Escalating cost of medications: The worrisome, risky situation in Nigeria

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Costs of drugs and medicine in Nigeria have risen sharply. This has been attributed to the fall in the naira value and fuel subsidy removal. SADE OGUNTOLA and KAZEEM BIRIOWO examine the situation and the risks it poses for the people of this country.

It is a known fact that in Nigeria, the first port of call at the sign of an ailment is the local pharmacy. The absence of widespread and encompassing health insurance means that many Nigerians pay out of pocket for healthcare against global best practices in healthcare. However, paying for drugs at the pharmacy or neighbourhood “chemist” is now a scary venture due to fast rising cost of medication. The high cost of drugs and medicine has also impacted on treatment at healthcare centres from primary to tertiary, and hospitals both public and private.

Stakeholders have described this as a worrisome situation. They said that the non-availability and escalated cost of many medicines, particularly for chronic illnesses in Nigeria, is a security risk, which tends to lower Nigerians’ life expectancy, and bring economic woes.

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Chief Executive Officer and co-founder of Remedial Health, a drug distribution company in Lagos, Mr Samuel Okuwada, stated that the average price of imported drugs has increased by 200 percent while those manufactured in Nigeria also rose by about 40 percent in the past six months due to many reasons.

He declared: “Augmentin is the most popular antibiotic that’s given out in Nigeria today. It was once sold for N4,000 per pack, then it became N6,000 per pack. Now it is N40,000, if you can find it to buy. Also, Ventolin inhalers for asthmatics today are no longer in the market. People have tried its other brands: for some people, it works, and they’re fine. For some others, it doesn’t.

“Seretide, also for asthmatics, is not in the market as well. Its price too went from about N8,000 to about N75,000, and now you can’t even find it in the market. Now, for most people who use Seretide, nothing else will work for them. Now doctors are trying to find different drug combinations to give them; and for some people, this combination is just not working to control their asthma.

“For diabetics, they spend every week about N40,000 buying the medications they need. So, these are the issues: many medicines are out of stock, and a number are totally unaffordable to the common man. N40,000 is more than Nigeria’s minimum wage. We are in this terrible situation.”

He stated that Nigeria is no longer a priority for multinational pharmaceutical companies because of the difficulties these companies face in doing business, such as not being able to get dollars to repatriate back to their home countries, bad roads, multiple taxes, high cost of electricity, and the high dollar-to-naira exchange rate, among others.

“Today, 85 percent of the medicines that we sell to Nigerians are imported in ready-to sell form. The ingredient used to manufacture the remaining 15 percent in Nigeria is imported. So, everything we consume in terms of medicines is imported. It means everything depends on the dollar exchange rate. It also relies on the price of shipping at the time.

“Now, the customs service is treated as a revenue-generating agent, with daily targets from the Federal Government. What does the customs service do? They try to find ways to extort as much money as they can when you are importing. Now, as an importer, you have to pass that cost on to the clients that buy these medicines.”

Mr Okuwada, also a pharmacist, said Nigeria will only be said to actually manufacture drugs when it starts to manufacture the basic active pharmaceutical ingredients for medicines that it needs by itself.

According to him, the COVID-19 pandemic should have warned Nigeria and other African countries not to be reliant on the importation of drugs when India and China banned the export of pharmaceutical products.

“If you are reliant on them, it is a national security issue. If they decide not to supply you with medicines anymore, what happens to your city? That is a calamity. Hypothetically, what if a country decides to go to war with Nigeria and decides to poison medicines supplied to Nigeria? But we haven’t really seen any change. We are still pretty much 100 percent reliant on imports, especially in terms of pharmaceuticals,” he said.

Okuwada declared that Nigeria needs to create policies and environments that would enable entrepreneurs to manufacture active pharmaceutical ingredients and other medicines in Nigeria.

Executive Secretary, Nigeria Union of Pensioners (NUP), Oyo State Council, Comrade Olusegun Abatan, in a reaction, said the escalating cost of medication has been an harrowing experience because many pensioners are unable to afford to buy even the simple medications they require due to their costs.

“Pensioners are worst hit because they cannot afford simple medications to buy. Many pensioners are going down with disabilities and diseases. Since the time the fuel subsidy was removed, we have lost not less than 50 people because they don’t have money to buy medicines, and again, there is no medical assistance for them from the government.

“They are left on their own to either die or survive. It is quite unfortunate that this is the case even though senior citizens abroad are taken care of.”

Dr Olaoye Onungbogbo, an octogenarian and former commissioner in Ondo State, said it was unacceptable that a drug for benign prostate enlargement rose from N2,000 to N7,000, saying this might mean more people turning to herbal medicaments for their health and treatment.

Dr Bolaji Aremu, also an octogenarian, described his experience with the escalating cost of medications as terrible and asked that the Federal Government revisit its policies to ensure there is foreign currency for the importation of medication for use in the country.

He berated the Federal Government for allowing available foreign currency to be used for the importation of vehicles into the country, leaving behind more important things like medicines.

While saying that the scarcity and exorbitant prices of medicines should be an incentive for Nigeria to look at developing its local herbs for treatment, Dr Aremu said the harm that the scarcity and exorbitant prices of medicines have caused is not minor, particularly with chronic illnesses.

“The government needs to relax import duties on the importation of medicines; something has to be done very fast.”

Chairman, Association of Community Pharmacists of Nigeria (ACPN), Oyo State branch, Mr Adebayo Gbadamosi, linked the scarcity and escalating cost of medications to the hesitancy of importers to bring them for sale in Nigeria because many people would not buy them due to their high cost.

He stated that what many of them do now is to hike the cost of what they have in stock.

“When I went to get medicines from my distributor, within the span of two weeks, more than 60 percent of them were above the selling price in my pharmacy, depending on the product and their supplier.

“The increase in price cuts across all medicines. It is a challenge to us as community pharmacies. We are not happy about the situation because our working capital has gone down. Before, if I need N1 million to stock up, it is now N3.5 million. So, it is affecting us because our buying capacity has reduced.”

Mr Gbadamosi stated that community pharmacists who were not thinking of emigrating are now considering doing so because of the increasing challenges of doing business in Nigeria.

Rising costs of medication due to naira fall

Some experts are of the opinion that the increase in medication costs is due to naira devaluation and the removal of fuel subsidy. These economic challenges have significant impacts on healthcare affordability leading to an increase in the cost of importing medications. As a result, pharmaceutical companies have passed these costs to consumers, leading to higher prices.

In addition, the removal of fuel subsidy has contributed to higher transportation and operational costs for businesses, including those in the healthcare sector.

Increased fuel prices are affecting the entire supply chain, from the transportation of raw materials to the distribution of finished medications. These added costs are also transferred to consumers, further exacerbating the financial burden on patients seeking medical treatment.

Therefore, the combination of Naira devaluation and the removal of fuel subsidy has created a challenging economic environment, impacting the cost of essential medications for patients in Nigeria.

In Kubwa, Abuja, a 69-year-old retired teacher, Adamu Zaza Shekwelo, who disclosed that he was battling with hypertension, rheumatism and diabetes, said he was shocked when he visited the pharmacy to get his medical supplies and was told that the money he had was not enough.

He said: “I used to get a tablet of hypertension medication for between N800 and N900 and the one for diabetes for around the same amount prior to fuel subsidy removal in May.

“Currently they are sold for as much as N3,500 per tablet. How am I supposed to purchase the medications from just my pension?” he lamented.

Similarly, in Lifecamp area of Abuja, an elderly woman who craved anonymity said she has been battling diabetes and hypertension since she retired in 2018. She now relies on her children because her pension has not been regular.

“Death may be near if nothing is done to help people like me who are managing some chronic ailments,” she said.

She disclosed that she used to get a pack of one of her routine medications for around N8,000 earlier in the year, but it increased to around N25,000 from July, shortly after fuel subsidy removal.

“I resorted to taking some local herbs because I can’t afford those drugs that haven’t done much to improve my health,” she said.

Another Abuja resident, Grace Joseph, said her friend died two weeks ago because her family could not afford medication for shortness of breath and other ailments.

She said trouble started when there was an increase in cost of drugs since June when country experienced fuel subsidy removal and the subsequent inflation.

A retired worker living in Dutsen area, Johnson Yaro, speaking on how he has been coping with the cost of medication while managing his diabetes and sight problems, said his monthly pension could not cover the cost of his medications.

He, however, said his children had taken it upon themselves to buy the medicines and other supplements for him, lamenting the difficulties that it has been a struggle for him since July this year.

A pharmacist at one of the pharmaceutical stores in Abuja, Chigozie Princewill, said the exchange rate and the removal of petrol subsidy, among others, were responsible for the hike in drugs and medicine.

“The unfortunate increase in cost of medications and pharmaceuticals in Nigeria is moving towards increasing Nigeria’s mortality rate that results from different health conditions.

“There may be no anti-malaria drug that can be sold for N1,200 to N1,500 in any pharmacy in the days ahead. I have seen the dynamics in terms of the pricing index.

“As we speak now, the exchange rate is over N1,000 to $1. Every endeavour has a business side to it, whether it is healthcare, information technology, engineering, or even an academic profession.

“Government needs to intervene as soon as possible to save the situation or expect to deal with the worse situation when it happens,” he said.