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Nigerians have continued to groan over the rising cost of essential and nonessential drugs and medicines, tests and scans in recent times. Many people have died because they are unable to afford the needed medicines, while others have turned to alternative medications that are readily available but not cheaper. The government, experts say, must intervene to keep the cost of these medications stable and to save lives, Isioma Madike reports.
The cost of basic drugs, such as antibiotics, analgesics, anti-diabetics, and key medications for other chronic conditions, has gone beyond the reach of ordinary Nigerians. This has left many patients struggling to access the healthcare they desperately need to ensure that falling sick does not equate to a death sentence. The most vulnerable are those without steady sources of income, as well as those without reliable health insurance. Toyin, who resides at Abule-Egba, belongs to this group. She is hyperten- sive and needs to take her drugs on a daily basis in order to maintain a manageable blood level. She takes amlodipine, lisinopril and metoprolol succinate. When she went to purchase these drugs at Boluke Phar- macy at Pen Cinema, Agege on Tuesday, she was shocked to discover the price had gone up for the second time within a month. Boluke is one of the cheapest pharmacies around where one can get reliable medicine to buy. The three medications which she bought for N7,800 about a month ago, is now over N15,000. While these drugs are life-saving, the outrageous cost has become a daily burden for her. This has forced Toyin to take a risk with her health by missing doses. She has eventually resorted to local herbs, which also does not come so cheap. In a chat with this reporter, Toyin said: “Most of us on this line of drug are dying in piecemeal; we can’t afford medicine for our ailment any longer. And some of us have resorted to local herbs as alternatives even when we are not sure of their efficacies. As it stands now, we live by the day as we are no longer sure of what will happen the next moment.”
But, if the case of those battling hypertension is pathetic, diabetic patients’ cases are simply heartrending. The affordability crisis has pushed many of them to resort to herbs also. Some of them, who spoke with Saturday Telegraph, lamented the negative effects that rising drug costs are having on both their health, and survival. A retired teacher, now in his 70s, told Saturday Telegraph he now lives hopelessly, depending on friend’s handouts for his survival. “I only think of drugs whenever I receive favour from my longtime friends. I’m even ashamed to keep asking them for money to buy medications because they are the reasons I am able to feed my family of four as well. The stipends that come from my monthly pension remains a far cry to what can sustain me and my family,” said the Oshodi-based man, who prefers to remain anony- mous. Ikechukwu, who had been suffering from inter- mittent coughs and chest pains, also said he resorted to taking herbal mixtures because the hospital treatment bills were outrageous and he could no longer cope with the high cost of medications. “One of the drugs my doctor rec- ommended costs about N90,000 and I usually buy two of it every month.
However, that is not the only medicine I take on a daily basis. In all, I spend over N138,000 for my monthly drugs alone. This is killing, especially that I have a young family; two of them are still in secondary school while the last one is in primary school. How on earth do I cope with this burden? “Paying my bills has become a night mare. This is why I often sacrifice my medication for food. It’s really not been easy,’’ Ikechukwu lamented. A recent market survey by this reporter in Lagos revealed that the prices of common medications such as painkillers, and antibiotics, especially have been on a steady rise since January. The most affected are prescrip- tion drugs, the cost of some of which many can no longer afford. The above horrible narratives may be why ordinary Nigeri- ans with health challenges are today in grave danger. Add to this is the problem of the naira which has continued to depre- ciate against major world currencies. The deregulation of the foreign exchange market, which sparked a chain of economic crises, has equally pushed health- care delivery to the abyss as it becomes a major casualty within the economic chain web.
Pharmacist perspective
Chairman Pharmaceutical Society of Nigeria, Lagos State chapter, Oyekunle Babayemi, points to weak regulatory controls because of insufficient funding of appropriate regulatory agencies as a major reason for high cost of drugs. Government, he said, needs to grant more tax holidays as well as remove some high tariffs introduced in the last few years in the pharma sector as these costs are passed to consumers. He said this is particularly instructive with regards to NAFDAC where high cost of registration of drug products and good manufacturing practice inspection fees need to be addressed. He said: “The industry is having issues with payment as the NAFDAC Automated Product Administration and Monitoring System (NAPAMS) generated tariff is more than the CBN rate when calculated with the dollar fees on NAFDAC tariff. “The financial implication of this is that all manufacturers and importers of pharmaceutical products in Nigeria have to redesign their packaging and labelling features, a venture that will cost the pharmaceutical industry an estimated N500 billion at a time the Federal Government is seriously struggling to bring down the cost of drugs in Nigeria. “The Federal Government needs to have an Ad-Hoc Presidential Committee on drug distribution. The chairman must be a Registered Pharmacist, must double as a Honourary Adviser on pharmaceuticals l to the President. Even when President BolaTinubu and Health Minister, Prof. MuhammedAli-Pate, mean well, the pharma space has become too significant and strategic to be run with success by a non-pharmacist in view of the sensi- tivity of drugs relative to outcomes.”
Medical doctors speakA Public Health Physician, Pro- fessor Bayo Onajole, while giving his viewpoint on the healthcare problem the country faces, said that access to health care goes beyond the physical structure or nomenclature of the lo- cation. He added: “More depends on the quality of services with access to lab- oratory, pharmaceutical consumables, and radiological access tops the lad- der. The current Nigerian situation has complicated the above. Hence it will not be surprising if sickness and death rate continue to rise.” Former President, National Association of Resident Doctors, Dr Uyilawa Okhuaihesuyi, prefers to look at the is- sue firstly from the prism of the world inflation indices, which he said, are at a record high with most around 19- 40 per cent globally. The inflation indices, according to the statistics bureau, he added, are around 33.96 per cent as of March.
This, he said, increases the price of every commodity. “The day-to-day components such as syringes, cannulas, drapes and gowns, emergency drugs, and so on, are all mostly imported and with the current currency exchange rates being bizarre, cost of healthcare will naturally soar. Deepening poverty from the above poses a major challenge to cost in the health systems. “It’s like asking if we produce cars in Nigeria. China, Bangladesh, India, and Vietnam remain our hope for medicines that can be purchased for use owing to the abject poverty of our citizens. We can’t even talk about getting drugs from European nations. So yes, we are truly in dire straits and the government and their agencies should sit up and take bold steps and decisions in solving these issues. Prof. Olufemi Babalola, former president, Guild of Medical Directors, believes the astronomical cost of healthcare in Nigeria is a significant burden on its population, driven by various economic and systemic factors. Healthcare inflation in Nigeria, he said, has been on a steep rise, with the consumer price index for health services increasing by 15.80 per cent year-on-year as of May 2021, reaching a 10-year high. There has been another round of inflation, he also said, since the coming to power of the current government.
He said: “The situation is exacerbated by the country’s heavy reliance on imported medical equipment and pharmaceuticals, which are affected by the volatile exchange rate of the Naira. For example, the Naira’s de- valuation has led to higher costs for imported medical supplies, which in turn has driven up healthcare costs. “The funding for healthcare is also critically low, with Nigeria spending only about 3.89% of its GDP on health- care, a figure significantly below the global average.
Out-of-pocket expenses constitute 76% of total healthcare expenditure, making medical care unaffordable for many Nigerians Consequently, many Nigerians resort to self-medication and visiting roadside chemists, which further jeopardises their health. “Additionally, Nigeria faces a shortage of healthcare professionals, with only 1.95 doctors per 1,000 people, far below the recommended number for effective healthcare delivery. This shortage increases the pressure on existing medical facilities and contributes to the rising cost of services. Of course, with the ‘Japa’ syndrome, the situation is compounded in many ways. “Despite these challenges, there are efforts to improve the situation.
The Central Bank of Nigeria has launched several interventions aimed at boosting healthcare capacity, including N100 billion healthcare support funds during the last administration. It is not clear that the funds were well spent or that the initiative was carried forward to a logical end.
“The current administration has not come up with any meaningful initiative in this respect as of now. Indeed, significant investments and reforms are still required to meet the healthcare needs of Nigeria’s growing population.” Dr Biodun Ogungbo, a Neurological Surgeon, agrees that the cost of medicines, tests, scans and hospitalisation has increased significantly. Drugs and medical consumables, he said, are up to four times more costly over the past year. Everyone cites the foreign exchange rate as responsible for the increase in the costs.
“Unfortunately, hospitals cannot afford to continue without reviewing the cost of care and passing on some costs to patients and their relatives. However, hospitals cannot triple or quadruple costs so only modest in- creases are possible. Even then, the number of patients going to the hospital has declined significantly and more people are resorting to other treatment options such as the traditional healers. “Hospitals have seen their profit margins eroded and some doctors in private practice are choosing to close down or sell up and relocate abroad,” he added.
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