By Sola Ogundipe
FOLLOWING an alleged Federal government proposal toÂ include eightÂ additional drugs on the Import Prohibition List (IPL), the average Nigerian who is currentlyÂ spendingÂ 23 per cent ofÂ his/her income on drugs, may have to brace up to purchase these same drugs and others yet to be determined at even higher prices.
Though theÂ specific categories of drugs being pencilled down for the ban are still under wraps, it was gathered thatÂ a proposal recommending the inclusion of more drug items on the import prohibition list from 17 to 25Â is soon to be forwarded to the Ministry of Health for implementation.
In 2005 17 drug categories were banned on the premise that the move would herald a seamless transition from importation to local manufacturing,
Observers within the industry circles have since raised concerns over the development, saying it would further worsen the nationâ€™s already precarious drug supply and availability system.
Findings byÂ Good Health Weekly indicate that there may be no going back on the impendingÂ ban believed to be comingÂ on the heels of the soon-to-be deregulated downstream sector of the petroleum industry. Even though the Federal Ministry of Health is yet to issue an official statement, the argumentÂ raised from certain quarters is that rather than adding moreÂ drugs to theÂ importation ban list, government should indeed come up with further palliative measures to cushion the effects of the pending deregulation of the downstream sector of the petroleum industry.
Observers recalled the argument proffered for the ban which was that local manufacturers would fill the gaps that resulted, but what occurred thereafter was an astronomical rise in drug prices, precisely among the banned.Â To date, the bannedÂ drugs remain beyond the reach of the ordinary Nigerian.
Already, market surveys indicate significant price differentials for some of the items banned. For instance, before the banÂ in 2005, a pack of magnesium trisilicate tabs/1000Â Â Â cost N250, but by December 2009, the price had jumped to N1000 – 300 per cent increase.
Similarly,Â aÂ 200mg bottle of ferrous sulphate containing 1,000 tablets whichÂ could be bought forÂ Â Â N85Â in 2004,Â was being sold for N30 at the end of last year.
Other drugs affected by the 2005 importation ban are clotrimazole cream/tube and chloroquine tabs 250mg/ 1000Â which increased in cost by 140 per cent from N25 to N60 and N500 to N1200 respectively. Cost of the 100 mg/1,000Â pack of vitamin C tablets also rose by 140 per cent while a tube of penicillin skin ointment has risen by 108 per cent. But that is not the end of the story.
Data from the Federal Bureau of Statistics (FBS) indicate that chloroquine rose from about N53.0 per treatment course at the time of the ban, to N60.0 at the end of 2005, peaking at N100.0 by the first quarter of 2009.
A typical multivitamin pack of 60 tablets which stood at N113.0 at the time of the ban in 2005 came to N122.0 at the end of the year, hitting N145.0 by the end of the first quarter of 2009.
A recent studyÂ by the pharmacy department of the University of Nigeria, Nsukka on the extent of effectiveness of Nigeriaâ€™s Essential Drugs List within a four-year period, essential drug supply by Nigerian manufacturers is inadequate.
In other surveys,Â the Federal Ministry of Health, the World Health Organisation and three other world bodies, agreed that Nigeria amongst the eight countries in the world with the highest drug prices. According to the study, â€œprices of generic medicines as much asÂ 82.5 per cent more expensive in Nigeria than in the seven otherÂ countries in both public facilities and private pharmacies, however, it was established thatÂ Nigeria incorporates the least mark-up when compared to the seven other countries.
But part of the problem may well be that the Nigerian pharmaceutical industry still operates under the ECOWAS Common External Tariff (CET) regime, even thoughÂ Federal government has made exception of some food items in order to make them available. By this, drugs that hitherto had tariff range of zero to five per cent now attract 20 per cent, further complicating the drug availability problem.
In a protest letter to the Minister of Health, Prof. Babatunde Oshotimehin,Â the Association of Pharmaceutical Importers of Nigeria (APIN) while acceding to the idea ofÂ shoring up the local drug manufacturing sector, however advised that the proposed ban should be jettisoned.
The letter signed by Pharm. Nnamdi Obi and Barr. Chiweze Ukwuoma, President and General Secretary of the Association respectively, recalled that it was because no stakeholder was consulted before the 17 drugs were banned in 2005, that all of the banned items, except for paracetamol, were not sufficiently provided for locally, leading to scarcity and price hikes with the complications of fakery that follow drug scarcity.
Another angle to the argumentÂ is that such a proposal would abruptly terminate the 10-year permit given for the importation of such drugs.
Calling for the setting aside of theÂ proposed ban, the Association recommeded that Nigeria should, rather, stick to the well planned NAFDAC programme of a two tenured term of import permit for all imported drug labels, so as to ensure a seamless transition from importation to local manufacturing.
The question, for now is that rather than ban more drugs from importation, why does government not introduce palliatives to cushionÂ effects of the pending deregulation of the downstream sector of the petroleum industry?
Presently, there are 86 local pharmaceutical manufacturing companies in operation in the country. Between them, they are producingÂ less than 30 per cent of the nationâ€™s drug requirements. Consensus is that the industry should stick to the well planned NAFDAC programme of a two tenured term of import permit for all imported drug labels, so as to ensure a seamless transition from importation to local manufacturing, which has already begun to yield the desired result
From records, no local factory audit has ever been done to determineÂ local capacity plus actual output, or extent of compliance with WHOâ€™s GMP (Good Manufacturing Practice) for local firms. Yet any country hoping to meet the MDG regarding drug sufficiency should put these standards in place
From hindsight, one of the major indices of the performance of the primary healthcare delivery remains improved access to essential drugs and this was what led to introduction of the Bamako Initiative by the WHO/UNICEF in the late 1980â€™s. The plan was to improve access to essential drugs for the most vulnerable in society and thus improve health outcomes.
But three decades down the line,Â outcomes and/or impact of the initiative on Nigeriaâ€™sÂ health indices leaves much to be desired, with not so significant improvement in health status of the average Nigerian being registered on a large scale.
While the current Nigeria Drug Policy (NDP) clearly enunciates and provides policy direction for the core objective of the Bamako Initiative as â€œEquitable access to essential drugs at the community levelâ€, it appears the implementation guidelines may not have drawn on the NDP policy guidelines to provide an adequate framework/tools to ensure efficient realization of the core objectives of the Bamako Initiative.
Further, argument on the drug sufficiency programme is that implementing such by administrative fiat can only compound the present problem of high drug prices induced by scarcity and indirectly compound the problem of fake drugs.
It is also the concensus that the contemplation of a further ban on drug importation even as the deregulation of the downstream sector of the petroleum industry stares Nigerians in the face would be double jeopardy.