Doctors, nurses contributing money to buy drugs for patients – President, cancer society
The President of the Nigerian Cancer Society and National Action on Sugar Reduction Coalition, Dr Adamu Umar, speaks with LARA ADEJORO on the rising prices of drugs and how patients are coping. Excerpts:
How would you describe the current impact of rising drug prices on patients in the country?
It’s not only the rising cost of drug prices but generally, the rise in the cost of living. Food is medicine too, and we have found ourselves in a situation where the ordinary Nigerian is suffering because of the threat of inflation; something that used to sell for N200 is now selling at N1,000. We are still battling with the minimum wage, and that is even for those that are working. There are so many Nigerians who are not working, the majority of whom are in rural areas with little or no capital. The cost of living is very high, likewise, the cost of drugs. The difference between the cost of food and drugs is the fact that drugs are inevitable commodities, so that has a very negative impact on society in general. It has a way of bringing down the productivity status of Nigerians. Many Nigerians cannot afford to put food on their tables, not to talk of getting healthcare. This is the reason we always call for universal health coverage so that everybody will be covered, and the minimum package, at least, will be accessible to Nigerians. The National Health Insurance Authority covers a very insignificant percentage of Nigerians because over 86 per cent of Nigerians are paying for healthcare out of their pockets. So, it is creating a very negative balance to productivity because a healthy nation is a wealthy nation. Once you can’t afford to buy the drugs, it means that the status of your health is in a situation where you can’t be productive. The way Nigerians are, they always go for the cheaper option. Most of these drugs sold on the streets are expired, and this is because Nigerians cannot afford to buy the best medicines prescribed by their physicians.
Can you provide specific examples that illustrate how patients have been affected by these increases?
Let me give you a typical example of a certain drug that used to sell for N2,500, when the company left Nigeria, that particular drug is now N30,000. There’s an antimalarial drug that used to be N600, it is now N2,000. Meanwhile, the income of Nigerians and the minimum wage have not changed. A course of chemotherapy that used to be about N60,000 is now about N100,000. Some patients take six courses, some take nine courses or more. You can imagine the burden on those suffering from chronic illnesses like diabetes mellitus, cancer, and other diseases that will keep them on drugs for a lifetime.
Are there particular patient groups that seem to be disproportionately affected by these cost increases?
I have not conducted any research, but this is across the spectrum because of the skyrocketing foreign exchange, the dwindling value of the Naira, and the lack of palliatives. I interact with cancer and diabetes patients every day, and the cry has intensified because the problem does not seem to be abating. Every day, there is demand on what to eat, and money spent on medications, so I can say it affects from the minutest to the most chronic illness because it’s all the same market we buy from. The only difference is that when you treat malaria effectively, it goes away unlike diseases like cancer, diabetes mellitus, and hypertension you will be taking drugs daily.
Have you noticed any changes in patients’ ability to access essential medications due to the cost of these drugs?
Yes, though I can only account for those that we get to meet. People are even afraid to go to the hospital now because when a doctor prescribes a medication, the money to buy is not there. So, you see people patronising drug hawkers, and patent medicine stores to get what their money can buy, which is not usually a good thing; and instead of taking a full cycle of drugs, they take it for three or four days because they can’t afford it. The only panacea is the full implementation of the NHIA Act that makes health insurance compulsory for all Nigerians. Many Nigerians are not even aware of the voluntary health insurance policy, many are not aware that the informal sector exists, and that you can pay a certain amount and get insurance coverage. Another problem is that the drugs in some of these hospitals are not even available. You have so many complaints, especially from these insurance patients that the prescribed drugs are not available. We need to see proactive measures by the government to bridge the gap, so that the burden on patients will be reduced, and they can access essential medicines.
How do patients typically respond when faced with higher drug prices?
Some of them seek alternatives or rely on people for money to purchase drugs; this is the reality we battle with every day. Cancer patients, particularly, are suffering, because of lack of full access to drugs. When the Cancer Health Fund became rational, it was a pilot project and only restricted to certain hospitals, so not all patients could freely access it. Even with the funds, some drugs are not directly covered. For cancer patients, the amount of complaints we receive has skyrocketed because of the economic hardship. A lot of patients have sold their houses. I met a patient in Calabar recently who has sold her house, she’s waiting to be enrolled into the CHF but her money has finished, and she doesn’t have relatives in that area. What happens to those kinds of patients? Many patients have died silently because there is nowhere they can go. Patients who have chronic illnesses are suffering because this is not a one-off thing. You are talking about a minimum wage of N30,000 and someone is on a drug that costs N100,000 monthly. Where will that person get the money? The situation is terrible, and unbearable to a lot of our patients. This, of course, leads to poor prognosis, and poor health outcomes because when you don’t get the best treatment at the right time, you don’t expect to have a good outcome. And, as I said, people are dying because of the economy, people are dying because of their inability to access essential medicines. I have seen several instances where doctors and nurses will contribute money to buy drugs for patients.
What role do you think policy changes or advocacy efforts could play in mitigating the impact of rising drug prices on patients?
When the right policies are implemented, you will have a better health outcome. The full implementation of the NHIA Act will ensure that all Nigerians are covered under the Act. When you have health insurance, it is believed that at least the basic healthcare needs of that individual are taken care of. What we are pursuing at the National Action on Sugar Reduction Coalition is that when the government introduces taxes on sugar and sweetened beverages, we expect that these taxes should be channelled appropriately towards health interventions, especially for non-communicable diseases like cancers, diabetes, hypertension, and others, so that patients can have some form of succour. The coalition and some legislators are working towards creating a legal framework for sugar and sweetened beverages so that when there is a law, there is some amount of money channelled to health interventions. The government should be proactive in increasing the health budget. Since 2001, the African Union declared that nations should budget at least 15 per cent of their annual consolidated budget to healthcare, but in Nigeria, we are battling between five and six per cent. Without proper budgetary allocation to healthcare, you don’t expect our hospitals to work effectively, you don’t expect the essential medicines to be there, you don’t expect the health workers to be motivated.
Looking ahead, how do you foresee the issue of rising drug prices evolving, and what implications can this have on patients?
What we need is a proactive government that can ensure that we block all the loopholes. The regulatory agencies should be up and doing and Nigeria should go into local production. We have a lot of domestic drug manufacturers; they should be empowered to produce the best for Nigeria so that we can control our pricing system. The government should provide a conducive atmosphere for local drug manufacturers to thrive, and ensure that our hospitals are fully equipped and managed so that Nigerians can get the best of treatment. If we don’t change this perspective, it is not possible to come out of this. Once it is not addressed, people will look for cheaper options, they keep accumulating health issues, and by the time they eventually get to the hospital, it will be late.
What strategies do you recommend to patients to navigate the situation?
Unfortunately, the patients have very little or no option. As it is, if you are sick, you must look for resources to take care of yourself. If you are not covered under insurance, there is no way the government can pay for you, and if you are not from a well-to-do family, there is no way you can get the best of care. So this is why patients are left to suffer, or die in the process. We shall continue to push for good health policies so that the patients will be the beneficiaries, if not, the patients are always at the receiving end.
How can healthcare providers collaborate with pharmaceutical companies and policymakers to address rising drug costs?
This is already happening. There is a particular pharmaceutical company in partnership with the Federal Ministry of Health for cancer, they call it a cancer access programme, it’s a collaborative approach, and I think that same company is also in partnership with the NHIA. The Federal Ministry of Health, and the NHIA work with healthcare providers in health institutions. That cost-sharing mechanism is ensured so that they get drugs directly from the company, the company will give a discount, the government will pay some certain discount, and the patient will pay 50 per cent of the cost price. So, if that is already happening, it means it can be amplified, and other drug companies should key in. Drug manufacturing companies are in the market for business, and you don’t expect them to give free drugs. And, of course, the healthcare providers cannot give what they don’t have; if you don’t have a particular brand of medicine in your pharmacy, you can either dispense what you have or you ask the patient to go and buy elsewhere. A lot of healthcare providers are equally advocates, and that is how we can champion this course so that there can be a win-win situation for everybody.
