmacy practice across two continents has contributed to my knowledge positively.

PSN-YPG Lagos: Do you have mentors? How did you meet/find them and use their knowledge and/or resources as a boost?
Pharm Efuribe: Yes, I do have mentors. Some are my senior professional colleagues while others are acquaintances in the corporate and political sectors. My husband is an economist/business analyst so I do engage in intelligent discussions with him on things like achieving the SDGs, developing the Nigerian economy and achieving better healthcare systems. I learn a lot from my mentors. I love engaging in critical thinking.

PSN-YPG Lagos: You are the founder of Ask Your Pharmacist with Adaku (AYPWA), a health promotion and advocacy initiative. Please tell us about your initiative? The why, how and of course, impact story.
Pharm Efuribe: AYPWA was birthed out of the desire to make a change towards patient-centered care by providing medicines information, medication reviews and health promotion for Nigerians. Its mission is to provide education/create awareness on public health issues, healthy living, self-care and wellness, especially in developing countries where healthcare facilities are inadequate. AYPWA partners with the United Nations – My World 2030 campaign and the World Health Organization (WHO) public health campaigns. In my advocacy for better healthcare systems, I call governments to action where public health /health promotion facilities are lacking, in line with the UN SDG Agenda. Through AYPWA, a lot of impacts have been made in the areas of advocacy, health promotion and pharmacists representation. Recently, I have been offering public health enlightenment for the COVID’19 pandemic and the impact has been so rewarding.

PSN-YPG Lagos: There certainly have been crests and troughs in your journey, which helped you grow in leaps and bounds. Please tell us about some of them.

Pharm Efuribe: When I started AYPWA, on social media, a lot of people who were my followers did not understand my objectives, but today I am happy with the tremendous impacts the initiative is making. More people have adopted healthy eating, exercises, mindfulness and self-care. Along my journey, I have received great support from other healthcare professionals, NGOs and government parastatals. I have been invited as a guest clinician on different Nigerian TV stations to provide health education and public health enlightenment. It has been a rewarding experience and I am having fun doing what I love doing. My articles have been featured in many Nigerian newspapers/blogs like THIS DAY news, Vanguard, Punch, Nigerian Tribune etc.

PSN-YPG Lagos: Amidst your advocacy engagements, how do you manage with family and work in the mix? What do you do for fun to get away from the buzz?
Pharm Efuribe: I multitask a lot and I do not engage in time-wasting activities. I do a lot of housework, but I also create time for recreation and indoor/outdoor sports activities. Sometimes, I relax by watching Nollywood movies or reading novels. I also love writing articles.

PSN-YPG Lagos: I’m sure you’d agree, to pull our weight as a leading nation in Africa, we need to show capacity to provide solutions to global health problems. With your exposure abroad, what do you think we need to do differently as pharmacists and pharmacists-in-training?

Pharm Efuribe: I think we should engage more in integrated healthcare and adopt a multidisciplinary team approach in our clinical settings. We need to create more awareness on the roles of pharmacists so people can utilize their services more. Pharmacists-in-training need to take up different aspects of pharmacy like Industrial pharmacy and drug formulation. We also need to go into clinical trials and drug development more. Pharmacists in Nigeria need to get into strategic positions to ensure we have the opportunity to engage in strategic healthcare provision decisions.

PSN-YPG Lagos: You were selected as a 2019 Youth Ambassador for the anti-poverty group, The ONE Campaign. Part of your work is to raise awareness on the fight against extreme poverty, particularly in Sub-Saharan Africa. What engagements did/have you initiate(d)?
Pharm Efuribe: I visited the UK House of Parliament, engaged with MPs and we discussed ways of replenishing the global fund to fight malaria, HIV/aids and TB in Sub-Saharan Africa. I have also been involved in public health campaigns and I have written many articles in this area. I have continued to lend my voice to improve healthcare systems in Nigeria through advocacy, training and research.

PSN-YPG Lagos: With the COVID-19 pandemic, our healthcare system was thrown into further chaos. Consequently, the government employed ad-hoc staff in health promotion capacities to help manage the strain placed on the system. Should this approach be proactively rather than reactively employed, it will reduce the burden on the healthcare system as these other clinicians or allied health workers will have enough training and experience to manage infectious and/or non-infectious conditions. What more can be done to help our government understand the need for proactive measures such as this? Can we as private individuals or groups do any better to help improve the system?
Pharm Efuribe: Historically, we are known to apply the ‘Fire Brigade’ approach when dealing with healthcare issues and disease outbreaks. Although the COVID-19 pandemic took everyone by surprise, I believe we should have an effective emergency public health response team anyway. Across the world, ad-hoc staff and volunteers have been recruited to support frontline staff to help battle the COVID-19 pandemic, but we have to ensure we have the necessary lifesaving tools like oxygen, ventilators etc. in all our public hospitals. The private sector has to up their game in corporate social responsibility and all hands must be on deck to help provide public health enlightenment in our communities. One strategy we can use is to engage the ward councilors in each ward and task them with responsibilities of supporting public health campaigns.

PSN-YPG Lagos: InterProfessional Collaboration (IPC) is critical to efficient healthcare delivery. Nigeria’s physician-to-patient ratio is 4 doctors per 10,000 patients. This, amongst other factors, necessitates collaborative efforts between healthcare professionals to reduce the strain on the doctors and optimize patient care. However, lingering conflict between physicians (medical doctors) and other health workers under the aegis of the Joint Sector Health Unions (JOHESU) coupled with a weak legislative framework on definitions and enforcements of the responsibilities of the health actors threaten IPC and patients' access to proper healthcare. What actionable strategies can be employed to achieve the much-needed collaboration?
Pharm Efuribe: There is need for more integrated healthcare in Nigeria where every member of the healthcare team: doctors, pharmacists, nurses, physiotherapists, dietitians, community healthcare workers and other healthcare professionals will work together to contribute their own quota towards excellent health promotion and healthcare delivery.
It seems the expertise of pharmacists is not fully utilized in Nigeria for modern healthcare delivery strategies. The status quo must change if we have to move forward and develop our healthcare system. We have very weak laws to support this, so medical/healthcare professionals have to get involved in politics as well. I believe we need to imbibe regular multidisciplinary team (MDT) trainings; this is very common in countries where healthcare professionals work together. I do engage in weekly (MDT) clinical meetings where we discuss patient cases and learn from each other. Also, we have to redefine the structure of leadership in the healthcare sector so we can assign leadership roles across different professions, this would encourage more collaborative working a well.

PSN-YPG Lagos: What does a regular day look like for you?

Pharm Efuribe: My alarm goes off at 6:15 am. Work starts at 8 am on the dot. On a usual day, I finish at 6 pm, drive back home and engage in 30 minutes exercise. At work, I complete face-to-face/telephone consultations with my patients. I also engage in medicines management, medication reviews and other tasks. I try to go to bed around 10 pm but sometimes I go to bed at 11 pm.On the days I don’t go to the office, I engage more in my advocacy campaigns and health promotion. My days are really busy so I have to multitask.

PSN-YPG Lagos: How do you de-stress as you strive to stay productive and manage your time effectively?
Pharm Efuribe: I engage in mindfulness activities. I also exercise, walk and ride my bike sometimes.

PSN-YPG Lagos: You’re a UN SDG Campaign Action Partner. How did you manage this and what does the partnership entail?
Pharm Efuribe: I signed up to be an advocate. I receive regular updates from the UN SDG Headquarters in Germany and I participate in campaigns/advocacy. I also have an action partner web handle where I collate My World surveys and engage in SDG actualization activities. My main focus is SDG 3: Ensure healthy lives and promote wellbeing for all at all ages. My health promotion initiative, AYPWA is linked to my SDG campaigns. I also partner with the WHO public health campaigns, write health articles and share evidence-based information.

PSN-YPG Lagos: A historical partnership exists between Nigeria and the UN SDG Action Campaign dating back to its processor, the UN Millennium Campaign. The United Nations pledged its partnership and support to Nigeria to deliver on the implementation of the SDGs. Are you aware of any engagement between the Office of the Senior Special Assistant to the President on the SDGs (OSSAP-SDGs) and the network of Nigerians within the UN and the International community aimed at SDGs implementation? If yes, what are we to expect?
Pharm Efuribe: I met the SSAP-SDGs at the UN SDG Headquarters in Bonn Germany, during the Global Festival of Action and I visited the Nigerian SDG stand, where I met delegates from Nigeria. I also had discussions with the ex-Governor of Anambra State, Peter Obi who is involved in SDGs campaign and I discussed my projects with him. He also gave some advice on how to ‘fit’ my projects into the Nigerian system and get the ball rolling. I am making plans to visit Nigeria to have more discussions about the projects I have in mind towards achieving the SDG’s in Nigeria. I have regular discussions with groups and individuals working towards achieving the SGDs in Nigeria and I have collaborated with a few of them to deliver some projects.

PSN-YPG Lagos: One of the goals within the SDG 3 goal for 2030 is to achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. I understand you actively campaign on this front and monitor the situation in Nigeria. What is your assessment on the probability of us achieving this, seeing as we have only the next decade? What adjustments can we make to better the odds?
Pharm Efuribe: I think we still have a long way to go towards achieving the UHC in Nigeria, I have published a lot of articles on this topic. In Nigeria for instance, we have a few HMO schemes covering the organized private and public sector. The ‘common men’ on the streets do not have any sort of health insurance whatsoever, leaving them at the mercy of chance. In an unfortunate event of a serious illness like cancer or organ failure, they find themselves in a situation where they cannot pay for medical services. A lot of avoidable deaths have occurred due to lack of funds to pay for medical treatment.
The public primary care providers are underfunded and the issue of corruption has eaten deep into the fabric of the healthcare system where funds allocated for medical equipments, pharmaceuticals etc. are diverted for personal use.
According to WHO, as articulated in SDG 3, “Health is crucial for sustainable human development, both as an inalienable human right and an essential contributor to the economic growth of society. Health contributes to national development through productive employment, reduced expenditure on illness care and greater social cohesion”. I believe that universal health coverage (UHC), delivered through an adequately-resourced and well-governed health system, will be capable of addressing health challenges. Universal health coverage must ensure full access to affordable, accountable, appropriate health services to all people. The Nigerian government can do more to improve health outcomes and tackle poverty, by increasing coverage of health services, and by reducing the impoverishment associated with payment for health services. We can subsidize the payment for health services and provide emergency healthcare at the point of need by ensuring we are constantly reviewing our health policies and implementing proven international strategies. The health budget does not in any way reflect the health needs of Nigerians. This needs to be reviewed. As Individuals, if we take health promotion seriously, and change our lifestyle habits, then we can make changes that would reduce the cost of healthcare as well.

PSN-YPG Lagos: What are we to expect from you going forward?
Pharm Efuribe: My primary objective is to contribute my quota to my beloved country, Nigeria by helping her achieve the UN Sustainable development goal 3, ‘’Ensure healthy lives and promote well-being for all at all ages”. I am also a resource person for health promotion projects, health education and public health campaigns. Recently, I launched a new project, AskMeAnything, which is my debut free private consultation for Nigerians. On this platform, I provide medicines information and tailor-made medication reviews for patients. Also included in the free package are selfcare counselling, good health & wellbeing coaching. I would love to relocate to Nigeria as soon as I get a suitable role so I can be on ground and get my hands dirty, we can’t achieve everything online, so I would love to work in the SDGs department, Ministry of Health or any another suitable organization.

PSN-YPG Lagos: Any parting words for Young Nigerian Pharmacists?
Pharm Efuribe: To the young pharmacists out there; you have chosen a noble profession. Pharmacists are highly respected healthcare professionals worldwide.
There are different areas of pharmacy you can go into. Pharmacy practice has moved beyond dispensing or OTC medicines sales. There are diverse areas of specialization out there for you to explore.

PSN-YPG Lagos: Thank you so much for your time, Pharm Adaku Efuribe. PSN-YPG, Lagos truly appreciates you.