In this report by Sade Oguntola, patients and health workers say the cost of lifesaving medications is a major challenge to access to medicines, which encompasses the constant availability and affordability of essential medicines.
MR Kazeem Shittu was diagnosed with a prostate enlargement that makes urination a bit difficult. His doctor recommended some medications to help ease the voiding of urine. But his challenge a few months back was the scarcity of the medications.
“I tried buying the medication from a big pharmacy shop, but it was out of stock. The pharmacist said I should buy another brand of the medication. But days later, it turned out to be not as effective as the original brand I was given at the hospital,” Mr Shittu recounted.
On his part, Oladipo Adeoluwa was diagnosed with stomach ulcer at the State Hospital, Akure, Ondo State, after complaining of excruciating pains in his stomach lasting for over a month. Unfortunately, the drugs his doctors prescribed for him triggered more pain.
“I went back to the hospital and I was asked to undergo an endoscopy test. The test was to cost N68, 000 but I’ve not been able to run the test because I don’t have the money. Business is not buoyant. I can’t afford the drugs they say I should be taking. One finished last week, another finished yesterday, and they all cost over N8, 000, but it’s hard to get money to buy the drugs.”
Meanwhile, the high healthcare costs are causing many of the patients to get sicker from delaying, avoiding or stopping medical treatment. Mrs Deji Olaopa, 65, has lived five years of her life treating Type 2 diabetes. Like everyone with type 2 diabetes, his life is ruled by the clock – with meals, blood tests, insulin injections and the rest – all on a strict regime dictated by diabetes. However, adhering to the routine has been a struggle because she is a pensioner battling the skyrocketing prices of her medications.
Nigeria’s inflation rate surged to 19.64 percent in July 2022, up from 18.60 percent in the previous month. This is the highest rate recorded since September 2005, according to the National Bureau of Statistics (NBS). The inflation rate is taking a toll on many Nigerians. With the skyrocketing food prices, school fees and the costs of treatments and drugs, many individuals are falling behind financially since they depend on out-of-pocket care.
Medicines play an indispensable role in the improvement of health, the preservation of lives, the enhancement of public welfare, the promotion of trust, and participation in healthcare services. The availability, pricing, and affordability of medicines are particularly important in this regard as they significantly affect the survival rate of populations from diseases. But Taofik Odukoya, the Chief Executive Officer, Vanguard Pharmacy, said many medicines, particularly those for chronic illnesses, had become scarce and more expensive because of the Federal Government’s policy on foreign exchange. It resulted in the extension of the inventory time from the conventional 3 months to almost 9 months.
“The problem started around the COVID-19 period. Initially, we thought that it would ease out by May 2021, but unfortunately, all through 2022, the problem remained. Most of these prescription drugs are imported, whether it is coming in a raw material or finished product. By virtue of the regulation policy, the pharmaceutical companies after selling their inventory cannot easily change their money back to dollars except through the Central Bank of Nigeria. They cannot source their dollars through the black market either. At the CBN, it might take 4 to 5 months to get mere $ 1 million. Now this, linked with the time for shipment, means that one will be looking at an inventory gap of 9 months for an imported medicine. Unfortunately, entrepreneurs are also in business to make profit.”
Mr Odukoya declared that the availability of drugs like ventolin inhalers and strong antibiotics like augmentin is currently a big challenge. “That is why the President Bola Tinubu’s government needs to get the economy quickly back on track as soon as possible, making sure that the dollar problem is addressed positively.”
The Chairman, Association of Community Pharmacists of Nigeria, Oyo State Branch, Mr Bayo Gbadamosi, said many drugs, especially for chronic illnesses like diabetes and heart conditions, are now both scarce and unaffordable unlike before.“Drugs that we sold for N500 last year are now about twice or thrice the price now. The dollar exchange rate is affecting the cost of medications. About 70 to 80 percent of our prescription medicines come from outside Nigeria where the cost of production is cheaper. All these drugs will get scarce at some point. Eventually, when they are available, the price will be very exorbitant. It still points to the need for local production of medicines to increase access with the affordability of medicines.”
Mr Abiodun Ajibade, Managing Director of Alvid Pharmacy Limited and past chairman, Pharmaceutical Society of Nigeria (PSN), Oyo State branch, said not many people were aware that access to and availability of prescription medicine had become a challenge in Nigeria because they were not affected in any way. According to him, there had been a 30- 40 per cent reduction in access and availability of these medicines due to the Federal Government’s policy on foreign exchange that affected the ease of transactions of pharmaceutical companies that import them into Nigeria. “Poor access to and availability of medicine started for some time now but it has continuously increased its impact on the healthcare system. The foreign exchange policy which is a major driver for this is terribly affecting the pharmaceutical sector. For instance, companies that are importing brands of some antibiotics have been rationing them because they want their stocks to last for a longer period. There have been issues with getting medications for benign prostate enlargement, hypertension and even infusion fluid, which is an essential medicine for emergency care
“Getting to buy infusion fluid was a big problem about 2 years ago, there was a major scarcity. Basically, this life saving fluid is produced locally but it requires its raw materials to be imported into the country. Right now, although they are now available, they are very expensive compared to what they used to be sold before. Infusion fluid went from N150 to N700.”
The cost of all medications has gone up, some by as much as a 100 percent increment. The price of a common malarial medication, Coartem, which we then sold for a maximum of N1, 500 about one and a half years ago, is now N3, 000.
Moreover, Mr Ajibade added that even when people trade the branded medicines for the generic brands which are most times cheaper, it does not guarantee that they will get the worth of their money. “The pioneer or branded form of a medicine has an optimal performance that will always be ascribed to it. However, most of the time, because its generic form may not be made with the same technology, even though both contains the same active ingredients, they may not work exactly with the same efficiency because of the difference in their bioavailability. The drug profile, for instance, might say that it contains 500mg of the active ingredients. But when it is swallowed, it might deliver merely 200mg of its active ingredient because of its poor dissolution rate and other factors. As such, it will not give you the required biological response.”
Frank Muonemeh, Executive Secretary of the Manufacturers Association of Nigeria’s Pharmaceutical Manufacturers Group, in a report in July, was quoted as saying that inflation is choking the pharmaceutical industry. He said: “The industry is taking excruciating pains to absorb the incremental cost of production, especially when you look at the smart investments at stake. If you transfer the high cost of production to the patients, they will not buy drugs again and they will continue drinking alternative local herbs, which will lead to a decrease in access to medicine for Nigerians as out-of-pocket expenses are still at a very high percentage.
“We are not even talking about inflation. We are talking about diesel, which is at an all-time high, the gas for energy. Some of the facilities use diesel because there is no steady supply of electricity due to the consistent failure of the national grid.”
Moreover, Dr Kolawole Akande, a hepatitis expert at the University College Hospital, said the cost of medicines for many chronic illnesses, including hepatitis B, was an added factor in increasing cases of liver problems from infections like hepatitis B. According to him, “we found that many of our patients are not taking the medication for hepatitis B for various reasons. The drug is not that expensive, its cost might be from N6,000 to N10,000 every month. One of the common reasons was the fact that many of them couldn’t afford those drugs and that is why the government can come in to subsidise the evaluation for hepatitis B and also the treatment for hepatitis B infection.
“These drugs for the treatment of hepatitis are all imported. So the government can encourage the pharmaceutical companies to start to produce these drugs. In our clinics, for instance at UCH, Ibadan, hepatitis B is the most common disease that we see.
“In fact, we book about 60 patients every week to see because if you don’t do that, some of them, you will give them appointments for the next 6 months or 7 months and they are anxious because the patient load is there. So the government can really do a lot.”
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