Nigeria’s first attempt to subsidise the high cost of cancer treatment is stumbling barely two years after the Federal Government launched the promising scheme.
The Chemotherapy Access Partnership (CAP), which promises a 50 percent slash on the cost of 16 priority cancer drugs and chemotherapy treatment, is being outwitted by generic drug cartels offering prices cheaper than the subsidised rate.
Zainab Shinkafi-Bagudu, Kebbi State first lady and co-lead of First Ladies Against Cancer (FLAC), sounded the alarm during an online media chat where she disclosed that the majority of the drugs provided under the scheme were wasting away in various hospitals.
Rather than being prescribed, doctors are redirecting struggling patients to marketers of the generic version of the drugs sourced cheaper from countries such as India, a top exporter of pharmaceutical drugs in the world.
Price differentials have increasingly placed generic drugs atop the prescription preference of physicians at the expense of over-the-counter or branded drugs.
An analysis by the Nigerian Representatives of Overseas Pharmaceutical Manufacturers (NIROPHARM) shows that generic drugs have maintained double-digit market share growth and the trend is expected to continue over the next 10 years, as more countries move towards generic prescriptions.
“So, instead of buying CAP drugs at N230,000 or N250,000 for a round of chemotherapy for breast cancer, people buy made-in-India at N170,000 and they are directed there,” Bagudu explained.
“Some of these CAP drugs are actually sitting on the bench and not working as they should because demand generation is poor, which is one of the reasons why organisations like FLAC should be included in those kinds of programmes,” she said.
Generic medications are considered key players in reducing healthcare costs and improving access to care, especially in a country home to an estimated 80 million poor people.
Except few that suggest performance differences between brand-names and generic drugs, most researchers find little differences.
The development shows the government has to rethink its approach to easing the burden of high out-of-pocket expenditure that cancer forces on people.
One of such solutions is to ensure that the Cancer Health Fund of about N1 billion, which has been carried over since 2019, is appropriately disbursed, Bagudu said.
Another is to develop a partnership between the government and private service providers who have invested a significant amount of resources into cancer diagnosis and treatment in Nigeria.
At Marcelle Ruth Cancer Centre, a private facility, for instance, some costs are similar to public NSIA-LUTH Cancer Centre. However, the efficiency with which the private centre is run and set up is more improved than the typical Federal Government facility.
“NSIA-LUTH centre was set up to be economically viable as a different type of venture, but they are charging a bit more than Marcelle. Marcelle charges about N1.2 million for the whole package of radiotherapy while LUTH charges around N1.5 million.”
Apart from partnerships, Ladi Hameed, Roche Holding country-manager, suggested that Nigeria gets a viable insurance system that takes affordability out of the hands of patients, using the power of its huge population to negotiate for better services, better prices and better outcomes for patients.
This will sustain investments and keep the healthcare system running.
One of the main challenges to healthcare access in Nigeria is that the system still expects patients to fund treatment from their pockets, Hameed said, noting that with such a situation, initiatives like CAP may never be fully optimised.
“The chemotherapy access programme and also the cancer health fund are a stop-gap. But the long-term solution is to ensure that we all have health insurance that we pay a little amount into so that when anybody needs care, they can go for it,” the country-director said.
Similarly, Amina Abubakar Bello, wife of the governor of Niger State and FLAC’s co-lead, proposed that Nigeria needs to have a pool of resources that the government can use to provide services required for quality healthcare.
She identified resistance to insurance from civil servants who compose a large number of those who can pool resources to push the NHIS as one of the challenges faced by the National Insurance Scheme in states.
“They are not buying into the scheme and they are the formal sector where you know you are going to get that money guaranteed every month.
“We have to promote insurance for people to see how it can reduce costs for the general public,” Bello said.
Nigeria has an estimated 302,076 populace who battle with cancer and are faced with a struggle for remedial treatment under less than 10 radiotherapy machines country-wide, where at least 200 are required.
They equally suffer 96.6 percent deficit of clinical oncologists as less than 100 oncologists practise in Nigeria instead of 3,000, according to the African Organisation for Research and Training in Cancer.