Hope dashed!

From Fred Ezeh, Abuja 

National Health Insurance Authority (NHIA) has announced the discontinuation of actions on its proposed plans to roll out some branded drugs that would be useful to over two million of its subscribers in the country.

Inflation and several unfriendly factors were identified as majorly responsible for the development, also pointing the way of rising economic inflation in Nigeria as being witnessed in all sectors of the economy including the pharmaceutical sector.

The National Agency for Food and Drug Administration and Control (NAFDAC), earlier in the year, hinted that devaluation of the naira was largely responsible for the rise in cost of pharmaceutical products particularly locally produced ones, adding that high exchange rate also made procurement of raw materials and equipment imported for production extremely high.

It also that added that over reliance in foreign countries/pharmaceutical companies for Active Pharmaceutical Ingredients (APIs) and the non-actives otherwise known as Excipients are also some of the reason for the experience, adding that difficulties associated with procurement of dollar also forced the cost of the imported drugs to hit the roof. 

The past leadership of the NHIA had conceded the idea of producing branded drugs for NHIA enrollees/subscribers as a result of several complaints by enrollees about the unavailability of drugs and several excuses from health facilities.

It’s also a way of boosting confidence in the drugs, and also ensuring constant availability of the products across its accredited health care facilities.

How it started

In October 2023, NHIA announced that beginning from the following month, its enrollees would begin to access drugs and other health products that are branded in its name.

The initiative of branding NHIA medicines and other health products was to facilitate the supply of affordable, acceptable, accessible, and available quality medicines and the enrollees may require other health products as.

It was expected to enhance the production of high-quality medicines that will inspire the confidence of users in the health insurance services, helping to bring in more subscribers into the health insurance pool.

To this end, commitment was secured by the management of the NHIA led by its former Director General, Prof. Nasir Sambo, for pharmaceutical companies and Drug Management Organizations (DMOs) to ensure that the drugs were rolled out as quickly as possible for the benefit of subscribers.

Agreement with DMOs

After several consultations with relevant stakeholders, 12 indigenous pharmaceutical companies and eight DMOs were accredited to commence the manufacturing and management of the NHIA-branded drugs for use at all health care facilities for NHIA enrollees at all levels.

Document obtained from NHIA indicated that a total of 44 submissions were received from interested indigenous pharmaceutical companies, which were scrutinized and synthesized by the selection committee. At the end of the scrutiny, 20 companies and eight DMOs were selected to provide the services for the initiative.

Operational agreements were, however, reached with the selected indigenous pharmaceutical companies to commence the production of 33 branded products for the health insurance ecosystem in the first phase of the initiative.

Seven states, namely, Delta, Enugu, Gombe, Jigawa, Niger, Osun and Sokoto states and the FCT, were chosen for the pilot phase of the implementation of the initiative, which was earlier scheduled to start the following month. Sadly, that target couldn’t be achieved.

Partnership with NAFDAC, others

Before the collapse of the plans for the branded drugs, NHIA had secured the support of the National Agency for Food and Drug Administration and Control (NAFDAC), and other relevant organizations to strengthen the monitoring of the branded drugs, perhaps, in anticipation of the roll out of the drugs for use across the country.

The idea was that since NAFDAC has a strong post-marketing strategy, its involvement will ensure that the drugs are of high quality and properly delivered to the right places and people.

NAFDAC’s world-class laboratory located in Lagos was being positioned to play a critical role in ascertaining the quality of the drugs vis-a-vis the quality and content of the Active Pharmaceutical Ingredients (APIs) as specified.

Fears and intended benefits

There have been several complaints and misgivings about the quality of drugs and other pharmaceutical products being provided for NHIS subscribers at various health facilities across the country.

Subscribers have had to contend with the challenges of unavailability of some basic drugs/ products whenever they visited the health facilities, in addition to fears of being given substandard drugs because they are NHIA patients.

Muruf Adeola, a NHIA enrollee who is resident in Abuja, said he has, on several occasions, abandoned the drugs given to him at several public health facilities in Abuja (names withheld), for the treatment of typhoid and other ailments because they seem substandard.

“At one occasion in April, the health workers refused to give me the brand of drug I had wanted. They said that it’s not within the NHIA cover. I had to abandon the drugs and went for the brand of drug I have trust on. It’s not my first experience, and I am sure it won’t be the last,” he said.

NHIA, however, explained that the 33 branded pharmaceutical products that would be produced in the first phase would be used to respond to simple ailments like malaria, upper respiratory issues, and typhoid, among others including a secured discount for IV fluids which are often used to save lives at critical time.

NHIA DG explanation 

NHIA Director General, Dr. Kelechi Ohiri, confirmed that actions on production and roll out of NHIA-branded drugs are halted but on a temporary basis for some reasons.

He told Daily Sun Newspapers that between the time the concept was conceived and agreement signed, and now, a lot has happened in the drug manufacturing and distribution industry considering the issue of inflation that has hit the entire economy of Nigeria.

“Nevertheless, my team is working and meeting with multiple stakeholders on a regular basis to review tariffs of the drugs as contained in the agreement signed with the pharmaceutical companies and DMOs. Undoubtedly, the premise for which the things were done has changed significantly because of several factors including inflation.

“However, we are looking at sustainability. So, we would love to start and sustain it, but we can only achieve that if we have all that is required of us to work with the DMOs. Majorly, we are reviewing the tariffs and other contents of the Memorandum of Understanding (MoU) with the pharmaceutical companies and DMOs. 

“Clearly, rolling out of the NHIA-branded drugs is a good idea, and the aim is to achieve a few things like affordability and quality of drugs that are used for enrollees. We want to eliminate the era of substandard or counterfeit drugs in the circle, and this will help us achieve that.

“We also want to ensure that the reimbursement system to health care facilities is efficient and guaranteed. Nevertheless, NHIA is providing a guarantee that these drugs would be safe and accessible to enrollees contrary to the fears of otherwise by some people. 

“Obviously, medical inflation is very high and it’s telling on everyone. Hence, there’s the need for options that would help cushion the effects of medical inflation on Nigerians.”