Systemic Barriers to Pharmacist Prescribing Authority in Nigeria: An Institutional Analysis Using Historical, Policy, and Comparative International Perspectives

Pharmacist prescribing authority, encompassing independent, collaborative, and supplementary prescribing models, has been adopted in numerous high-income and middle-income countries as a strategy to extend access to medication management expertise and reduce prescriber bottlenecks. In Nigeria, pharmacist prescribing remains legally unrecognized despite chronic physician shortages and evidence of pharmacist competence to manage therapeutic decisions. This study conducted a systemic institutional analysis of barriers to pharmacist prescribing authority in Nigeria using historical reconstruction, policy analysis, and comparative international perspectives. A three-layered analytical design was employed: historical analysis of professional regulation documents dating from 1964 to present, using archival research; critical policy analysis of current pharmacy and medical practice legislation; and comparative case studies of pharmacist prescribing implementation in the United Kingdom, Canada, Uganda, and South Africa using documentary evidence. Theoretical integration was achieved through neo-institutional theory. Findings identified five systemic barrier clusters: jurisdictional boundary maintenance by the medical profession enforced through institutional arrangements; legislative inertia within current pharmacy practice laws; absence of pharmacist prescribing training infrastructure in Nigerian universities; professional association fragmentation undermining unified advocacy; and public perception gaps around pharmacist clinical competence. Comparative analysis revealed that countries achieving pharmacist prescribing authority had in common a unifying policy champion, demonstrable workforce access crises, and pilot evidence from structured programs. These insights generate an actionable national roadmap toward pharmacist prescribing recognition in Nigeria, including legislative reform milestones and pilot program designs. Keywords: pharmacist prescribing, institutional analysis, pharmacy legislation, Nigeria, professional authority