Yaoundé - 18/06/2019

Journal africain d'informations sanitaires, environnementales et de développement durable

Dr Prosper Hiag : « La couverture santé universelle est la meilleure manière de combattre le médicament de la rue»

Dr Prosper Hiag, Président de l’Ordre National des Pharmaciens du Cameroun

Le Président sortant de l’Ordre national des pharmaciens du Cameroun donne les avantages de la couverture santé universelle dans la lutte contre les faux médicaments.

 

Pourquoi une assemblée générale ordinaire maintenant, au lieu d’une extraordinaire?

La loi 90/035 qui organise la profession de pharmacien nous fait l’obligation à cette heure, d’organiser une assemblée générale ordinaire tous les ans. Il peut avoir des assemblées extraordinaires, mais tous les ans, il faut une assemblée ordinaire. Le mandat dure 03 ans. Il peut être rallongé en fonction d’un certain nombre de contraintes. Ça été le cas, à mon mandat. Il a été prorogé parce qu’il y avait des travaux, qui avaient été entamé et qui devait être achevés pour une durée de 06 mois donc, de février jusqu’au mois d’août. Mais au mois de juillet, il y a eu la convocation du corps électorale au Cameroun. Pendant cette période, il était difficile d’organiser une assemblée. Il n’était même pas recommandé d’organiser une assemblée générale qui allait mobiliser prêt de 400 pharmaciens notamment pendant la campagne électorale, donc on a préféré attendre et le ministre a prorogé de 03 autres mois au poste de président de l’ordre. C’est pour cette raison que nous avons organisé cette assemblée au mois de novembre. Et pour clore donc le mandat qui avait commencé en 2015 au mois de janvier, nous avons été installé en janvier et élu au mois de février. Voilà un peu sur le plan légal ce qui est prévu par les textes en matières d’organisation d’une l’assemblé générale.

Quel en a été l’objectif principal ?

C’était de faire un bilan de mandat. C’était de dire voici, vous nous avez donné un mandat en 2015 nous sommes à la fin, voici ce que nous avons fait. Et d’obtenir de l’assemblée un quitus parce que le bilan c’est le rapport moral du président, le rapport d’activités de la secrétaire générale ou du secrétaire général. Et surtout, le rapport financier car l’argent étant toujours le nerf de la guerre, il faillait expliquer ce que nous avons fait et comment nous l’avons fait.

Direz-vous que le bilan de votre mandat a été positif ?

Oui, il a été positif car à la fin, le quitus a été voté. C’est à dire qu’on a approuvé ce que le président et sont équipe ont fait comme réalisation et menée comme action. Le lendemain devrait se tenir l’assemblée générale extraordinaire élective, mais bon dans nos traditions, il y a ce qu’on appelle le quorum. Le quorum c’est le nombre de personnes présentes par rapport au nombre de pharmaciens, inscrits au tableau de l’ordre. On en a 900 inscrits au tableau de l’ordre et là, il y en avait que 435 pharmaciens. Il fallait les deux tiers (2/3) de 900, ça fait 600 pharmaciens. Nous étions moins de 400. Avec des procurations, on pouvait atteindre les 435. C’est pour cela que l’assemblée générale élective n’a pas eu lieu, faute de quorum, donc elle est renvoyer dans a peu prêt un mois.

Pourquoi une telle absence notoire des pharmaciens à cette assemblée générale ordinaire ?

Peut être on a mal communiqué. Mais de ce je sais, on a essayé de communiquer par les canaux habituels. Ce sont les grossistes répartiteurs, par leur message facture. Ce sont les Sms (messages téléphoniques), c’est également notre partenaire de téléphonie mobile qui a rappelé aux pharmaciens sur notre base de données, qui a envoyé les informations également. Donc on a utilisé tous les canaux habituels pour pouvoir communiquer, les mails, les ‘’whatsap’ (application téléphonique) pour pouvoir informer au maximum.

La vérité c’est que beaucoup de pharmaciens sont hors du pays. Ça c’est un souci qui dure même, depuis des années. Nous avons une diaspora importante. Ces pharmaciens ne sont pas toujours là, sur place et il y a parmi, les jeunes notamment des jeunes qui font partie de la division. Ce sont eux les plus nombreux. Ils viennent de rentrer dans le métier. Soit ils vont dans la fonction public, quand ils ont été formés à Yaoundé, à Douala, ou dans le privé, pour beaucoup qui sortent de l’Université de Bangangté. Ceux là, très souvent ne trouvent pas le job au pays et vont voir à l’extérieur, pour ceux qui peuvent le faire. D’autres n’ont pas simplement les moyens de se déplacer pour venir à l’assemblée. Ça aussi ça existe.

 

A quoi est dû le taux de chômage des pharmaciens ?

Je crois que nous formons à ce jour, 150 pharmaciens par an au Cameroun, depuis quelques années. Lorsque je prenais mon mandat, nous étions au numéro 1100. Et aujourd’hui, nous sommes au numéro 1800. C’est-à-dire qu’on a inscrit 600 à 650 pharmaciens de plus en 03 ans et quelques. Ça veut dire qu’on a fait monter la démographie de prêt de 60%. C’est important ce chiffre là. Il faut pouvoir absorber et intégrer tout ce monde là, dans le métier. Ce n’est pas facile. Quelques soient les solutions qu’auraient trouvé la fonction public, à un moment donné ça va plafonner. Il faut peut-être revoir le nombre de pharmaciens qui sort par rapport au nombre d’emplois qu’on peut créer. C’est à ça qu’il faut arriver. C’est de dire que nous allons former tel nombre de pharmaciens parce qu’il y a un nombre de personnes qui vont prendre leur retraite, il y aura tant de postes créés dans la fonction public, il y aura tant de sites à créer dans un certain nombre de localités. C’est en fonction de cela qu’on doit former. Il faut vraiment une cohérence entre le nombre de pharmaciens qui sort et le nombre d’emplois qu’on est à mesure de créer dans la profession.

Qui est pharmacien?

Dans la pharmacie, il existe plusieurs métiers ; le pharmacien de l’hôpital a un métier a part. C’est celui qui participe à la l’organisation de l’hôpital, il participe auprès des médecins pour trouver des solutions thérapeutiques, à mettre des stratégies thérapeutiques ensemble, au choix des médicaments, et au bon usage des médicaments à l’hôpital. Tout ça fait partie de ses missions. Ils sont également appelés à faire des choix aux niveaux des fournisseurs. Ils doivent les agréer, les auditer, ils doivent s’assurer que ce sont les médicaments de qualité qui sont livrés à l’hôpital et qui va soigner le malade à l’hôpital.

Le pharmacien d’officine, lui il est dans son officine. Il fait de la dispensation, il fait du conseil, il fait de la communication en direction du public qu’il accueille, qu’il reçoit. Donc, c’est un prestataire de services. Des services qu’on appelle aujourd’hui, les services pharmaceutiques. Là aussi, c’est un métier qui est orienté vers le patient mais un patient qui est en ville, un patient qui est dans sont quartier, pas un patient qui est à l’hôpital. Mais évidement, dans le cadre du réseau ville hôpital, on peut-être amener une fois qu’on a commencé à suivre son traitement à l’hôpital, le poursuivre à l’officine c’est ça le réseau de l’hôpital ville.

Pourquoi des pharmacies à l’hôpital et à l’extérieure ?

Il y a une pharmacie de l’hôpital car l’hôpital doit avoir les médicaments pour les malades hospitalisés, pris en charge par l’hôpital. Il faut absolument un certain type de médicaments à l’hôpital. Par exemple, les médicaments de la douleur. Mais il faut agir vite, vous avez été opéré. Il ne faut pas que vous ayez mal. Vous êtes accidenté, il faut que tout de suite on réagisse. On ne doit pas allé chercher le médicament en ville. Il faudrait que l’hôpital ait le stock nécessaire qui permet d’intervenir et d’assurer les soins du malade. Il est normal qu’il y ait une pharmacie à l’hôpital, mais cette pharmacie est à usage interne.

Pourquoi cette différence de prix entre la pharmacie d’officine et la pharmacie externe ?

Les pharmacies de l’hôpital vendent surtout du médicament générique et ça peut-être également des spécialités mais ce sont des spécialités hospitalières. Normalement, on ne devrait pas avoir le même médicament à l’hôpital qu’à la pharmacie. On devrait avoir les médicaments hospitaliers sous cette présentation là. D’ailleurs que, c’est un médicament qu’on va déconditionner et qu’on va donner au malade. Au moment de la facturation, elle ne serait pas la même que si vous avez acheté un médicament en ville. Les médicaments de l’hôpital coûtent moins cher parce que l’hôpital ne fait pas la même marche de prix que le pharmacien et en plus à l’hôpital, on ne paye pas les impôts. Le pharmacien en paye et beaucoup. Donc, le pharmacien a une marge qui est réglementée. Il l’applique à l’hôpital et il y a des marges mais qui sont des marges qui sont là pour couvrir un certain nombre de prêts mais qui ne sont pas des marges commerciales. Elles sont également fixées part un texte. Les prix des médicaments dans les formations sanitaires publics dont les marges appliquées sont fixées par un texte réglementaire, normalement le prix devrait être le même dans tous les hôpitaux.

Où en est-on avec votre proposition de réforme de la réglementation de la profession?

Ces textes sont aujourd’hui à la fin et nous allons remettre le document au ministre au cours d’une audience qui va nous accorder très prochainement. Nous allons lui remettre ces documents sur lesquels la profession a souhaité voir des changements car ce ne sont pas des pharmaciens qui écrivent la loi, ils proposent aux législateurs. Ils proposent au technicien de droit. Il dit que, voici comment j’aimerais que mon métier soit demain. Il appartient maintenant au technicien de formuler sous la forme de textes ce qu’il a entendu, ce que le pharmacien a dit.

Quel est le champ d’action du pharmacien ?

Le médecin diagnostique, prescrit et le pharmacien dispense. Ils doivent collaborer car ils ne font pas le même métier. Mais de plus en plus, on parle d’inter professionnalité, de mettre tous les accords ensemble, l’infirmier, le médecin et le pharmacien, chacun jouant sont rôle. L’infirmier c’est celui qui va administrer les médicaments qui ont été prescrits par le médecin et qui ont été dispensés par le pharmacien. Le pharmacien va parler médicament le médecin va d’avantage parler de diagnostique, de savoir ce qui se passe chez vous et dire qu’est ce qui vous faut maintenant et en discuter avec le pharmacien. Quel est la meilleure solution thérapeutique pour vous. Il faut qu’il en parle et c’est ce qui est intéressant en milieu hospitalier. C’est de voir que ce dialogue existe, qu’il s’installe et ce par rapport à un malade particulier. On discute et on voit quelles sont les possibilités, quelles sont les stratégies que l’ont va mettre sur pied. Donc, ce sont des métiers complémentaires et qui ont pour seul mission d’apporter des soins de qualité et surtout guérir le patient, soulager le patient beaucoup plus.

« Celui qui importe sans agrément fait des importations clandestines, illicites. »

Quel est le principal problème que rencontre le secteur pharmaceutique et comment y remédier ?

Nous avons malheureusement une gangrène qui s’appelle médicament de la rue. Il faut que la communauté nationale se mobilise contre ce drame. Le médicament de la rue n’est pas bon. Il faut absolument qu’on le combat tous les jours et sans relâche. Mais la meilleure manière de le combattre ça va être encore de mettre sur pied la couverture sanitaire universelle. Lorsqu’on aura cet outil chacun aura sa carte d’assuré et lorsqu’il aura une prescription, on ira à la pharmacie prendre ses médicaments sans débourser de l’argent. En ce moment là, il n’aura plus besoin de demander le prix avant d’aller chercher l’argent ou de demander le prix pour aller chercher ailleurs qu’à la pharmacie. Dés qu’on aura réglé ce problème, je vous assure que l’économie du médicament se portera mieux. Les pharmaciens iront mieux, l’industrie qui s’installe fonctionnera mieux et on créera plus d’emploie dans le secteur. Et ces jeunes qui sortent auront un emploi décent.

D’où viennent les médicaments de la rue ?

Tous les médicaments se retrouvent dans la rue. Normalement ceux qui doivent importer doivent être agréés. Celui qui importe sans agrément fait des importations clandestines, illicites. Bon, vous avez plusieurs portes d’entrée dont la porosité de nos frontières parce que contrôler tout ça n’est pas évident. Donc, il faut évidement que dans le cadre d’un plan de lutte multisectorielle, tous les secteurs qui sont engagés dans cette bataille travaillent ensemble. C’est-à-dire les douanes, le commerce, la justice, la police, la gendarmerie, le ministère de la santé, les impôts car il n’est pas normal par exemple qu’on entre dans un marché et on trouve des personnes avec des patentes vente des médicaments. Dans un marché ! Est-ce que c’est normal ! Les cachets c’est sur les documents que vous allez utiliser, mais on peut les utiliser pour tracer le médicament car sur la facture, apparait un numéro de lot et c’est ce numéro qui peut être suivi et évidement cela renvoie au travail qui peut être fait par le laboratoire national de contrôle et d’expertise.

« Il n’est pas normal par exemple qu’on entre dans un marché et on trouve des personnes avec des patentes de vente des médicaments.»

 

Peut-on parler de pénurie en médicaments aujourd’hui ?

Je voudrais ajouter qu’on a fait de gros efforts pour améliorer l’accessibilité et la disponibilité du médicament depuis les années de la dévaluation où il n’y avait pas pratiquement de médicaments, puisqu’on parle beaucoup de médicaments dans les hôpitaux aujourd’hui. Mais il faut se souvenir qu’à la dévaluation du franc CFA, il n’y avait pas de structure qui s’occupait de la distribution des médicaments dans les hôpitaux et que la Cename a été créée en 1976, a démarré ces activités vers la fin des années 1990 et à fait du bon boulot. Aujourd’hui, il y a quelques soucis. Mais nous en tant que professionnels, nous souhaitons que cet outil continu à remplir les missions fondamentales qui lui ont été confié. C’est d’approvisionner les structures de formations sanitaires publiques d’abord en médicament générique de qualité. Aujourd’hui, il y a les médicaments dans les hôpitaux parce qu’on a mis en place une centrale d’achèvement pour le faire, pour acheter en gros, passer des appels d’offre pour baisser les prix. Il faut que cet outil là, ce dispositif que nous avons mis en place continue, que la Cename fonctionne, qu’elle remplisse ses missions. Ça permettra au secteur public d’avoir le médicament. Le secteur privé lui, est très organisé avec les grossistes privés qui importent et qui distribuent, qui ont une bonne logistique. Mais les deux systèmes doivent fonctionner de manière concomitante pour permettre au patient qui va à l’hôpital, d’avoir le médicament et à celui qui va à l’officine d’avoir des médicaments de qualité.

Quels sont vos projets, après la présidence à l’ordre ?

Il y a une vie après la présidence et il y a beaucoup de choses à faire. Il y a beaucoup de travail, rassuré vous. j’ai quelques idées là-dessus. Après la présidence, on peut faire beaucoup on peut écrire, on peut réfléchir avec d’autres, on peut organiser une formation continue, on peut entrer dans le mouvement associatif des pharmaciens, jouer un certain rôle avec l’expérience emmagasinée. C’est six années au conseil et deux mandats comme vice-président et comme président, je pense qu’il est temps de passer à autre chose.

Entretien mené par Carole Ambassa

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