A third world country like Nigeria lacks equitable access to medicines and healthcare commodities. Boasting of a population of roughly 220 million the giant of Africa is deficient of capable human and material resources to cater to the welfare of its large citizens. The reasons are not far-fetched: i) There is a major lack of a maintenance culture for the available insufficient medical infrastructures ii) Inadequate optimisation of indigenous skills and knowledge iii) Brain drain in the health sector due to emigration to developed countries for greener pastures iv) Poor governance and lack of accountability on the path of political leaders v) Lack of implementation of relevant policies in the public health system.
With the current situation of things across Africa -the war in Sudan, civil unrest in Senegal, coup in Burkina Faso, Mali and Niger, insecurity in Congo DR and high cost of living in Kenya, Rwanda, Ghana, Sierra Leone and Nigeria, the lack of access to critical and essential medicines is at a peak in the African continent leading to millions of preventable deaths. The National Health Insurance Scheme (NHIS) an agency of the Federal Government established by decree 35 of 1999 which became CAP N42 (CFN) 2004 and has been repealed by the National health insurance Authority Act 2022 has a mandate to attain universal health coverage in Nigeria by 2030. The mission of this agency to pool financial resources for strategic purchasing of affordable healthcare for Nigerians is almost unattained as patients majorly pay out-of -pocket for medications or have to fall back on private HMOs as most of the essential drugs are always out of stock.
In the Nigeria of today, brands of medications from Patent Pharmaceutical Companies are scarce and unaffordable for the common man. This among many others is as a result of the following; i) Adoption of a 3rd party distribution model by some multinational companies ii) Increase in the cost of production for indigenous manufacturing companies attributed to high cost of importing active pharmaceutical ingredients and manufacturing equipment iii)High costs of sustaining Standard operating procedures and Quality control/Quality assurance procedures iv) Skyrocketed costs associated with sales and marketing of medicines and medical consumables v) In availability of a source of adequate and steady power supply as a result of frequent collapse of the National grid vii) Inflation in the prices of essential medicines and commodities brought about by removal of subsidy on petrol and petroleum products that used as alternative source of electricity for running production viii) Heightened costs from clearing of imported drugs with customs duty as a result of floating of the naira.
The latest trend observed in this precarious period is the resort to the use of plant based herbs to treat ailments. Nigerians patronise traditional herb sellers that mix different concoctions (seed, bark, stem, root, leaves of plants) with alcohol and soft drinks. These alternatives are cheaper and more accessible than orthodox medicine and there is this connotation that they don’t expire. The danger with this practice is that it lacks the professionalism of standardisation in a research laboratory. The dosing rate and safety profile of these remedies are not measured nor checked so the masses are at the risk of coming down with chronic diseases such as liver and kidney failure.
There is an urgent need for evidence-based scientific approach in the field of traditional medicine via pharmacognostic interventions. There is need for a pronounced engagement, such as public private partnerships between the government and experts with evident professional excellence in the public health system space that would serve as advisors and partners in ensuring efficient supply of medications to the populace. There is need for a drug management agency to be introduced in the ministry of health of every state, for the smooth implementation of essential medicine programme. There is also a need to integrate traditional medicines with conventional medicines as a form of holistic approach to treatment of ailments. It is also imperative to critically review the activities of the National Health Insurance Authority. Lastly, Nigeria needs an optimum supply chain management competency in the public healthcare space as supply chain is a core aspect of the health system.
By
Firinajoyisopin Oyetunde Oyelude (B.Pharm, MPH, CSCA)
