Combating fraudulent practices in anti-retroviral drug procurement

It is estimated that 3.1 million Nigerians are living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS). To halt the spread and ensure that those living with the virus have easy access to anti-retroviral drugs, the Federal Government needs to discontinue engaging contractors in the procurement of anti-retroviral drugs.

If this is done, the Executive Director, Civil Society Legislative Advocacy Centre (CISLAC) and Transparency International, Auwal Ibrahim Musa revealed that it would save Nigeria $6 on every anti-retroviral drug if it buys from the manufacturers rather than through contractors.

Musa speaking, at a briefing, to support government’s reform aimed at purchasing HIV drugs directly from manufacturers rather than through contractors, disclosing that there had been strong resistance by some contractors with support of some insiders to prevent the National Agency for the Control of AIDS (NACA) from buying HIV drugs directly from original manufacturers which allows government to put more people on treatment.

“Giving the existing cost-efficient practice by the United States Government and Global Fund involving direct purchase of the drugs from the manufacturers, we are worried by the ill-informed, pocket-serving and discrediting petitions by some vested interest, who have endlessly benefited from inflated prices of the drugs in the last five years, to discourage the ongoing effort of NACA to directly source the drugs primarily for sustainability and wider coverage. CISLAC/TI Nigeria gathered that the contractors currently sell the anti-retroviral drugs at $13 per patient as against $7 given by the manufacturers.”

He added that while international treaties and governments across the world recognise adequate, accessible and affordable health care as a fundamental human right, medicine financing in Nigeria is generally out-of-pocket.

Musa also said the continued rise in price has made many essential and prescription medications unaffordable, and therefore inaccessible, by quite a large number of Nigerians, who live below poverty line.

“This without doubt comes with grave consequences of morbidity and mortality to consumers of health care products in Nigeria. The non-affordability triggered by high production and supply costs encourages the sale of fake and substandard drugs in the country, while consumers who are compelled to seek cheaper drug alternatives ceaselessly fall prey to fake and substandard drugs with damage to their health.

“As the Nigerian government struggles to sustain provision of free anti-retroviral drugs as part of HIV programmes at health facilities in the country for an estimated 3.1 million people living with HIV/AIDS, this effort is mostly sabotaged by inflated prices quoted by supplying contractors, whose activities render government’s effort inadequate to eliminate the high and sometimes inequitable economic burden of HIV/AIDS on households.

“This exorbitant prices quoted by existing contractors renders government financially incapacitated to adequately provide for, and make anti-retroviral drugs accessible across health care facilities, which records resultant regular stock-out, health hazards and relapse of illnesses.”

While acknowledging NACA’s plan to establish HIV Trust Fund driven by private sector to support existing efforts of the government, Musa observed that without current support by US government and the Global Fund, it would cost Nigeria N50 billion to treat one million people living with HIV annually.

“We are also concerned that over-reliance on donor funds in the fight against HIV in the country constitutes a dangerous trend to sustainability, hence the need for the government to take full ownership in the prevention and treatment of HIV in the country.

“Corruption in the treatment of HIV/AIDS is no different from the corruption in the health sector. In 2003, Nigeria’s ARV programmes attracted much criticism when treatment centres were alleged to be handing out expired drugs and rejecting patients.”

As a result of the negative implication of buying HIV drugs through contractors, CISLAC/TI Nigeria insisted that fraudulent contractors who undermine the Public Procurement Act must be thoroughly scrutinized and discouraged from defrauding the government through inflated anti-retroviral drugs supply services.

It also called on the newly appointed Director General of NACA to engage stringent reforms in the Agency’s procurement process for impactful, efficient and cost-effective wider and sustainable service delivery in Nigeria.

It further demanded that NACA Director General should devise appropriate sustainability plan for the procurement of drugs and consumables through cost-effective and encouraged technically know-how for domestic production in the presence of dwindling donors’ support; and avert recurring of challenges thrown at the country by COVID-19 pandemic.

Participants at the event

CISLAC/TI Nigeria also believed that the DSS should investigate the activities of Politically Exposed Persons (PEPs), who constitute themselves as faceless contractors and their relationship with the leadership of the Network of People Living with HIV, who it learnt are secretly used to obstruct and frustrate NACA’s effort from directly purchasing from manufacturers.

To ensure a sustainable plan, CISLAC/TI Nigeria asked regulatory authorities, like NAFDAC, to support and enhance local production of affordable antiretroviral drugs with serious consideration while issuing marketing authorisation to local manufacturers.

It also argued that a review of heavy tax burden on the pharmaceutical sector would avert multiple taxation by local, state and federal governments as well as high tariffs on raw materials, packaging materials and other ancillary materials used to manufacture medicines, primarily to encourage local production in the country.

It further called on the government to develop a pricing policy to reduce reported high prices and wide disparity between prices of essential drugs in the country.

Also speaking at the event, a legal practitioner and CISLAC board member, Adeshina Oke, highlighted the importance of good health to leadership, productive economy, and healthy citizens.

He noted that a sick country cannot have a good leadership, neither can it have a productive economy or citizens, reason concerted efforts must be taken to rid the country of moves capable of deteriorating the country’s health system.

“And we cannot depend on donors forever as a country. In the long term, we must begin to look towards empowering our higher institutions for research purposes. These drugs could be a lot cheaper if they are manufactured here in Nigeria.

“Nigeria must empower her institutions so that they can be fit enough to uphold the country, should in case that day comes and funding stops coming in for purchase of retroviral drugs. And the time to start preparing is now,” Oke stated.