…Seek herbal alternatives
By Ngozi Nwoke
Lagos-based businessman, Mazi Austin Ewa-Ekoh, is preaching a sermon. He is telling those who care to listen: Try not to fall sick. Sleep early, quit smoking, avoid alcohol, drink a lot of water, eat lots of fruits, exercise regularly and stop drinking too much soda.”
Austin’s sermon is inspired by the skyrocketing price of essential pharmaceutical drugs in Nigeria, even as many doctors are now giving outrageous medical bills.
The rising price of drugs is attributed to the foreign exchange crises, as many of the products are imported. There is also the effects of the removal of fuel subsidy. Of course, many Nigerians are forced to seek cheaper alternatives such as herbal products, among others.
Data from the International Trade Centre, a multilateral agency, shows that the importation of pharmaceutical products into Nigeria dropped for the second straight time to $1.05 billion in 2022 from $1.37 billion in 2021.
A former president of the Association of Industrial Pharmacists of Nigeria, Lolu Ojo, said the cost of replacing drugs is one of the factors influencing the costs of drugs.
Ojo said: “By the time you are replacing the drugs you need now, the prices are up. Also, forex is a challenge. Even the cost of fuel now is a factor influencing the prices of drugs. Some companies use cars for the sale and distribution of their products and they will fuel the car.
“For instance, if you were using N30,000 to fuel your car, you would be using at least N45,000 to fuel it now. So, these things will influence the prices of the drugs. Unfortunately, if it continues like this, people may find it difficult to buy essential drugs by the end of the year.”
Similarly, the Pharmaceutical Manufacturing Group of the Manufacturers’ Association of Nigeria said the cost of pharmaceutical products in the country has increased by 300 per cent. According to the group, the challenges of foreign exchange and the high cost of production are some of the factors responsible for the rise in costs of drugs.
An interview with doctors, pharmacists and the common people revealed that some malaria drugs, which cost an the average of N3,500 in the last three years, now go for between N7,500 to N8,000 in some pharmacies in Lagos.
Mr. Chibuike Egbuna, a pharmacist in Green Care Pharmacy, Ibeju-Lekki, Lagos, warned against the decision for alternative medicine such as herbal and native medicines that have implications on treatment outcomes and mortality. He noted that those patients suffering from life-threatening diseases are extremely vulnerable because failure to access their medications could result in death.
He said: “Ciprofloxacin 500mg tablets costs about N3,500 for a sachet of 10 tablets two months ago. Today, it costs about N4,500 per sachet of 10 tablets. Rocephin 1g injection (brand of Ceftriaxone) costs about N2,500 per vial two months ago, today it has risen to more than N7,500 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. The increase in dollar exchange has resulted in the hike in prices of medicines for about 80 per cent.”
It is feared that the situation has led to rise in complications, especially in chronic diseases and deaths. Some people who spoke to Daily Sun said they have resorted to traditional medicine since they could no longer afford conventional treatments.
A health practitioner at Federal Medical Centre (FMC) Owerri, Imo State, Celestine Anwayi, said there was 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.
Anwayi said affordable prices for medicine is a major factor that guarantees a reliable health system. He said a sustainable health system could only be achieved when there is affordable access to quality medicines and health products.
He 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, Chima Uzobor, a pharmacist at Forever Living Health Pharmacy, Lagos, said most patients now find it extremely difficult to access their needed medications as a result of exorbitant cost.
The pharmacist said from the prices of medicines, it becomes glaring that access to essential medicines has already been impeded, given the scenario where prices have more than doubled, while the people’s sources of income have remained greatly stagnated.
He said: “The implications of the high cost of medicines are that treatment will become impossible, the level of mortality rate will increase and, of course, morbidity. Patients who are suffering from underlying life-threatening diseases are extremely vulnerable because failure to access their medications could result in untimely death.
“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.
“It is 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.”
Caleb Divine, another pharmacist from the Oasis Care Pharmacy, Yaba, Lagos, said when patients cannot afford to pay for their prescribed medications in hospitals and pharmacies, they fall back on unlicensed and unregistered medicine shops to purchase seemingly cheaper brands. In the process, they end up purchasing substandard and or fake products.
“The current prices of drugs will result in some patients experiencing treatment failures, heightened morbidity and mortality for reasons explained above,” he said.
Forty-two -year-old Imo State civil servant, Ezekiel Udodinma, said that the subsidy removal has led to a 20 to 50 per cent rise in health care costs.
He said: “The removal of fuel subsidy has contributed to the increased rate of medicines and medical equipment. These have led to high-cost of 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.
“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.”
Charity Aaron, a 30-year-old pregnant woman in Lagos expressed fears on the cost of hospital charges as she is due for delivery next month. She lamented: “I am afraid of the high rate of drugs in the hospital. Every day I go for antenatal, they present expensive bills to me and it has increased my blood pressure because my husband is a carpenter and my business is not doing well.
“I beg the government to provide free healthcare services for pregnant women, nursing mothers, elderly ones and the disabled. These people are the most vulnerable.”
On how to address the situation, Prisca Adewale, a medical doctor at Life Foundation Specialist Hospital, Ikeja, Lagos said it is high time for the government to look into how to alleviate or reduce this economic burden by the citizens.
She said: “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.”
Timininu Gabriel, a 34-year-old, Lagos-based kerosene seller, complained: “English medicines are now expensive. I can’t afford to buy them again. I just rely on ‘agbo’ [a Yoruba word for herbal drinks], which I prepare myself to treat malaria and typhoid. I have lemon grass at the back of my house. I only need to buy pineapple and lime to boil with it, which usually costs me around N1,500.”
She added that even when she took the malaria medicine, she still felt sick after two weeks of taking the medicine, noting that the medicine was never effective and that was why she preferred the native herbs for treatment. She said: “The worst part is that I buy the malaria medicine at a very expensive rate and it’s still not effective. I will still have fever until I take ‘agbo’.”
Bethel Okwu, a Lagos-based chef who is asthmatic, said he has earned the same amount of salary for over five years in a confectionery industry and he cannot afford to buy an inhaler to suppress the asthma attacks when they come.
“I have been on my inhaler for close to 25 years. For the last four months, I used to buy it for N4,800 to N5,000 depending on the location. But today, it is N8,000. When I could not afford it anymore, I resorted to taking herbs and eating lots of garlic and glove spices because it helps clear the respiratory tract. It was the hike in the price of the inhaler that made me realise the efficacy of garlic and gloves in the respiratory tract.”
Ubong Nathan said a malaria drug that was sold for about ₦1200 is now sold for between ₦2800 and ₦3200. More so, he said health workers who were not contemplating leaving the country for greener pastures abroad, are now preparing to leave the country.
A consultant pharmacist at Impact Pharmacy, Surulere, Lagos, Mrs. Stella Omokaro, said: “Prices of drugs are very terrible, some went as high as 200 per cent increase while some 100 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.”
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 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.
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 for the production of drugs here,” he said.