Nigeria: How Cost of Medicines Leave Many At the Mercy of Malaria

Malaria drugs.
25 April 2018

Today is World Malaria Day. Daily Trust looks at how the cost of anti-malarial weighs down on the populace

Usman came into the pharmacy with a prescription of malaria medicine from a hospital. However, he said he could not afford the N 2, 000 cost of the Artemisinin based Combination Therapy (ACT) malaria drug brought to him. He asked for a cheaper version of the drug, and was given one that costs N1,400 but said the cost was still beyond him.

The 35-year old recharge card seller said he only had N400 and as he walked out in pains, one of the pharmacists called him back and gave him the drug with the intention of paying with his own money. Not all Nigerians are as lucky as Usman.

Nosa narrated that his friend Samuel died because he could not afford malaria drugs. The security guard felt feverish towards the end of last year and went to the hospital. After paying for tests, anti-malaria medicines were prescribed for him but he couldn't afford them. His neighbours however told him there was no need to spend large sums of money when he could simply buy herbal medicine popularly called agbo at a far cheaper price. He bought it at N50 and took it for three days.

However, a week later he started having stomach cramps, chest pains like something was stuck in his throat. He was taken to the hospital as his case worsened and was diagnosed with kidney failure. He died a few hours after his first dialysis session.

Taofeek Ademola, 50, a civil servant told Daily Trust that for over a year, he has not bought anti- malaria drugs from any pharmacy or hospital whenever he had malaria. He said he relied on agbo because they are effective and cheaper. Many women interviewed at Durunmi community in Abuja said they couldn't afford malaria drugs so they often go to a patent medicine vendor called Silas.

When contacted, Silas said because of the cost of the drugs, some residents of the community sometimes ask for chloroquine.

He said even though he knew chloroquine has been banned for malaria treatment, he still gives it to them when they pressure him. Artemisinin based Combination Therapy (ACTs) is the approved treatment for malaria in Nigeria but findings by Daily Trust showed that the cost of the drugs especially since 2017 is weighing down on the populace.

Nigeria has the second largest burden of malaria in the world and a lot needs to be done in preventing and managing the disease. Many Nigerians are dying daily from malaria, resorting to herbal medicines, and fake medicines because they could not afford the cost of anti-malaria medicines.

According to the Minister of Health, Professor Isaac Adewole, over 90 % of the population in Nigeria is at risk of malaria. He said children and pregnant women were more vulnerable to the disease.

Dr Godwin Ntadom, Chief epidemiologist of the federation, said malaria is caused by an infected female anopheles mosquito.

Speaking during a visit by the National World Malaria Day partners to Internally Displaced Persons (IDP) Camp in Durunmi, Dr Bolatito Ayenigba a public health physician, with the USAID Breakthrough Malaria said it was important for people to be tested for malaria before being treated.

Investigations by Daily Trust revealed that government's introduction of taxes on importation of malaria drugs in 2016, dwindling international funding for malaria control, and forex, among others, are increasing the cost of malaria medicines.

Funding for malaria control efforts in Nigeria is mainly done by international donors, particularly the Global Fund, and its funding has been dwindling.

The Global Fund had supported malaria control efforts all over the country but at the moment only supports 13 states of the country, Presidential Malaria Initiative (PMI) supports 11 states leaving the remaining states of the country without any cover or support for malaria.

Also to make malaria drugs affordable for Nigerians, since 2012, The Global fund under a private sector co-payment mechanism, hosted by the National Malaria Elimination Programme, subsidizes anti-malaria medicines popularly called 'ACT with a green leaf logo'. They were meant to be sold at not more than a dollar. However, the cost of these medicines have risen to betweenN600 to N1000 in some pharmacies our findings revealed. They have become more expensive because of reduced and removed subsidies by Global Fund.

Many poor Nigerians are ignorant about this medicine and do not ask for them when they go to pharmacies. Its 24 dosage is also not attractive as many tend to go for anti-malaria medicines with less dosage.

Also some pharmacies mostly sell medicines that have higher prices than the ACTs with green leaf logo while importers knowing that the grant will be ending in three years have not been making supplies as they should.

Experts said there is need for government to invest in local production of malaria drugs by supporting local manufacturers with technical and infrastructural development.

"Local production of quality anti-malaria medicines (ACT) will go a long way to meet national goals," said Dr Bolatito Ayenigba , a public health physician,

"So that donors will not spend money importing drugs for the country but will rather buy from local manufacturers."

Dr Albert Kelong Alkali, the national chairman of the Association of Community Pharmacists of Nigeria (ACPN) said the cost of Antimalarial drugs are high for an average Nigeria not to talk of a below average person or masses of the country . The cost now compare to three years ago has increased to an average of 40% , he said.

He said the main reason is overdependence on imported drugs." With the gradual withdrawal of donations of drugs especially anti-malarial, you can be sure further increase is possible if effective policy is not put in place." Executive Secretary of Pharmaceutical Manufacturing Group of Manufacturers Association of Nigeria (PMG-MAN), Dr Obi Peter Adigwe said that in the 2016 Fiscal Policy, government instituted an import adjustment tax for Anti-malarials together with three other categories of medicines, for which incontrovertible evidence indicated that local production outstripped national consumption.

He said this landmark policy was one of the most important measures undertaken by government to support local production of medicines however, when compared to other countries in our setting, Nigerian Medicines' Manufacturing has immense potential, both in terms of ensuring sustainable access to medicines, as well as contributing to national socioeconomic development.

Adigwe who is also the chairman, National World Malaria Day committee said government must also improve the ease of doing business in the sector by working with Manufacturers to remove tedious and cumbersome regulatory and bureaucratic bottlenecks.

On the way forward, President of the Pharmaceutical Society of Nigeria (PSN) Pharmacist Ahmed Yakasai called for a downward review of prices of anti-malarials now that the forex is cheaper and more available in the country. He said that government needs to make the business environment more conducive for Pharma businesses by instituting a reasonable tax regimes and make capital available and affordable.

WHO urges investment in malaria prevention

Also the World Health Organisation (WHO) has also called on Nigeria and other countries affected by malaria in Africa to work with development partners to boost investments in malaria prevention and control. WHO Regional director for Africa, Dr Matshidiso Moeti made the call yesterday in her speech by the WHO, Country Representative in Nigeria, Dr. Wondi Alemu to commemorate this year's World Malaria Day.

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