...Delay not worth it, people are dying - Oladigbolu
...Govt must progressively intervene in high tariffs - Akintayo
...Implementation details must be properly worked out -- Ifeanyi
...FG developing a harmonisation implementation framework -- Alausa
By Sola Ogundipe and Chioma Obinna
As Nigeria's pharmaceutical industry eagerly awaits the implementation of the Presidential Executive Order aimed at reducing the cost of essential medicines, and generally revamping the health sector, delays in the implementation process have pushed back the timeline for its take off.
In June 2024, President Bola Tinubu signed an Executive Order to strengthen Nigeria's health system by exempting pharmaceutical machinery, equipment, goods, and accessories from tariffs and excise duties, reducing production costs and making healthcare products more affordable.
But two months after the pronouncement, checks by Vanguard revealed that the cost of items in the key categories of health equipment that are covered by the Executive Order, remain prohibitively high.
Among these are pharmaceutical medications, medical devices such as diagnostic imaging machines, laboratory equipment, surgical instruments, ECG machines, ventilators, syringes, needles, gloves, medical dressings and diagnostic kits for malaria, HIV, etc.
Vanguard gathered that while the government set a 30-day deadline for the development of a harmonisation implementation framework with the Ministries of Finance and Industry, Trade, and Investment, the exact timeline for the take off of the Executive Order remains uncertain.
On when Nigerians can expect to start seeing the benefits of the Executive Order, the Minister of State for Health and Social Welfare, Dr Tunji Alausa said the government is working diligently to expedite action on the framework, that will guide relevant agencies in operationalising and implementing the Executive Order.
Alausa said, "We are developing a harmonisation implementation framework with the Ministers of Finance and Industry, Trade and Investment. Government agencies involved include the National Agency for Food and Drug Administration and Control, NAFDAC, the Federal Inland Revenue Service, FIRS, the Standards Organisation of Nigeria, SON, and the Nigeria Customs Service, NCS.
He said the government was moving quickly to develop the harmonisation implementation framework within 30 days, and once completed, the Executive Order will go into effect quickly.
"We have met with the Attorney General of the Federation about the need to move quickly on this we are working night and day to get this effected so that Customs will start implementing process as well as the FIRS. We are setting up a technical working group on this implementation framework, so that the Executive Order will take effect immediately.
Worried by the apparent lack of progress as the 30-day window has elapsed, players in the health industry have expressed concerns about the potential impact of the delays on the cost of medications and the livelihood of Nigerians even as there is uncertainty regarding the immediate effects of the executive order on drug prices and are urging the government to step up action on the policy.
Delay not worth it, people are dying -- Oladigbolu
On his part, Immediate past National Chairman of the Association of Community Pharmacists of Nigeria, ACPN, Pharm Wale Oladigbolu, said the delay in implementation of the Executive Order is not worth it because people are dying, even as the prices of drugs have continued to spiral up.
"We haven't seen the impact of the Executive Order, that's at the down end where I practice. Prices of drugs at the retail stores are still very high and we see a lot of people not being able to afford the treatment that they actually need. Health insurance which should have helped the people is not working in the Nigerian context.
"A whole lot of people who are in the informal sector are not covered by health insurance, so the prices of medicine are high. The affordability is not there, and people's income are strained. People's incomes are strained. And when I mean strained, I mean really strained. They need to choose between food with high costs, fuel with high costs, and drugs with high cost. So they need to juggle those factors. So people only come to the pharmacy for purely essential things.
So things like high blood pressure that does not have warning, a lot of hypertension patients are dropping their medicines, especially with those who have poor health education, they have dropped. They see hypertension as not troubling, so you see a lot of non-adherence to medication because of high cost of medication. High cost of food. And indeed, high cost of work.
"The delay is not worth it because people are dying. We have not seen an impact or drop in the cost of medicines in Nigeria, so the Executive Order has not had any impact. This speaks to what the federal government should be doing.
"Before you issue an order, you need to check the baseline, you need to do a survey, conduct the baseline. And when you issue an order, two months down the line, you need to conduct another survey to compare the former with the new, and that has not been done, but I can tell you whole heartedly that we haven't seen an iota of drop in drug prices in this country. "
Implementation details must be properly worked out -- Ifeanyi
Responding to the development, the National President of the Association of Medical Laboratory Scientists of Nigeria, AMLSN, Dr. Casmir Ifeanyi, while the concerns about the delay are not misplaced, the details of the implementation of the Executive Order should be properly worked out
Ifeanyi, an Infectious Disease/Public Health Expert, remarked that for effectiveness, the government should put turnaround time when Nigerians can begin to see outcomes.
"The concerns being expressed in certain quarters about delay is not misplaced. We are equally concerned that the details as per the framework for the implementation of this Executive Order are still very sketchy. They are not readily available, and this leaves us to a very big worry about the fate that befell the health care fund.
"And so we are only worried that we hope that this Executive Order will not go the failed route of the $100 billion health fund that was made available, or said to have been made available during the President Mohammed Buhari era.
"That said, I would also want to think that Executive Order is one thing, fleshing it out and providing the details is another, and therefore, 60 days is not too much a time for us to become overtly concerned and worried.
According to Ifeanyi, the Ministries of Trade and Industry, Finance, Federal Ministry of Health and Social Welfare, the Ministry of National Planning, the Ministry of Finance, and the Ministry of Trade and Commerce or Industry, need to work out the details worked out multi-sectorially.
"So you find out that there's going to be a multi-stakeholder engagement to work out the details for the implementation of the executive order, it is no longer on the desk of the president to do. Therefore, we will need to appeal to Nigerians and to stakeholders, to be a little more patient. It is important that people are expectant and excited because the cost of drugs
Lamenting the high cost of diagnostics, medications, consumables and healthcare services rising daily ans compromising services., he said they have gone well beyond the means of the average person.
"The scarcity or near-absence of all these Therefore, individuals are using their bare hands to barely manage and care for patients. When things like the Executive Order come, we expect that for effectiveness, the government should put timelines, there should be obvious turnaround time when we expect that Nigerians can begin to see outcomes.
"I think 60 days or thereabout is too short a time because production of any kind would have planning phase, incubation phase, and a trial and error phase in which we run trials to see if we have got it right or not before you go full scale for commercialization and distribution. So we need to still be patient. That means perfect time.
"The delay is necessary, but it is not yet time for us to begin to lose breath and become very much overtly concerned because if you hurry into such endeavor, you will feel it is about production and production will take time. You need to set up production lines, you need to allow it to incubate. You need to now turn off your first product. Let me use something as to make an example.
"Caution must not be thrown to the wind. The due process and attention need be paid to details. I do not think the government has forgotten about it. It's in the works," he affirmed.
Govt must progressively intervene in high tariffs -Akintayo
On his part, former Chairman of the Lagos State Pharmaceutical Society of NIgeria, PSN, Pharm. Olumide Akintayo, said the inherent birthing of the Executive Order must trigger off a new pharmaceutical industry couched and laden with possibilities and fruitfulness.
"The Federal Government through the Federal Ministry of Health and Social Services must progressively intervene in the matter of unfortunate tariffs and unfriendly policies churned out by some of the key regulators in the pharmaceutical sector if prices of drugs will crash in the interim.
"These tariffs are a major reason drugs availability, accessibility and affordability can no longer be guaranteed in alignment with the National Drug Policy. While congratulating President Tinubu on this feat,it is sacred to once again make a case for the appointment of an Adviser, Pharmaceuticals to the President who will coordinate the plethora of endeavors that are Pharmacy based and inclined in the Tinubu administration.
FG must be more proactive -Okotie
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The Managing Director, Engraced Pharmacy Ltd., Pharm. Jonah Okotie, queried the posited that the Ministry of Health had a duty to create awareness and enlightenment about its policies and how to appropriate them.
"The Executive Order is one thing, the preparedness of everybody, every stakeholder in the industry is another thing, and then the other thing we want to talk about is the people who are concerned. Do they understand how to appropriate the Executive Order, because sometimes the problem we have is not what to do, is how to do it.
"So how much is the Ministry of Health doing to make sure the stakeholders understand how to appropriate it? Because if they really don't understand how to appropriate these things, they can have the best of policies, which amounts to nothing for everybody.
So that's on one hand.
"Government officials themselves, do they understand that this policy exists, is there awareness on the part of the agents of government to ensure that this policy comes to light? How will implementing this policy bring down the price of drugs? Is it at the importation level, production level or whatever? So it's about developing a trade or generating a trade that is going to run through the industry to ensure to pull down the prices of drugs to the end user at the end of the day.
"As for the delay, don't let me preempt anything because sometimes what we don't know, we can't speak much to. I presume that at the manufacturer's level, at the importation level, at the Ministry of Health level, there are engagements that are going on to see how to implement the Executive Order so that the price of drugs is going to come down, because I don't want to take it for granted that people work to get the Executive Order, only for them to just be watching it.
Okotie said one of the things that led to the Executive Order was the fact that prices of drugs were going up abysmally, and then drugs were going up on the shelves, and these things was going on without anybody really addressing it before government began to pay attention.
"It is the Executive Order, but life does not work in isolation. What about the cost of transportation? What about the cost of so many other things? What about the cost of energy? As much as you want to be talking about the Executive Order, there are other factors that affect the prices that are not constant. So for the Executive Order itself to work, we really have to go back, sit down and try to come up with a trade that helps us to ensure that it really achieves what it's intended to."
