As the harmattan breeze blew through Lagos, where many are struggling to prepare for Christmas, 48-year-old Elvis Osemede sat on a hospital bed, appealing to his landlady over the phone not to evict his family.
Osemede, who holds a university degree in Business Administration and was working as a security officer at a bank before he lost his job, has seen his debt balloon.
He fulfilled his obligations as a tenant for years before a previously unknown illness sent him to the Intensive Care Unit at the Lagos University Teaching Hospital (LUTH), accruing almost N2 million in debts over six months.
Soaked in despair, he struggled with secondary hypertension – a form of high blood pressure caused by another medical condition.
From the ulterior view of the window by his bed, a tree stood in the grass, bearing dark green leaves dotted by a flush of red flowers. The imagery is soothing to sight, symbolising resilience, tenacity, or even hope of a rebirth. But Osemede stared blankly, with his thoughts appearing to be several miles away from his hospital bed.
He can hardly afford anything, not even the drug he needs to regulate his hypertension.
To Osemede, the surge in drug prices means more than a power play between the forces of demand and supply or what some multinational pharmaceutical drug makers exiting Nigeria simply put as an “overhaul of their business model”.
He is torn between two choices: have his daily dose of amlodipine and skip lunch or secure dinner and risk a free fall with his blood pressure rate.
If it gets very critical, nurses occasionally aid him with leftovers of drugs from dead patients, another nightmare he grapples with.
“For now, I don’t buy drugs anymore. I ration what I buy. I owe a lot and my siblings said they have spent so much to keep me alive. I’ve lost my job due to this sickness. Please assist me to find a job,” the father of three said in an inaudible tone that seemed forced out of air restriction.
A senior nurse in the male ward A2, who prefers to be identified as Okorie, said Osemede was one of the longest-staying indigent patients discharged but can’t leave due to debts.
“Getting drugs is a big issue. If there is any patient that died and is on that drug, we usually shift it to them,” she said.
As of December 18, a pack of Norvasc Amlodipine (10mg) produced by Pfizer was priced at N37,000. This marks at least a 56.9 percent increase from what it cost in January 2022, although some generic amlodipine are sold for as low as N5,400. However, the efficacy rate differs.
Amlodipine primarily functions as a medication to treat high blood pressure and angina – a chest pain caused by reduced blood flow to the heart.
It works by relaxing and widening blood vessels, allowing blood to flow more easily and reducing pressure on the heart.
The price of Amlodipine besylate, which is the active chemical compound in the drug, declined significantly across the major pharmaceutical manufacturing hubs including the United States, China, and Germany.
In the US, for instance, the price declined by 19.44 percent in September compared to 3.41 percent in June, leaving the cost per metric tonne at $76,290.
In China, prices declined further by 19.05 percent within the same period compared to 3.65 percent in June 2023, stabilising at $75,000 per metric ton.
In Germany, prices reduced by 18.95 percent from 4.25 percent, settling at $75, 820 per metric ton.
The reverse is the case in Nigeria, whose pharmaceutical manufacturing system relies heavily on imports from these countries.
For instance, the value of medicines imported into Nigeria rose by 68 percent to N81.8 billion between July and September 2023, according to the National Bureau of Statistics (NBS), exerting more pressure on drug prices.
India was Nigeria’s top import trading partner for drugs, followed by the US, China, France, and Germany.
Earlier data from the National Agency for Food and Drug Administration and Control (NAFDAC) indicate that the value of finished imported anti-malaria drugs grew from N6.4 billion in 2018 to N12.1 billion in 2021.
Nigeria’s reliance on imported drugs exposes prices to crippling shocks from currency devaluation and a suffocating web of taxes levied by government agencies like NAFDAC, Nigerian Drug Law Enforcement Agency, and Standards Organisation of Nigeria, even after an executive order aimed at easing business.
The official exchange rate surged from N463.38 per dollar to N889.86 as of December 15. At the parallel market, the naira depreciated to 1,186 per dollar from 762/$.
As a result, 57-year-old Veronica Wilkinson, battling the brutal reality of anorectal cancer, is forced to pay exorbitant hikes, far exceeding international prices.
During her latest hospital admission occasioned by incontinent bleeding, Peculiar, her fourth child, discovered that one of the chemotherapy drugs prescribed had soared by roughly 66.7 percent.
“Xeloda was N57,000 but it has increased to N95,000 now. We are drained physically, mentally, and financially. We want them to discharge her and go home to manage her with a nurse. Staying in the hospital can’t help,” Peculiar said as she struggled to hold back tears.
Xeloda is an anticancer medication produced by Roche, a global pharmaceutical firm based in Switzerland.
Veronica already faces a cost of living crisis that has seen the food inflation rate hit 32.84 percent in November from 24.13 percent in the first quarter of the year.
She has no social insurance coverage to offset her cost of care, leaving her medical expenses completely out of pocket.
Her husband, who was key to building a support system for her when the condition was diagnosed two years ago, has also come down with a stroke caused by diabetes and hypertension.
The condition forced the 65-year-old auditor out of job last August.
Nigeria’s economic woes deepened in 2023, as it witnessed a surge in poverty, with rising inflation and sluggish growth pushing an additional 14.2 million people into poverty as of November.
This figure adds to the existing 89.8 million Nigerians already in poverty at the start of the year, bringing the total to a staggering 104 million, according to a World Bank report.
The removal of the petrol subsidy sent petrol prices soaring from N184 to N617, leaving public transportation providers with no choice but to raise fares.
This is why no relative or friend of Esther Sunday is by her sick bed after she was admitted to LUTH last week over complications of a large heart.
The 28-year-old left Nasarawa to work as a customer service attendant in Lagos. But now, she survives on the goodwill of doctors, nurses, cleaners, and even patients.
She needs funding for tests, medication, surgery, and post-operation care.
But all that seems like a lofty dream.
“I feel abandoned,” she said tearily.
In November, Mohammed Ali Pate, the coordinating minister of health and social welfare, said he had initiated an engagement with pharmaceutical companies to explore strategies for reducing drug prices.
The move followed an increasing outcry over how the steep rise in drug prices and treatments has worsened the cost of living crisis facing many Nigerians.
However, the promise has not been fulfilled.
Stakeholders believe the federal government needs to direct efforts at boosting the local production capacity in the long run to cut substantial costs lost to logistics.
They condemned the reality of having over 90 percent of consumables used in the diagnostic sector imported, for instance, saying it’s unsustainable for the country to achieve drug security.
Samuel Okwuada, CEO and co-founder of Remedial Health, a digital procurement platform for pharmacies and hospitals, told BusinessDay that the low-hanging fruit is for the government to yank off heavy tariffs on the importation of drugs.
“If they do that today, drug prices will adjust downwards,” he said in an exclusive interview.
Bassey Etim, a sales executive at DCL Laboratories Products Limited, said heavy tariffs are doing more to complicate the woes of sick Nigerians.
“The fluctuations in the exchange rate have affected the price of things we import into the country. We gave a quotation of N14 million to supply some autoclaves. By the time they approved the supply, the price had jumped to N22 million,” Etim said.
“This has affected the cost of diagnosis in the lab. The cost of some malaria test kits has moved from N12,000 to N22,000 in the last four months. It all boils down to production in-house so that we can curb the significant costs lost to logistics.”
Nonye Umahi, founder of Cuanu Consult Ltd, a health business development consultancy, called for more efforts to be directed at the ease of doing business.
“Most of the inputs we use come under the cold chain, with some in negative temperatures. They don’t get into the health facilities early enough because of compliance issues at the port. There are thousands of tests done in the medical labs and it’s time we start manufacturing them,” Umahi said.