16 March 2011

Liberia: Who Is Monitoring the Regulators?


PRESIDENT ELLEN JOHNSON-Sirleaf announced the appointment of new members of the Liberian Medicines and Health Products and Regulatory Authority (LMHRA). The announcement, unfortunately, did not go beyond the list of those appointed and their placement in the regulatory hierarchy. Fortunately though, the announcement left room for conjecture about what exactly the appointees are supposed to be doing – serve as “regulatory authority” of the amount, quality, and sale or distribution of health and medical products coming into the country.

HONESTLY, WE KNOW practically nothing about this body, including its capability, core mandate, and working relationship with the Pharmacy Division at the Ministry of Health and Social Welfare. As far as we can remember, it is the Pharmacy Division of that ministry that has been in charge of the regulation of health and medical products. It has been issuing licenses for medicine and pharmacy operators, assigning trained pharmacists to supervise pharmacies, and issuing restrictions on the type of drug and drug-related products to be sold in which outlet. As far as we can remember also, the President of Liberia appoints only the head of the Pharmacy Division, leaving the ministry to affirm members of the Pharmacy Board, who are usually drawn from the pool of pharmacists in the country. Whether that division continues to exercise these responsibilities appears unlikely as to us. For all practical purposes respecting efficiency and productivity, both the LMHRA and the Pharmacy Division, together with the Pharmacy Board, cannot coexist without one being subordinated to the other or effaced.

OUR HUNCH IS that the LMHRA, by its high profile presidential appointees, must be the superior, which raises these fundamental questions: (1) How does LMHRA’s apparent takeover of the functions and duties of the Pharmacy Division affect the quality, safety, and mode of distribution of health and health-related products in Liberia?; (2) Has the Executive Mansion taken over the business of medicine and health products regulations from the Ministry of Health, given President Sirleaf’s high profile appointment of the entire corps of LMHRA?; and (3) who will monitor the regulators to ensure that it is not business as usual with pharmacy and medical products regulation? We ask the first question to make the point that it is high time the government of Liberia buckled down to business and got serious about the health of the Liberian people. For centuries, this country has been virtually unable to provide quality and professional health services for its citizens.

SUCCESSIVE GOVERNMENT ADMINISTRATIONS, from Tubman to the present, have simply constructed buildings across the country and neglected to provide trained healthcare providers, let alone to talk about providing drugs and medical supplies, on sustained bases, to cater for the needs of the sick. In order to reinforce its lip service to healthcare delivery, the government simply created the Division of Pharmacy at the Ministry of Health and neglected to equip it with analytical laboratories to test the potencies, safety, and efficacy of drug and related products brought into the country – something the division needs to be able to objectively license proprietaries and dispensers across the country. This professional body has only to rely on empirical evaluation, which is holistically subjective and ineffective. Some unscrupulous international NGOs have taken advantage of this lack of technical verification mechanism to import and distribute outdated drugs, food supplements, and even pharmaceuticals to health outlets or administer them directly to patients. As the result of this failure, the Liberian market is inundated with fake, poisonous, over- or under-potent drugs, drugs not approved for human treatments, or drugs withdrawn from the market for dangerous side or adverse effects. Today, no one knows exactly how many Liberians are dying from the use of these drugs sold at such unlikely places as the peddlers’ markets and in the communities by “black-baggers” and “gobachovs”, without safety verification or doctor prescription. The government must begin to solve this problem by ensuring that the apparent substitution of the Pharmacy Division with LMHRA will improve the health outlook of the nation.

THE SECOND QUESTION concerns the politicization of the health sector, which we fear will exacerbate the problems outlined above. If the LMHRA must do the work of the Pharmacy Division, it has to be professional, meaning its officers must serve at the credit of their peers and not appointed by the government of Liberia. The authority’s place with the drug enforcement administration, which we understand is under the Ministry of National Security, has to be defined to avoid overlaps and therefore dependency of one agency on the other or to avoid cross-purpose administration. The third question is just sequel to the second: if the government appoints the leadership and members of LMHRA, who will monitor them to ensure that they are performing their duties – the minister of health and his deputies, who are also political appointees, the unsuspecting consumer public, or the director of the cabinet?

AS THE NATION ponders these questions in the wake of the President’s Friday announcement, we urge the Sirleaf Administration not only to be contented with appointing individuals to professional responsibilities, but to ensure that the work of these people brings necessary and relevant changes to the service and relief to the Liberian people. This it must do by revisiting its health policies to improve on the evaluation and monitoring aspects of health delivery, something not satisfied simply by the changing of nomenclatures or the making of political appointments. The question, “Who is monitoring the regulators?” remains crucial to ensuring that Liberia ceases to be a free-for-all dumping ground for dangerous medicines and health products.

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