VOL. 2 2015
Chairman's express our sincere gratitude to you for the trust address reposed in us and by the grace of Almighty God we shall be leaving the Association of Community Pharmacists of Nigeria (ACPN) better than we met it. No sooner had I assumed the Leadership of ACPN than I was faced with the issue of the National Drug Distribution Guidelines. This matter is receiving t gives me great pleasure and honour to inform you utmost attention, with high level consultations on the various activities at your National involving all stakeholders concerned and as work is Secretariat since you entrusted the running of our progressing our ultimate target is to sanitize the great association in June at Sunshine 2015 to a brand presently chaotic drug distribution in Nigeria. I urge new EXCO under my Leadership. Let me therefore you not to be in doubt that your leadership will do use this opportunity to on behalf of the Natinal EXCO everything within its reach to ensure a secure and more conducive atmosphere for practice by all Community Pharmacy Practitioners in Nigeria.
To familiarize myself with the players in the Pharmaceutical Industry courtesy calls were made to Managing Director and Management Team of Gsk, Biofem, World Wide Ventures Ltd and the Chairman of Greenlife Pharmaceuticals Ltd. Other companies will be visited in due course.
Again courtesy calls were made to the Registrar of Pharmacists Council of Nigeria, the Executive Secretary of the National Health Insurance Scheme(NHIS) and Chairman Board of Fellows . We will continue to engage the Regulatory authorities , next on the line is NAFDAC and NDLEA to ensure better practice environment.
We have engaged Glo mobile network management team as a follow up to the already signed memorandum of understanding on Glo Mobile Money and Closed User Group (CUG) . I will like to use this opportunity to encourage members to key into these scheme as this will serve as extra service to our teeming clients/patients Furthermore, I represented you at the FIP World Congress of Pharmacy and Pharmaceutical sciences 2015 between the 29 September - 3 October 2015 at Dusseldorf, Germany . The message I have brought back is that of change in all areas of practice, so I am urging you to look at your practice critically and continue to carry out some positive change .
Finally as we plan for Enugu 2016 I wish to solicit for the support of all members to make the conference a highly educative and rewarding one . God bless you, God bless ACPN and the Federal Republic of Nigeria.
Dr . Albert Alkali. FPCPharm.
National Chairman
t brings me great joy to be at this point of my The profession of Pharmacy especially life again. Bringing you another edition of our community practice (like the biblical quote) is troubled on every side, yet not distressed; Perplexed, but not in despair. We do sincerely Indeed, the Good Lord has been so good to me, hope that this conference will ignite the flame of my family, to ACPN and to the Nation.
change and progress to our profession.
Irrespective of what a lot of people might think, I strongly belief that our Nation is about to To all delegates at the 88th Annual Conference of emerge as one of the brightest nation's on the our esteemed society "Abuja 2015", I say a big planet. Just watch out!!! welcome to you all.
A year has just flown by. It seems just like As a reminder, this is an election year and I want to yesterday when I took up the reins of office as urge you all to vote "Selfishly" so as to bring about the Editor of this newsletter. Time does fly the leader that YOU want. A new team is now in place at the ACPN deliberations and I most sincerely wish you a National office. The New Executives have better 2016 in advance.
already begun enthusiastically and you can be Lawrence Ekhator.
sure of a great outcome towards the upliftment of Community Pharmacy Practice in our Nation.
Pharm. Madehin Gafar OlanrewajuNational Treasurer Dr. Alkali Albert Kelong, FPCPHARM National Chairman, 08035903469, [email protected] Pharm. Daniel F. Ajayi, MAWNational Financial Secretary Pharm. Samuel O. Adekola 08066230510, [email protected] National Vice Chairman 08036722654, [email protected] Pharm. Chima A. OgbuNational Publicity Secretary Pharm. Adeoye Afuye MAW National Secretary, 08068508974, [email protected] Pharm. Mrs Bukola FolorunsoDIC Chairman, Pharm. Lawrence Ekhator National Assistant Secretary, 08033432538, [email protected] Pharm (Alh) Olufemi Ismail Adebayo, FPSN Immediate Past National Chairman, 08037175060, [email protected] All correspondence to the newsletter should be addressed to:The Newsletter Editorial SecretaryACPN National NewsletterACPN National Secretariat: 52A, Ikorodu Road, Fadeyi Lagos.
Tel:08187335846 e-mail: [email protected] "EXPLORING NEW FRONTIERS IN
On the occasion of the opening ceremony of
First, let me thank the Executive Committee of ACPN for The Pharmacist must have graduated from an approved inviting me to this Conference and to share my thoughts University in Nigeria, gone through internship and NYSC on a topic that is very relevant to the Survival of mandatory programs. Then he is qualified to be registered Community Pharmacy Practice in Nigeria. by PCN and can superintend a Pharmacy facility. I cannot Permit me to recognize the efforts of some Pharmacists in but agree with the qualities of a Pharmacist in terms of this State that have contributed to the growth of knowledge, attitudes, skills and behavior which WHO Pharmacy Practice and indeed Community Pharmacy Consultancy summarized as seven Star Pharmacist I wish to specially recognize and commend the deep Care giver - provide caring services in the community.
interest shown by the Executive Governor of this State in Decision maker - appropriate & cost effective use of the harmony that exist among health workers in the state. He is an epitome of a team player in the Health care iii. Communicator - as an intermediary between Doctor The practice of Pharmacy has been changing over the iv. Leader - assume Leadership position in the years prompting its Practitioners especially Community Pharmacists to explore new frontiers. Manager - manage Staff & resources Today anybody with a reasonable level of education can vi. Life long learner - continue learning programs update access reliable information on drug use, indications, vii. Teacher - provide mentorship to the young ones contraindications etc. by logging onto one of the relevant websites. Information on diagnosis and treatment of Community Pharmacists are therefore healthcare diseases has been demystified and the question is do providers who patients can consult on: patients still need our services? Health -related problems as he has healthcare products & services To begin our discussion on the topic of the day, I will like to Some Health problems can be managed at the point take some definitions: Health problems requiring additional diagnostic Explore: means to search, research or inquire into. skills and treatment can be referred to the physician Frontiers: An undeveloped field of study, a topic Must guarantee the integrity of medicine sold inviting research and development simply put it an ensuring proper storage.
Community Pharmacy: is a healthcare facility that PLACE OF DRUGS IN HEALTHCARE
provides Pharmaceutical Services to a Community. It involves a registered Pharmacist licenced by A good healthcare service is judged by its ability to Pharmacist Council of Nigeria to superintend and promptly assess the sick, provide care and give the right run the business. Majority of Community medication to resolve or manage the illness. Drugs thus Pharmacies are founded and privately owned by have a special place as indispensable life savers in Pharmacists or group of Pharmacists.
Healthcare delivery. At the Launch of the prescription legend in the United States of America (USA) in 1962, In USA, companies own the big chain Pharmacies. Private President J. F. Kennedy described the Pharmacist in the ownership is very few. In the U.K, companies own 60% of following kind words "The Pharmacist is an indispensable all Community Pharmacies as part of their multiple link in the chain of National Health protection and promotion, if we do not have Pharmacists, it would have been necessary to invent him "this was reaffirmed by Dr. Community Pharmacy Practice is both a professional and Hiroshima Nakajima former World Health Organization business practice. Globally community Pharmacist attend Director General when he said in 1989 "without Drugs, a to the drug needs of majority of the people in Africa. In health service has no substance and no credibility".
Nigeria and most African countries, Pharmacies are most COMMUNITY PHARMACY PRACTICE ENVIRONMENT accessible Health facility. They are usually first point of Community Pharmacy practice is both a professional call in by patients in the neighborhood. practice and private business. Community Pharmacists attend to the drug needs of majority of the people in Africa. According to an IFC publication in 2008 (Business of Health in Africa), of the total health expenditure of $16.7 billion in 2005, about 60% was out-of-pocket payment by individuals; much of whom are poor rural citizens. Also much of the expenditure is on drugs.
Some Community Pharmacists operate as Importers, Distributors and Retailers of drugs and are regulated in Nigeria by Pharmacist Council of Nigeria (PCN) and National Agency for Food and Drugs Administration and Control (NAFDAC). To understand the practice environment, the following figures from an IFC draft report are important to note: IFC data 2008 PCN data 2014 No. of registered Importers No. of Distributors No. of registered Medical Practitioner No. of Dental practitioners No of Wholesales Premises No. of registered Community Pharmacists No. of registered Pharmacists No. of registered Patent Medicine Stores No of Reg. Pharmacists as at May, 2015 No. of reg. Patent Medicine Stores May, 2015 , No. of reg. Pharmacy Technician May, 2015 2,526 Also, according to the IFC draft report, unregistered and unregulated open drug markets and informal sellers are responsible for about 70% of total sales of both ethical and OTC drugs in Nigeria. Therein lie the crux of the problem, since the bulk of fake and counterfeit products as well as parallel imports of pharmaceuticals enter the market through this channel.
The preponderance of malpractices carried out by quacks, sometimes with tacit connivance of professionals still abound. Also, despite some positive results reported by the Pharmaceutical Inspection Committees (PICs) of the PCN, these activity smacks of conflict of interest as the PCN lack capacity to own its fulltime Inspectors to carry out all inspection activities.
market through this channel.
Also, according to the IFC draft report, unregistered and Insistence of many Pharmacists to own and run unregulated open drug markets and informal sellers are Pharmacies alone despite obvious lack of resources.
responsible for about 70% of total sales of both ethical Many Pharmacies remain impoverished and and OTC drugs in Nigeria. Therein lie the crux of the sometimes look worse than patent medicine stores. problem, since the bulk of fake and counterfeit products Therefore Chain Pharmacies that can attract as well as parallel imports of pharmaceuticals enter the funding from reputable Finance Institutions and market through this channel.
allow growth of the Pharmacies should be encouraged. Happily a few are beginning to emerge In 2007, Pharmaceutical Manufacturers Group of the in Nigeria (Mediplus, Healthplus, Alpha etc) Manufacturers Association of Nigeria (PMG-MAN) The practice is largely dominated by middle aged estimated the total pharmaceuticals and healthcare and old Pharmacists. Only few younger and new products market size to be in excess of US$2 billion. This is graduate show interests in this aspects of practice excluding biological products like vaccines which was put apparently because of the poor remuneration and at US$100 million. Herbal products, vitamins, healthcare hostile practice environment.
consumables and medical devices are not included in this Practitioners, still to a great extent "compete" with quacks, (patent medicine license holders, illegal This is a huge market, but sadly, some 70% of all this operators and hawkers of medicine).
business is done through unregulated open markets.
The unstructured pricing system of most if not all Pharmaceutical companies do not attract NEW FRONTIERS THAT MAY BE EXPLORED IN
patronage from hospitals within and around the COMMUNITY PHARMACY PRACTICE
practice areas.
From earlier submission, it is obvious that Community Also, according to the IFC draft report, unregistered and Pharmacy Practices needed to be moved to the next level. unregulated open drug markets and informal sellers are Daily routine in prescription filling and counting of tablets responsible for about 70% of total sales of both ethical can be done by support staff's. Globally, task shifting is the and OTC drugs in Nigeria. Therein lie the crux of the order of the day in the Healthcare industry. Pharmacy problem, since the bulk of fake and counterfeit products Technician can be supervised to engage in most of the as well as parallel imports of pharmaceuticals enter the Pharmacists routine, such that the Pharmacist can concentrate on Pharmaceutical care using his deep products. There is a growing need of veterinary products knowledge and skills in clinical Pharmacy.
and so a section of the Pharmacy can be allocated to veterinary Pharmaceutical products. Such products National Health Insurance Scheme (NHIS)
One of the interventions of achieving the goals of Mineral supplements National Health and drug policy is the introduction of NHIS by decree 35, 1999.
Milking ointments Scheme was to address issues of :
Flea and tick repellants Healthcare funding Equitable access to Healthcare Promote professionalism Build Health data This can improve the economic fortunes of Community Improve on our Health indices Pharmacy Practitioner especially those in urban dwellings.
Almost 10 years after inauguration, the scheme has witnessed a stunted growth due largely to poor It is obvious that Group Practice can change the face implementation. NHIS is a big business and billions of of Community Pharmacy.
naira have been disbursed to healthcare providers and Pull resources together today ACPN members are not participating because of Take new identities the Nigeria factor of the winner takes it all.
Better bargain Powers with financial institutions At a time government is focusing on Universal Health Invest in drug distribution Insurance coverage for her citizen it becomes necessary Import rare pharmaceutical products for ACPN to reflect, go back to the drawing board and Form bigger entities to participate in NHIS and other engage relevant authority and bring back community Government big business Pharmacists into the scheme. We have a primary duty to protect the enrollee by guarantying the quality of drugs Participate in Government Health Programmes produced and dispensed to Nigerians who are in the scheme.
The Community Practice is better positioned to ACPN must invest in group practice and position participate in Community Health Programmes: This can Community Pharmacies in both rural and urban centers only be achieved by working closing with other such that enrollees in NHIS will find it very convenient to Healthcare providers. The Pharmacists should sharpen fill their prescription.
his skills & knowledge by attending short time certificate courses as approved by International bodies USAID, Public Health
It is desirable for Community Pharmacists to obtain Health Programmes such as: Diploma in Community Pharmacy Practice to integrate point of care diagnosis, in line with global trends towards preventive healthcare and based on the need for appropriate diagnosis, more effective management of common ailments. ACPN should partner with community pharmacy department of the post graduate college of Public Private Partnership (PPP) There is a huge potential for Community Pharmacists by Management of chronic disease
engaging with Public Health Institutions to bring The community Pharmacist is an invaluable asset, Pharmaceutical care to their patients: PCN records considering that treatment of chronic diseases often revealed that only 190 LGA's (24.5%) have at least one requires the long-term use of medicines: registered pharmacist while 584 LGA's (75.5%) do not Community Pharmacists must recognize preventing have any registered pharmacist.
chronic diseases common in the neighborhood.
Identify and study PCN guidelines on PPP Advocate for inclusion in provision of health Ensure your facility while in PPP can qualify to screening for chronic diseases as diabetes hypertension, cancer etc.
Counsel patients appropriate use of medicines.
Improve on professionalism Advocate lifestyles changes that prevent a chronic Economically viable venture disease and improve outcomes of drug therapy.
Command respect from financial institutions Alcohol, Smoking, Weight loss & Diet etc.
SpecializationPharmacy is dynamic and there is need to Veterinary Pharmaceutical Practice
specialize on specific areas that make you stand out in In this part of the world, community Pharmacist shay your Community.
away from stocking and dispensing of Veterinary Acquire skills & knowledge Community Pharmacists are community Enroll in post graduate programmes based knowledge resources that can help people Specialize in one or two areas after a need understand unhealthy lifestyle and early detection assessment is carried out in your Community (disease of chronic diseases and how to prevent same. prevalence in your community) Produce handbills and become an authority on Key into COPA centre initiative and hold franchise drugs to other healthcare providers in your of unique products.
Specialization will earn you respect and Homecare Services confidence. Bring more clients and improve your economic Focus on Elderly patients with chronic or terminal diseases.
I am one of the proponents that herbal medicines Chronic diseases - as many long term are the future of Pharmacy Practice. Evidence abound that illnesses are managed by means of prescribed drugs.
where orthodox drugs fail, herbal remedies have taken over and done very well.
These products are not cheap but our clients search and go To actualize some of the steps towards the new for them. It is also economically viable to engage in the sales frontiers in our practice, I would like to recommend of herbal medicines.
National executive committee of ACPN to ACPN can invite a Director of NAFDAC including set up a working committee to identify some of Herbal medicine Department of the Federal Ministry of these opportunities, classify them in terms of short Health to offer training to members that are interested.
and long term basis Engage government and relevant authority Some Pharmacies can specialize in herbal of bringing community Pharmacists back in the remedies and this will boost the image of the profession and NHIS scheme especially now that government is economic value of the individual.
favourably disposed to Universal Health coverage in DRUG USE IN SPORTS Community Pharmacists must take interest in ACPN to make special case to Pharmacists specializing in drugs use in sports. Products such as: Council of Nigeria in terms of group practice Anabolic Steroids ( lean mass builders to increase without breaching PCN laws ACPN practice working committee to visit Stimulants - amphetamine ( increase alertness and and make a case to the Minister of sports on the need decrease fatigue) to include pharmacists in their contingents to Narcotics - painkillers to relieve injury pain in manage drug use in sports within and outside Relexants - Alcohol & Marijuana ACPN members should from 2016 make it Diuretics - used by wrestlers mandatory for every member to demarcate a ACPN need to engage government at the highest level and section of their pharmacy for sales of vertinary ensure that colleagues who specialize in sport medicines are part of sporting contingents. There is a huge window of Community pharmacists should from 2016 opportunity for community pharmacist in drugs use in make it mandatory to employ at least one Pharmacy Technician as part of meeting the global trend in task Health Promotions shifting in most professions COMMUNIQUÉ OF THE 34TH ANNUAL NATIONAL CONFERENCE OF THE ASSOCIATION OF COMMUNITY PHARMACISTS OF NIGERIA (ACPN)"SUNSHINE 2015" HELD BETWEEN 31ST MAY TO 5TH JUNE 2015, AT JOJEIN HOTEL & RESORTS, AIRPORT ROAD, OBA-ILE, AKURE, ONDO STATE.
The conference was declared open by His the management of clinical diseases states. Excellency, Dr. Olusegun Mimiko, CON, the Conference enjoined Community Pharmacists Executive Governor of Ondo State. The to play increasing roles in chronic disease Chairman of the occasion was Dr. Joseph management, immunization and medication Odumodu, FPSN, MFR, the Director General, therapy management. These services should Standard Organization of Nigeria ably inculcate accountability, diagnostic screening represented by the President, Pharmaceutical to assist in improving therapeutic outcomes and Society of Nigeria (PSN), Pharm. Olumide lowering overall healthcare cost.
Akintayo, FPSN, FPCPharm, FNAPharm, FNIM. Conference reiterated the need for Other dignitaries that attended the conference practitioners to brace up and adopt global best include; the first lady of Ondo State; Her practices. Participants therefore called for Excellency Mrs. Olukemi Mimiko, Chief of staff ethical re-orientation and maintenance of to Ondo State Government, Dr. Kola Ademujimi, professional standard among members. It Ondo State Head of Service Mr. Toyin Akinkotu agreed that the professional role of Pharmacists Esq, Commissioner for Health, Ondo State, Dr. in the Community setting is evolving and Dayo Adeyanju, former President of the changing from the traditional dispensing and Pharmaceutical Society of Nigeria, Pharm. distributive role to best practices in patient Azubike Okwor, FPSN, FPCPharm, FNAPharm, FNIM, FFIP, the Representative of the Registrar, pharmaceutical care models, medication Pharmacists Council of Nigeria (PCN), Pharm. therapy management and effective patient Ahmed Babashehu, the Regent of Akureland, education to achieve good therapeutic His Royal Majesty, Pharm. Adetutu Adesida, Pharm. Deji Osinoiki, FPSN, other healthcare Conference deliberated extensively on professionals and eminent Nigerians.
the Chaotic Drug Distribution System in the country and therefore called on the Federal The Keynote Address was delivered by Pharm. Government to put all machinery in place (Sir). Anthony Akhimien, FPSN, FPCPharm, towards implementation of the new NATIONAL FNAPharm, Managing Director, Teo Pharmacy DRUG DISTRIBUTION GUIDELINES after Limited. The following Eminent Resource inculcating the finest tenets of rules of Persons presented papers during the plenary engagement with all the relevant stakeholders sessions as Subtheme Speaker, Pharm. (Mrs.) including those in industry, distributors, Folasade Lawal, MAW, Pharm. (Dr.) Emmanuel wholesalers and retailers to afford all Ayika and Dr. Adebodun Sanyaolu - (a stakeholders an opportunity to marshal a Veterinary Doctor).
common agenda in the ultimate professional Conference deliberated on the theme and and public interest.
subthemes of the conference and other contemporary issues in Community Pharmacy extensively on the concept of Retail Pharmacy Practice and the general state of the nation and Chain being promoted by the Federal Ministry made the following observations and of Health in conjunction with the International Finance Corporation and unanimously resolved Conference acknowledged the need by to jettisons the concept for the following the Society to make use of the skills and competencies of the Community Pharmacists in i) It encourages capital flight from the country through repatriation of their profit global standard. Conference implored the ii) It reduces capacity utilization of the available Pharmacists Council of Nigeria (PCN) to step up pharmaceutical manufacturing companies her monitoring and control activities in order to through massive importation of pharmaceutical drastically reduce quackery and other unethical products that are produced locally practices by the practitioners. Conference iii) Massive reduction of employed Nigerians on emphasized the need by the Pharmacists the pharmaceutical manufacturing sector of the Council of Nigeria to reform pharmacy education in all its ramifications to meet global iv) Closure of most of the registered pharmaceutical retail premises due to Conference observed drastic increase in unhealthy competition numbers of substandard, fake, unregistered and v) Lack of professionalism due to unhealthy counterfeit pharmaceutical products in the competitions and flouting of laws that regulate country and urged the National Agency for pharmacy practice. Food, Drug, Administration and Control vi) Pharmaceutical care, which has been (NAFDAC) to step up their regulatory activities promoted by the government worldwide would in respect of monitoring and closure of open no longer exist.
drug markets where those products are easily Conference advised foreign investors in Retails Pharmacy to partner with the existing Recognizing the critical role that the indigenous pharmaceutical retail chain Community Pharmacists and other trained premises in accordance with the existing laws healthcare professional play in the that regulate the practice of retail pharmacy.
management of pneumonia and diarrhea in Conference declared empathically that children under 5 years. Conference resolved to only Pharmacists should own and operate retail adopt the new WHO/UNICEF guidelines for the pharmacies in line with the relevant pharmacy management of childhood pneumonia and and drug laws, regulation and guidelines diarrhea diseases which recommend the use of especially, PCN 2005 regulation 79 and 81, the Amoxicillin Dispersible tablet as first line poison and pharmacy Act PPA and the National treatment for childhood pneumonia and co- Drug Distribution Guidelines. Retail pharmacy packed Zinc/Low osmolarity oral Rehydration is a professional practice and the window of Salt Solution (Zn.ORS) for the management of pharmacy profession anywhere in the world.
childhood diarrhea respectively. In the light of Conference lamented the wretched the above, conference therefore urged the output of the National Health Insurance Government of Nigeria, at Federal, State and Scheme (NHIS) which has achieved only a Local levels to fulfil their commitment to miserly 5% coverage which is also limited to the ensuring that budgetary provision is made for Formal Sector. Conference advised the Federal the procurement and wide distribution of these Government through the credible Buhari 2 life-saving medicines up to the rural and peri- Prudential Machinery to review the resources urban communities.
committed to National Health Insurance Conference reviewed the escalating Scheme against the background of a woeful insecurity in the country with special emphasis performance. Conference admonished the on the Boko Haram Insurgence and the spate of Federal Government to embrace new building bombings, kidnappings, abductions and blocks in the NHIS which will embrace ONLY wanton destruction of innocent lives and lawful payment mechanisms, restrict capitation properties. It called on Federal Government to to primary care centres and shift the orientation empower security agencies to put in more effort of the scheme to a private sector driven project towards bringing lasting peace and ensuring rather than public sector like we have at the security of lives and property in the Country.
Conference appreciated the Conference appreciated efforts made by government and the good people of Ondo the Registrar and the Governing Council of State for their care and hospitality. Pharmacists Council of Nigeria (PCN) in re- Conference commended the ABIYE positioning the activities of the Council to meet programme and Community Pharmacists Empowerment by the Ondo State Government.
(12) At the end of the 34th Annual General Meeting (AGM), the following National Officers were elected to serve the Association for the next one year.
Pharm. Albert Kelong Alkali, FPCPharm National Chairman Pharm. Samuel O. Adekola National Vice Chairman Pharm. Afuye Adeoye Emmanuel, MAW National Secretary Pharm. Lawrence Osarentin Ekhator National Assistant Secretary Pharm. Gafar 'Lanre Madehin National Treasurer Pharm. (Rev.) Daniel Femi Ajayi National Financial Secretary Pharm. Agnellus Chima Ogbu National Publicity Secretary Pharm. (Alh) Olufemi Ismail Adebayo, FPSN Immediate Past National Chairman Pharm(Alh.) Olufemi I. Adebayo, FPSN Pharm. Afuye Adeoye E,MAW Immediate Past National Chairman National Secretary In a "Mental Hospital" a Journalist asks a Psychiatrist: How do you determine Whether to admit a mental patient or not?Psychiatrist: "Well, we'd fill a bathtub with water and give the patient; (a-). a teaspoon,(B-). a glass cup, (C-). a bucket, and ask them to empty the bathtub.
Journalist: "Oh, obviously a normal person would use the bucket because it is bigger."Psychiatrist: "No. a normal person would pull the drain plug!"Psychiatrist: Please go to bed No. 39. We will start further investigations on you!"I am sure you reading also thought of the bucket right?Then, please go to bed No. 40!!!


Subscribe to Time » Give a Gift » Postcards Global Adviser Brazil's Start-Up GenerationBy LORI IOANNOU / SÃO PAULO Monday, Aug. 23, 2010 SHOCKING: $100Walmart Gift Cardfor $6.39SPECIAL REPORT: High ticket items are being auctioned for an. Hot Work At HomeCareersWork At Home Jobs Investigated. Can

Sebac nepal annual report 2015.indd

Foreword from Chairperson The summary presentation of SEBAC-Nepal's Social Undertakings pertaining to 2015 AD has come to Publication. It is extremely a jubilant occasion to share & cherish the meaningful outcomes and the degree of social economic transformation implanted in the social milieu entailing excluded, deprived, marginalized, vulnerable, resource poor, exploited