In Nigeria, a challenging trinity emerges as a stark reality – the convergence of ailing pockets, an ailing economy, and ailing health. As citizens grapple with the burden of the high cost of drugs, the dilemma intensifies, creating a complex interplay between financial strain, economic repercussions, and compromised well-being, reports Festus Akanbi
When Kingsley Akabueze returned home from a pharmacy in Abuja last week Monday, holding his high blood pressure medication, one drug on his prescription was missing because he did not have the money to buy it.
Since 2017, when his health complications put him at the mercy of three hypertensive drugs, Normoretic 50mg, Amlodipine 10mg and Losartan 25 mg, Akabueze, a junior civil servant had been struggling to provide for the medications and his family needs with difficulty.
Accessing Healthcare Service with Tears
Although the nation’s health sector has been having its fair share of the general rise in the cost of living, a combination of the foreign exchange policy change, fuel subsidy removal, and the exit of GlaxoSmithKline, a popular foreign drug manufacturer has pushed the cost of drugs beyond reach in recent times.
The price of some medicines has risen almost tenfold in Nigeria in the past few months, forcing patients like Akabueze to cut their dose or resort to local herbs.
Although the general rise in the prices of drugs is not restricted to Nigeria, analysts however, lamented that Nigeria’s case is worsened by the fact that unlike in developed countries where health insurance is popular, many people have to take care of their health matters themselves.
This was confirmed by the research firm Statista, which says only three per cent of Nigerians have health insurance, meaning patients must find the money themselves to buy medication.
Obstacle to Economic Productivity
The high cost of drugs in Nigeria has profound implications for the country’s economy. With a significant portion of the population struggling to afford essential medications, public health outcomes are adversely affected, leading to increased morbidity and mortality rates. This, in turn, places a strain on the healthcare system as more individuals seek medical attention when conditions worsen due to unaffordable medications.
Additionally, the economic productivity of the workforce is hindered as individuals may be unable to work or contribute fully to the economy when faced with health challenges. The government, too, bears the burden of providing subsidies or alternative healthcare solutions, diverting funds from other critical sectors. Therefore, addressing the high cost of drugs is crucial not only for improving public health but also for promoting economic stability and sustainable development in Nigeria.
The Reality
Analysts argued that considering the economic realities in Nigeria, over-the-counter medications may soon be out of reach of people who cannot afford hospital facilities in Nigeria.
A recent report by SB Morgen Intelligence, an Africa-focused market/security intel gathering and strategic consulting firm, which is titled: ‘Paying the Price on Health,’ analysed the impacts of the Nigerian economy and foreign exchange crisis on the prices of essential medicines in the country.
The group said it gathered data on the prices of medicines across four broad categories of Antimalarial, Antibiotics, Painkillers, and Common Cold medicines between 2019 and 2023.
The report indicates that antibiotics recorded the highest price increases, with 500mg Ampiclox capsules recording the highest jump. The cost price is said to have increased by 1,390 per cent and the selling price increased by 1,100 per cent between 2019 and 2023.
A Seretide asthma inhaler manufactured by GSK, for example, cost up to N8,000 naira in April but now retails for up to N70,000. Antibiotics like augmentin cost as much as N25,000, up from N4,500 in July. There is the fear that with continued reliance on poor sources of drinking water, many Nigerian lives are at risk, especially with the prevalence of typhoid fever and other water-borne diseases.
There are reports that antimalarial drugs saw the slowest price increase in the period under review, while only one (Novalgin) in the painkiller category has maintained its 2022 price in 2023, following a 25 per cent increase in price in 2022.
SBM noted that 19 per cent of respondents who participated in a 2023 survey reported spending a significant amount of their income on healthcare and 67 per cent of respondents who reported making lifestyle changes due to a high cost of living, listed cutting back on healthcare bills.
According to the report, across all drug categories, the highest jump in the cost and selling prices was recorded in the antibiotics section, which was attributed to the continued demand for antibiotics.
“Between 2022 and 2023, Amoxil recorded the fastest rate of increase, jumping by over 400 percentage points. This was followed by Ampiclox, which saw an increase of 240 percentage points,” the report said.
“The high cost of drugs in Nigeria is forcing patients to skip doses or forgo treatment altogether based on anecdotal observations.
“This can lead to the development of drug resistance, making it more difficult to treat infections. It can also worsen chronic conditions, leading to increased morbidity and mortality.”
The report further explained that when patients are unable to afford essential medicines, they may resort to self-treatment or seek treatment from unlicensed practitioners, which can lead to the inappropriate use of antibiotics, and contribute to the development of drug resistance.
GSK’s Planned Exit
On August 3, GlaxoSmithKline (GSK), a prominent UK-based pharmaceutical company, communicated to its Nigerian branch, GSK Consumer Nigeria Plc, its decision to discontinue the direct commercialisation of its prescription medicines and vaccines in Nigeria.
The company announced a strategic shift towards utilising a third-party direct distribution model for its pharmaceutical products within the country.
GSK attributed this significant change to a range of operational challenges. Primary among these was the difficulty in maintaining a steady supply of GSK drugs in the Nigerian market.
Additionally, the company faced considerable hurdles due to the scarcity of foreign exchange, which adversely affected its capability to manage and settle foreign currency-denominated trade payables with its product suppliers.
Furthermore, GSK identified several external factors influencing its decision. These included the prevailing insecurity in the region, the government’s decision to remove fuel subsidies, and the overall high cost of conducting business in Nigeria. These elements collectively contributed to GSK’s strategic realignment in the Nigerian pharmaceutical market.
Following GlaxoSmithKline’s (GSK) announcement, traders of pharmaceutical products report that there has been a noticeable scarcity of GSK drugs across the country.
According to the former Secretary of the Association of Community Pharmacists of Nigeria, Lagos State chapter, Jonah Okotie, since the exit of the British Biopharma company, GlaxoSmithKline from Nigeria, the prices of its products have gone up by 900 per cent.
Okotie, who is also the Managing Director and Superintendent Pharmacist at Engraced Pharmacy, said, “On the GSK drugs, there is over 900 per cent increment on the prices of GSK products and even on the local products, though the percentage varies to some degree. Some are over 900 per cent, others 800 and 700 per cent.
On his part, the president of the Pharmaceutical Society of Nigeria, Cyril Usifoh, was quoted as saying that most drugs were imported while local makers relied on imports for the pharmaceutical ingredients to produce medicines.
The naira has lost half its value since June, raising prices of everything from painkillers to drugs for chronic disease.
Also reacting, the Chief Medical Director of Lagos State University Teaching Hospital, LASUTH, Prof Adetokunbo Fabamwo, said the high cost of drugs was undesirable for the welfare of the average Nigerian.
“Nigerian citizens are already impoverished and cannot even afford to buy food to eat if they are sick and need to buy drugs; shortly we will have increased morbidity and mortality. So people will not be able to comply with their drug prescriptions. People will get sicker, and some of them may even die,’’ he said.
Also, people with mental health conditions are not spared, according to a Consultant Psychiatrist at the Federal Neuropsychiatric Hospital, Yaba, Dr. Stephen Oluwaniyi.
He said: “As far as management of those who already have mental health conditions is concerned, many of the conditions are what we call chronic disorders, in the sense that they need to continue with maintenance treatment, taking medications in one form or the other., apart from the cost of transporting themselves to the hospital, they have to pay for medication.
The former chairman of the Pharmaceutical Society of Nigeria, Lagos chapter, Gbolagade Iyiola, underscored the severity of the situation, saying until the government takes practical action, Nigerians will continue to lament.