Challenges to clinical pharmacy practice in Nigerian hospitals: a qualitative exploration of stakeholders' views

Rationale, aims and objectives: In Nigeria, a shift from the traditional pharmacists' role of dispensing and compounding of medications began in the 1980s with the introduction of drug information services and unit dose-dispensing systems in some hospitals. More than three decades after this, clinical pharmacy practice is still underdeveloped. This study was conducted to explore stakeholders' views on the barriers to the development of clinical pharmacy practice in Nigerian hospitals. Methods: Qualitative, semi-structured interviews were conducted with 44 purposefully sampled Nigerian stakeholders including pharmacists, pharmacy technicians, doctors, policymakers and patient group representatives. Transcribed interviews were entered into the QSR (Burlington, MA, USA) NVivo 10 software and analysed thematically. Results: Three major themes emerged from the study: pharmacists' professional identity, the structure of pharmacy practice and external barriers. The results revealed an ongoing struggle by Nigerian hospital pharmacists to establish their clinical identities as many non-pharmacy stakeholders viewed pharmacists' roles to be mainly supply based. Barriers to the development of clinical pharmacy practice identified included pharmacists' lack of confidence, shortage of pharmacy staff, underutilisation of pharmacy technicians, lack of specialisation and clinical career structure, medical dominance and opposition and lack of policies that support clinical pharmacy practice. Conclusion: Several years after its introduction, clinical pharmacy practice is yet to be fully developed in Nigerian hospitals. The barriers identified in this study need to be addressed in order for clinical pharmacy practice to flourish.