• Hospitals, practitioners apprehensive
Nigerians may have begun to feel the inflationary impact of floating of the Naira as well as subsidy removal 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.
Findings, yesterday, showed that some of the drugs are fast getting out of stock or unaffordable. Though the Federal Government plans to reduce the importation of drugs in the country from 60 per cent to 40 per cent to promote the local manufacturing of drugs, at least 70 per cent of medicines consumed in the country are imported.
Almost a month 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, the active pharmaceutical ingredients (APIs) are imported from neighbouring countries, especially for those that the country does not have their raw materials developed.
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 60 per cent to 150 per cent in two months.
For instance, two months ago, Ventolin Inhaler Brand of Salbutamol (by GSK Pharmaceuticals) cost on the average N4,500 per canister, today, it goes for between N6,500 to as much as N12,000 in some retail shops.
“Ciprofloxacin 500mg tablets cost about N2,500 for a sachet of 10 tablets, two months ago. Today, it costs about N3,500 per sachet of 10 tablets. Rocephin 1g injection (brand of Ceftriaxone) costs about N4,500 per vial two months ago, today it has risen to more than N6,500 per vial.
“The antibiotic Co- Amoxiclav (Amoxicillin and Clavulanic Acid 625 mg) cost averagely N5,000 for a sachet of 14 tablets, two months ago, while today, it goes for as much as N7,000 per sachet.
“Even paracetamol that is locally manufactured, is not spared by the galloping prices. A sachet of paracetamol tablets by 12 cost N150 two months ago, today, the same sachet goes for N250 and more in some retail outlets. The antimalarial Amatem, Brand of artemether Lumefantrine cost N1,800 two months ago, today, it goes for as much as N2,500 per sachet containing six gels.
“Seretide inhaler Brand of Salmeterol and Fluticasone) that cost about N5,500 two months ago, costs as much as N11,000 today, where available.
“Removal of subsidy on fuel has resulted in sharp increases in prices of medicines, ranging from about 60 per cent in some cases like paracetamol, to over 150 per cent increase for Ventolin Inhaler and others.”
It is feared that the situation has led to rise in complications, especially in chronic diseases and deaths. Some patients who spoke to The Guardian said they have resorted to traditional medicine since they could no longer afford conventional treatments.
Doctors and pharmacists who spoke to The Guardian said such decisions for alternative medicine and inaccessible medicines have far reaching implications on treatment outcomes, mortality and of course morbidity. They said those patients suffering from life threatening diseases are extremely vulnerable, because failure to access their medications could result in death.
The Guardian survey showed that most foreign drugs are presently and significantly scarce while the available ones are drastically expensive.
Products of companies like GSK, who supply the country with most essential antibiotics like Ventolin, Augmentin, Seretide, Cervarix (HPV vaccine for cervical cancer), Duodart, Zinnat, Ampiclox are out of stock and the slightly available ones are almost unaffordable.
A Clinical Pharmacist and Deputy Director Pharmaceutical Services,
Federal Medical Centre (FMC) Asaba, Delta State, Dr. Kingsley Chiedu Amibor, said there is no doubt that prices of medicines have skyrocketed in the last two months and the trend is worse with imported products that are not manufactured in Nigeria.
Amibor, who is also a former Chairman, Association of Hospital Pharmacists of Nigeria (AHPN), said factors that guarantee access to essential medicines include: affordable prices, sustainable financing and reliable health systems. He said universal health coverage could only be achieved when there is affordable access to safe, effective and quality medicines and health products.
The hospital pharmacist said from the prices of medicines listed, it becomes glaring that access to essential medicines has already been impeded, given the scenario where prices have more than doubled, while salaries have remained largely stagnated.
Amibor further explained: “Of course, it is already affecting healthcare delivery. Permit me to paint a true picture of current scenario- a good number of patients that manage to visit the hospital, after obtaining their prescriptions, they get to the Pharmacy and upon learning of the new cost of their prescribed medicines, some will tell you, ‘I am coming’ and disappear from the hospital and you will never see them again. For some others, out of about five prescribed medications, they may just barely afford to pay for two or three, while abandoning the rest.
“In both situations described above, there is no way to achieve optimal healthcare because of limited access to medicines. Some hospitals are not able to procure essential medicines from manufacturers, they just purchase limited quantities for the few patients that can afford them.
“To answer your question directly, the current situation has resulted in patients not being able to access optimal healthcare, especially with regards to accessing their prescribed medications.”
On the implications of spike in drug prices on treatment outcomes, morbidity and mortality, Amibor said most patients now find it extremely difficult to access their needed medications as a result of exorbitant cost.
“This has far reaching implications on treatment outcomes, mortality and of course morbidity. Those patients suffering from life threatening diseases are extremely vulnerable, because failure to access their medications could result in death,” he said.
Amibor explained: “Looking at the cost of inhalers to treat asthma for example, how can a worker that earns a minimum wage of N30,000 a month, and is asthmatic, cope with buying two inhalers at N19,000, and still meet up with other obligations? He or she might decide to apply the principle of opportunity cost and forgo his medications, so he or she can at least eat one or two meals a day. Of course, his or her asthma will get worse.
“Same for patients admitted for septicemia in hospitals. With time, their caregivers may run out of money to meet with hospital expenses and end up abandoning the patient in the hospital. Hospitals are daily inundated with cases of patients absconding from hospitals as a result of inability to meet up with their obligations.”
The pharmacist said another fall out is that when patients cannot afford to pay for their prescribed medications in hospitals and pharmacies, they fall back on unlicensed and unregistered patent medicines shops or even open drug markets, to purchase seemingly cheaper brands. In the process, he said they end up purchasing falsified, substandard and or outrightly fake products devoid of medicinal value. “To answer your question directly, the current prices of drugs will result in some patients experiencing treatment failures, heightened morbidity and mortality for reasons explained above,” Amibor said.
On the impact in the cost of medical procedures and surgeries such as Caesarean Section (CS), Amibor said the cost of accessing care has increased appreciably, it does not affect only essential medicines, but medical procedures and surgeries are equally affected as well.
He said most equipment and reagents that are used in diagnosis are imported, and so are affected by forex issues just like active pharmaceutical ingredients. Amibor said sutures for surgical procedures are largely imported, and have become very exorbitant because of import challenges such as limited access to forex and high exchange rates. “The cost of medical procedures has increased tremendously, and is still increasing, with the removal of fuel subsidy,” he said.
A former Commissioner for Health, Ondo State, Dr. Dayo Adeyanju, said subsidy removal has led to a 20-50 per cent rise in health care costs. He said these have led to high-cost health care with consequences on affordability and accessibility for the citizen as well as quality of care and this is a result of managing production costs to break even by some healthcare providers.
“This has led to a hike in the cost of all essential commodities including health care consumables leading to the high cost of producing health care. This includes the cost of pharmaceuticals, laboratory reagents as well as the cost of Labour.
“This is because health workers also demand a rise in pay to meet with the rising cost of living. During COVID-19, healthcare supply input costs spiked in late 2020 and 2021.
“Labour costs per adjusted hospital discharge grew 25 percent between 2019 and 2022, closely followed by pharmaceuticals at 21 per cent, supplies at 18 percent, and services at 16 percent. However, subsidy removal has led to a 20-50 per cent rise in health care costs,” he said.
Adeyanju said over 70 per cent of the cost of care is out of pocket by the patient and some of these have led to catastrophic spending affecting the wellbeing of individuals. The physician said it has inevitably led to increased mortality, particularly for disease conditions that require medicine for their control like hypertension and diabetics who must not go on drug holiday have to skip their medicine due to affordability of the drug.
On how to address the situation, Adeyanju said it is high time for the government to look into how to alleviate and reduce this economic burden by the citizens by considering the following: “As government is considering palliative, one thing to consider is to strengthen our health insurance to have pooled funds and share the risk of health care cost among the citizens. There must be a need to subsidize the premium and pay for indigent to cover more citizens towards achieving universal health coverage from subsidy removal savings.
“There is also a need to have Public Private Partnership in adoption for more enrollee by way of Corporate Social Responsibility (CSR).
“Improving the welfare of workers is already being considered by the government as part of the buffer for the high cost among other considerations.
“Local production of some of these commodities will also help bring the cost down and improve affordability of healthcare.”
Vice President, National Association of Resident Doctors(NARD)/Chairman, NARD committee on Medical Education, Dr. Jumbo Eniefiok Hezekaih, said a malaria drug that was about ₦1200 is now sold for ₦2800 to ₦3200.
Hezekaih said workers and patients turn out are low and seminars and academic exercises are either shelved for poor attendance or converted to virtual. More so, he said health workers who were not contemplating ‘Japa’ (leaving the country for greener pastures) hoping things will get better are preparing to leave the country.
“Your guess is as good as mine, poor follow-up visits and treatment failure, increased morbidity and mortality,” the resident doctor said.
He said health insurance is currently not meeting up with its supposed effectiveness, hence with the rise in cost of medications, and it can only move from bad to worse if nothing is done to ameliorate the present suffering.
A consultant pharmacist and medical director, Malix Pharmacy, Onitsha, Anambra State, Mrs. Adaeze Omaliko, said: “Prices of drugs are very terrible, some went as high as 200 per cent increase while some hundred per cent. The prices of drugs are going up and have caused lots of deaths, as many are no longer able to go to hospitals. The implication is high incidence of death as it is very difficult for the common man to access.”
MEANWHILE, pharmacists had, last month, lamented the scarcity of drugs produced by GlaxoSmithKline in Nigeria.
They said the scarcity is due to supply chain shortage, shortage of foreign exchange, and the impact of COVID-19.
According to them, the scarcity has led to an unprecedented increment in drug prices by 300 per cent.
President of the Association of Community Pharmacists of Nigeria, Adewale Oladigbolu, said the scarcity is due to supply chain shocks and the impact of COVID-19.
“There is a relative scarcity of GSK drugs and other products from other companies. That of GSK is pronounced because they are marketers of products that are widely known and widely used,” Oladigbolu said.
Oladigbolu said the scarcity is having a significant impact on patient care. “The products have gone up by more than 300 per cent as against what we used to sell, and those products are not readily available. Anytime patients need to use the innovator brand, the patients will have to pay more, but there are generic equivalents of those products, but all over the world, people tend to align with the innovator products.
“If the scarcity continues, it can even lead to the death of patients,” he lamented.
He noted that the association is working with industry leaders to resolve the shortages.
Also, the chairman of the Lagos State branch of the Pharmaceutical Society of Nigeria, Gbolagade Iyiola, said drugs like Ventolin, Augmentin, Seretide, Cervarix (for HPV vaccine), Duodart, Zinnat, Ampiclox made by GSK are scarce in the country.
“It is basically a forex challenge. Almost all their products are scarce. Duodart has been scarce in the last three months. Augmentin and Zinnat, which are in tablets and syrups, are scarce.
“For instance, we used to buy Ventolin at N1,200 and we sell to other pharmacies at N1,800, but with the scarcity now, Ventolin is now about N3,000 or N3,500. Since there is increased demand and there is reduced supply, the prices are going up.”
Iyiola said unscrupulous manufacturers may take advantage of the scarcity and deliberately produce poor-quality drugs to the detriment of patients.
“The Nigerian government must make sure that we make dollars available no matter the monetary policy made by the Central Bank of Nigeria. The monetary policy in Nigeria is not helping at all. Imagine if we have a GSK company manufacturing the products in Nigeria, then we will not be having this problem.
“Until our economy goes back to manufacturing, we will continue to have this problem. We need to make Nigeria attractive to enable the production of drugs here,” he said.