BY AWELE OGBOGU
While it is often joked that there is no way to decipher the contents of the stomach, meaning that one can improvise to beat hunger, it is not quite the same for drugs. The lack of access to drugs or resorting to fake medicines would easily manifest in dire consequences for the consumer.
“So are they going to wait for corpses to litter the streets before realizing that people can no longer afford to buy drugs or medicines?, a man asked.
A market survey revealed that the prices of common medications, such as pain killers, antibiotics, anti-hypertensive and anti-diabetic drugs have been increasing steadily since the beginning of the year. Hardest hit are prescription drugs, the cost of some of which runs into millions of naira.
While picking corpses from the streets may sound like an exaggeration, the truth is the country is toying with the possibility of a major health crisis, unless there is an urgent intervention to reign in the ever rising cost of medicines. The source said “what is needed is not the usual declaration of a state of emergency. It is more terrifying than it looks with major drug manufacturing companies leaving in Nigeria in droves.” The culprit is the environment for doing business, which is becoming more difficult for the operators with each passing day.
Nigerians with health challenges are in grave danger, as the prices of medicines are now beyond the reach of most people. Steadily, the depreciation of the naira against the US dollar and other major global currencies since President Bola Tinubu assumed office and the deregulation of the foreign exchange market, has sparked a chain of economic crises, in which healthcare delivery has become one of the major casualties. “The concern does not demand the usual government’s tokenism, but an effective emergency response.”
Investigation revealed that there is also the underlying problem of the mass exodus of medical doctors, nurses and other paramedics to Europe, the United States, Canada and Saudi Arabia for better pay and ideal working environment.
Owner of a major pharmacy in Asaba, Mr. Harry Oboh said that “this period is really a difficult one to fall sick in Nigeria. The prices of antibiotics, analgesics, hypertensive and anti-diabetic drugs, among others, have soared by over 400 and 500 per cent.” He gave instances with Augumentin, a popular antibiotic that used to cost N3, 500, but now goes for over N30,000. This means that for over 133 million Nigerians who have been identified as multi-dimensionally poor, this is like the “end time” unless one does not ever fall sick.
Investigations also revealed that most pharmaceutical products used in Nigeria are imported either from China, India or Europe. The non-availability of drugs may even get worse with the exit of GlaxoSmithKline (GSK) from Nigeria in October last year after 51 years. The British firm had expressed its desire to transition to a product distribution model in the Nigerian market. But many even doubted the plausibility of this business model since the easy repatriation of income from sales in foreign exchange to the home countries of multinationals is not currently feasible due to Nigeria’s fiscal conundrum.
The economy has about $7 billion in forex forwards that has reached maturity, a major concern for investors as foreign currency shortages continue to weigh down the naira currency. The Central Bank of Nigeria, (CBN) says it has cleared a backlog of about $2 billion of these forwards across sectors.
Oboh, a pharmacist said “in addressing the nation’s drug crisis, part of the focus should be on why most local pharmaceutical companies make do with marketing and distributing products manufactured abroad, instead of being manufacturers themselves”, adding that “some pharmaceutical products made under their corporate brands are actually manufactured by Indian and Chinese firms.” He called it an “untoward situation as exemplified by 70 per cent of drugs used in Nigeria being brought into the country as imported goods.”
Saying this has been affirmed by the Pharmaceutical Society of Nigeria he regretted that “it is why fake and substandard products easily get into the market, aided by weak regulation, porous borders and corrupt customs personnel.”
Data from the International Trade Centre put Nigeria’s drug import in 2020 at $2.4 billion, which has been declining since then due to forex pressures. In 2021, it was $1.37 billion and $1.05 billion in 2022. The downward trend continues as forex scarcity intensifies.
In the scheme of things, millions cannot defray healthcare costs, so they avoid treatment with quality drugs. Oboh said it looks dreadful. Saying the government is responsible for the economic turmoil and is doing nothing about it, he advised that “at least they should be support for drug manufacturers, while they should regulate prices. There is no time to waste on whatever the government needs to do”, he warned.
A federal retiree in Asaba, Mr. Nosa Ogumbor said “Nigerian citizens are already impoverished and cannot even afford to buy food to eat, not to talk of buying quality drugs when they fall sick.” Oboh therefore warned of increased morbidity and mortality.”
“When the cost of healthcare is out of the reach of the poor, they avoid going to the hospital for doctor’s attention and resort to self-help through self-medication and patronage of quacks.” Ogumbor said from experience, the most common thing to do is indulge in the use of herbs and other local concoctions. “I resort to prayers and spiritual intervention when I fall sick and my pension is not forthcoming.”
A pharmacist who did not want to be mentioned said “evidently, the solution is not in the impracticable idea of regulating the prices of medicines, which are imported. The problem is that we have the worsening forex situation on our hands. The naira depreciated to N1, 405 to a US dollar in the parallel market, while it went for N900.96 in the official window. This picture still shows a wide gulf between the two markets, thus making nonsense of the government’s policy drive for their parity. We dare say this is causing more harm to the economy and danger to the existence of Nigerians, compared to the little Tinubu may claim to have achieved.
Investigations revealed that the outrageous cost of life-saving drugs is a daily burden. Several people are now forced to take risks with their health, either by extending or missing doses, settling for less potent substitutes, resorting to self-medication or traditional healers or stopped medications entirely. What about those battling chronic ailments, such as diabetes, high blood pressure or cancer?
Experts were worried that a significant number of patients who are not taking their medications as prescribed may develop complications and incur even more expensive interventions later.
Some patients who spoke bemoaned the negative effects of rising cost of medicines, which weighed heavily on their well-being, financial situation and survival. Ngozi Uchenna, a petty trader, was concerned about her 10-year-old daughter, who has a persistent cough. Her worries were due to the high cost of the prescribed cough mixture. “I could not afford the drug syrup, so I’m taking her back home”.
James Akor also has sporadic bouts of cough and chest pains. He said he resorted to taking herbal concoctions because “one of the drugs the doctor said I should buy costs N120, 000 and I will need to buy it two or three times every month. Another drug is about N55, 000. Where will I get the money?, he lamented. “I can’t afford N1.2 million for one drug.”
What about a patient who was diagnosed with prostate cancer? He was yet to purchase any of the drugs prescribed by the doctor. The cancer was detected mid-stage, but he is only on palliative treatment because one of the drugs, Lupron Depot costs N1.2 million. The unemployed man was also placed on another drug, Zoladex, but one vial costs about N750, 000.
There are more pathetic cases. Agada Paul is a father of three, a civil servant diagnosed with heart problem. He is on a basic health insurance plan, which does not cover the full cost of treatment for his condition, so he has to pay out of pocket, but he has not saved for the rainy day and can’t get help. Mrs. Kate Oteri is 78 years old and diabetic. She is impacted by the rising costs of diabetes drugs, so she is ‘rationing’ her medication to make it last longer. Hers is the plight of being forced to choose between buying drugs or food, with children who are graduates but have no jobs.
What are the causes of high cost of drugs at pharmacies? It was gathered that in addition to the naira devaluation, price adjustments by drug manufacturers, weak government regulations, taxes, non-availability but high demand for specific medications are factors driving price increases. Health insurance is lacking, so many Nigerians still pay out of pocket for medical expenses, pushing more families into burgeoning health expenditures.
Experts are worried by this development. The consensus was that out of pocket expenditures will prevail until the gaps in financing essential healthcare services, particularly preventive health services, is addressed. Dr. Femi Akintunde cautioned that though traditional medicine practices and herbal treatments are prevalent and offer familiarity and cultural relevance, their effectiveness can vary significantly. “When treatment costs become too high, people are forced to seek affordable and untested alternatives. Although traditional medicine practices and herbal treatments are widely used in Nigeria, their effectiveness can be unpredictable,” Akintunde warned. Further he said: “While going to the pharmacy is okay for consultations for minor ailments and over-the-counter medications, relying on them for serious conditions can be risky due to limitations in diagnosis.”
“Although public clinics offer affordable care, they may face resource limitations and longer wait times. The bottom line is that the inability to access proper diagnosis and treatment from qualified professionals can worsen health outcomes.” He identified three major roadblocks to quality healthcare in Nigeria today- exorbitant cost for medications and treatment, long distances to medical facilities and dismissive attitudes of many healthcare providers.
But he re-emphasised that high cost of drugs remained the most critical hurdle, saying without health insurance or the ability to pay out-of-pocket, necessary treatment or medication will be out of reach. “Of these, the problem of cost is the most significant, because even if the patient succeeds in getting to the healthcare facility and there are cheerful health workers to attend to them, there is little that can be done if such patient is not covered by health insurance and cannot for drugs out of pocket or afford to buy the required drugs.
It was discovered that many patients struggle to stick with their medications. Drugs for chronic illnesses like cancer, heart disease and diabetes run into millions of naira. Even with health insurance, the cost of these drugs could be overwhelming, leading patients to skip doses or ration their medication.
It was also discovered that some patients, even when they start treatment, abandon them midway as the cost become unbearable. Oboh expressed particular concern about patients on multiple medication, saying that managing such regimens could be challenging, as high costs could increase the risk of accidentally skipping doses or medication errors.
“When people delay seeking medical attention, their condition can worsen and become more difficult to treat. This can lead to complications, increased healthcare costs and even death. “Worse still, if people with infectious diseases don’t seek medical attention and get the right drugs and treatment, they would unknowingly spread the diseases to others. This can be a particular risk for vulnerable populations like ours.
Meanwhile, it was revealed that the most important reason for the high cost of prescription drugs is the existence of monopoly. For many new drugs, there are no alternatives. In cases of cancer, even when there are multiple drugs to treat a specific malignancy, there is still no real competition based on price because most cancers are incurable and each drug must be used in sequence for a given patient. Patients will need each effective drug at some point during the course of their disease. There is seldom the question of whether a new drug will be needed, but only when it will be needed.
Even some old drugs can remain as virtual monopolies. For example, three companies, NovoNordisk, Sanofi-Aventis and Eli Lilly control most of the market for insulin, contributing to high prices and lack of competition. Ideally, monopolies will be temporary because eventually, generic competition should emerge as patents expire. Unfortunately, in chronic life-threatening diseases, this often does not happen. By the time a drug runs out of patent life, it is already considered obsolete and is no longer the standard of care. A “new and improved version” with a fresh patent life and monopoly protection has already taken the stage. In the case of biologic drugs, cumbersome manufacturing and biosimilar approval processes are additional barriers that greatly limit the number of competitors that can enter the market.
Clearly, all monopolies need to be regulated in order to protect citizens. This is what happens abroad through capping of launch prices of new prescription drugs.
But many stakeholders agreed that the Federal Government has not done enough to regulate essential drug products, leading to unaffordable prices worsened by inflation since Tinubu took over one year ago. No doubt, this has compounded the present suffering in the land.
