• Nigerians turn to herbs, churches as alternatives to Medicare
• Experts task FG on friendly policies to boost local manufacturing of pharmaceuticals
• We are working hard to address the issue, says health minister

The die is cast in the health sector. Patients and their relatives are getting more and more stranded. They have been caught between the proverbial devil and the deep blue sea as they can no longer afford to buy essential drugs to manage their ailments or save their lives.

Irreversible medical complications are setting in as many have resorted to cheaper, adulterated, falsified or fake drugs. Others have moved to churches and trado-medical centres while some have resigned to fate. The country is at the brink of a national healthcare disaster.

To worsen matters, hospitals affected by the recent hike in electricity tariff for some bands of customers by the Nigerian Electricity Regulatory Commission (NERC) are groaning over the burden placed on them and have warned that the essential services they provide would nosedive further as a result of the development.

President of Doctors, Savealife Foundation, Dr. Richard Okoye, warned that the electricity tariff hike would further destroy the healthcare system of the country.

“We got a letter saying that because of being in Band A, our monthly power bill is now coming to N25.3 million. That is crazy. A hospital is not a business centre. Hospitals are rendering essential services to the society. We are already struggling with the doctors leaving the country. If nothing is done urgently to revisit that decision by the NERC, I can put it to you that epidemic in hospitals will turn most hospitals into morgues.

“Power is the light of healthcare delivery. If there is power in the hospital, patients have a sense of hope of living again. In addition to that, the majority of emergency drugs, anaesthetic drugs can only be maintained at a particular temperature provided by the cold chain/refrigerating system,” he said.

Indeed, Nigerians have begun to feel the inflationary impact of the floating of the naira, departure of pharmaceutical giants as well as removal of subsidies as prices of essential drugs and cost of care in the health sector have spiked lately, much to the discomfort of care seekers and practitioners.

Barely 10 months since the Central Bank of Nigeria (CBN) pulled the plug on the foreign exchange (FX) market, the contending challenges have become more resilient and deep-seated, unsettling individuals and businesses across the board. For medicines locally produced, most of the Active Pharmaceutical Ingredients (APIs) are imported from India and China, because the country has not developed their raw materials.

A survey by The Guardian, which was corroborated by medical doctors and hospital pharmacists, showed that prices of drugs and medical services sharply rose by at least 150 per cent to 1,000 per cent in 15 months. The survey showed that most foreign drugs are currently scarce while the available ones are expensive. It is feared that the situation has resulted in complications, especially with regard to chronic diseases and eventual deaths.

Some patients, who spoke with The Guardian, said they have resorted to traditional medicine since they could no longer afford conventional treatment, a development doctors and pharmacists said have far-reaching implications on treatment outcomes, mortality and of course morbidity. They said that patients suffering from life-threatening diseases are extremely vulnerable because failure to access their medications could result in death.

In his reaction, the Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, said the escalating cost of pharmaceuticals is wider than what the sector can control directly.

Pate stated this during the recent webinar organised by The Cable, an online newspaper, to commemorate its 10th anniversary. The webinar was titled, ‘Addressing the Escalating Costs of Medicines and Medical Consumables in Nigeria’.

The minister said the escalating cost of pharmaceuticals has been an important issue, which the Federal Government has had series of engagements with industry players, practitioners and stakeholders.

He said it is part of a global phenomenon and linked to things wider than what can be controlled directly in the health sector, adding that Nigeria has been playing catch-up in the sector for 20 years.

He explained further that factors beyond the direct control of the healthcare sector like foreign exchange devaluation, cost of energy and decades of neglect in domestic pharmaceutical manufacturing are also contributing to the price hikes.

“If we had built an industrial base to manufacture APIs and pharmaceuticals, we probably would have much less impact from the global increase in the price of APIs and the supply chains. Nevertheless, we have focused on solving the issue. We have been working hard to do so through the presidential initiative to unlock the healthcare value chain announced in October 2023,” Pate said.

He noted that the financing of healthcare in Nigeria and its affordability have been a long-standing issue. “Less than 10 per cent of Nigerians have insurance or any insurance to speak of, which means most of our financing for healthcare is out-of-pocket. Hence, when prices go up, the impoverishment due to the cost of medical care also goes up. Nigerians get thrown into poverty, and many of us are a few steps away from poverty because of healthcare. If you have a catastrophic disease like cancer or kidney failure, it is easy because we don’t have a viable insurance platform. And this is not today; where we are today in terms of health insurance has been decades in the making.

“The president has directed that we work hard to find a resolution. As a government, we are also in collaboration with the private sector. Because we have a mixed health system, both sides will have to work closely, hand-in-hand, hence the engagement that we have had with the pharmaceuticals, ably led by Prince Julius Adelusi-Adeluyi,” Pate added.

The Director-General of the National Agency for Food and Drug Administration and Control (NAFDAC), Prof. Mojisola Adeyeye, also concurred that the rising cost of pharmaceuticals Nigeria is facing now is as a result of decades of decay.

According to her, if Nigeria does not focus on local manufacturing and revitalise the industry from the regulatory perspective, drug insecurity may persist.

She said: “NAFDAC took the harder way; the harder way is going to be the easier way in the long run. We started strengthening our own regulatory system; we cannot give what we don’t have. We have to give international standards, quality approach, to local manufacturing of drugs.

“In 2018 in Ilorin, Kwara State, the National Association of Industrial Pharmacists invited me, and I categorically stated that we would change the narrative from 70 per cent importation to 30 per cent. But when we have had decades of decay, that couldn’t have happened overnight. In 2019, we started the five plus five directive.

“We did a study where the top five drugs that are imported are also the top five manufactured in Nigeria. We did that before the pandemic.
“From that initiative, more than 30 per cent of companies in Nigeria are the result of the five plus five because many importers started building their own companies or partnering with local manufacturers through contract manufacturing. That is the way to make drugs available and accessible.”

To the President of the Nigerian Medical Association (NMA), Dr. Uche Ojinma, Nigeria needs to urgently declare a state of emergency in the pharmaceutical sector .

Ojinma proposed a multi-pronged approach, including establishing a health development bank, supporting local pharmaceutical companies and reviewing import duties on essential drugs and manufacturing equipment.

“We call for serious action, no longer plans and things to be rolled out. We want things that have been rolled out. Let us roll out the health development bank; let us help the local pharmaceutical industry. If we put our heads together, we would be the greatest beneficiary as economic productivity will rise.

“If we cannot bridge the inequality in the health sector, the rich that can afford the drugs will stay healthy and stay rich while the poor would be on a downward spiral.  We will have a problem on our hands because there is a point it will get to and people will no longer sit in their houses and die but move into the streets and seek a solution,” Ojinma warned.

On his part, the Executive Secretary of the Pharmaceutical Manufacturers Group of Manufacturers Association of Nigeria (PMG-MAN), Frank Muonemeh, stated that if local manufacturers were to pass all the costs of getting drugs to the end users, the average Nigerian would not be able to afford any medicine.

Also, Executive Secretary of the Anambra Primary Health Agency (ASPHDA), Chisom Uchem, said the Federal Government should promote research into local medicines that would make drugs affordable by Nigerians in the grassroots.

Her words: “I am thinking that it is time the government looked right inside to strengthen and encourage research. All these lemon grasses, guava leaves and so on, why can’t we encourage our people to go into research to know the constituents, the active ingredients that would make somebody take herbs and the person is fully recovered.”

Former Minister of Health and President, Pharmaceutical Society of Nigeria (PSN), Prince Julius Adelusi-Adeluyi, also said: “For us to go forward, we need a realistic public-private sector partnership. If we have that to address the issue and we collaborate, it can be quicker and easier. But we need to address the issue of the regulatory challenges. Some policies are very archaic and they need to be reformed.”

Chairman, Pharmaceutical Manufacturers Group of the Manufacturers Association of Nigeria (PMGMAN) and Managing Director, Daily-Need Group, Mr. Oluwatosin Jolayemi, said manufacturing in a developing country like Nigeria could be quite challenging and frustrating. He said the cost of medicine has gone up between 50 per cent to 500 per cent on different medications in pharmacies and various medicine stores as a direct result of the devaluation of the naira.

Jolayemi said in some instances, some medicines are temporarily off the shelf because they have become too expensive to hold and sell.

Jolayemi said almost all categories are affected as most APIs are sourced and imported. He emphasised that most Nigerians now struggle to buy necessary medicines whilst balancing all other human needs, adding that it is possible that this could lead people to self-medicating with whatever category of medication they are able to afford.

“Cost of procurement of almost any form of medication is now high given the early reason, and if you like to add the fact that some multinationals have decided to directly exit our economic space, that has put some particularly known brand out of the shelves hence the scarcity and when there is scarcity, it is natural for trade to take advantage of scarcity. Most antibiotics and inhalers are affected. Also, the cost of some of these APIs has gone up in the international markets and naira devaluation has compounded the Nigerian situation,” he said.

Former National Secretary, Pharmaceutical Society of Nigeria (PSN), Gbenga Falade, said the cause of the hike in the cost of goods and services is directly related to the value of naira, stressing that most businesses sell at the price they buy.

“We have always had this kind of price spike any time the naira loses value but what has made this one complicated is the non-availability of forex, which is forcing international partners in the healthcare sector to withdraw because of their inability to repatriate their funds without losing value. It is what it is. We must decide as a nation which direction we want to go to alleviate the problems faced by our citizenry,” the pharmacist said.

Chairman, PSN Lagos, Kunle Babayemi, said essential medicine prices have more than doubled and in some specific cases, the cost of life-saving medicines has increased due to acute shortages by up to a thousand per cent.

Babayemi said these latter price fluctuations were occasioned by a lack of resilience in the country’s medicines supply chain and over-dependence on importation of pharmaceuticals, especially finished pharmaceutical products.

The pharmacist said Nigeria has a pharmaceutical market where imports outstrip local manufacturing by a factor of 10, saying it is irresponsible.

He said the government has left the intentional policies like the National Drug Policy 2021 developed to safeguard the medicines supply chain and rather focused on incentivising importation of finished pharmaceutical products to the detriment of local manufacturing that provides a buffer against excessive disruptions.

Babayemi said the economy is besieged by the twin evils of rising inflation and exchange rate devaluations.

“Inflation has risen month over month and is closer to 30 than 25 per cent where medicines are concerned. Similarly, exchange rate shortages have meant that pharmaceutical companies have been sourcing their forex needs in the open market at exorbitant, unpredictable rates made worse by exposure to asymmetric risks,” he said.

He added that these challenges have led to disruptions in the supply chain of medicines for Nigeria, affecting both raw materials (industrial inputs) and finished pharmaceutical products.

“On the professional side, we are witnessing very high costs of lending, high and unpredictable costs of forex, asymmetrical risks for pharmaceutical companies and lack of impactful incentives from the government. The patients are experiencing this as higher out-of-pocket payments and some may have been priced out of affordability,” he said.

A consultant surgeon and endocrinologist at the College of Medicine, University of Lagos (CMUL)/Lagos University Teaching Hospital (LUTH), Prof. Olufemi Fasanmade, said zero to 90 per cent of drugs have doubled or tripled in price this year alone.

“So, those with chronic diseases like diabetes and hypertension have to raise a lot more to cover medications. People who had either or both of these conditions that used to spend between N10,000 to N30,000 monthly now have to contend with N25,000 to N80,000 on medications alone. So, many have improvised by reducing dosage or skipping a few days with disastrous effects on health,” he said.

Fasanmade said all operations have also gone up. “Caesarean Section (CS) that few private hospitals did for N250,000/N500,000 are all going for N1 million to N3 million,” he added.