Multiple tariffs associated with the importation of drugs into Nigeria are increasingly putting essential medicines for most non-communicable diseases beyond the reach of many.
Patients are boxed into paying several times more the international prices for many medicines due to the heavy tax burden imposed by government agencies including the National Agency for Food and Drug Administration and Control, Nigeria Customs Service, and the National Drug Law Enforcement Agency.
With more than 70 percent of drugs and consumables imported, these charges are intricately laced in screening processes that seem to be more aggressive about revenue generation than protecting the safety and quality of what flows into the country.
“We need to look at the ways by which we provide the basic medications. What I know is the process through which drugs are imported and sold within the country only ensures that the pricing is going to be beyond the reach of most Nigerians,” Ebun Bamigboye, clinical director and nephrologist at St. Nicholas Hospital, Lagos Island, told BusinessDay.
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“Each medication that any person wants to import needs to be registered. To register you need to pay a certain amount. For each batch that you want to import, you must pay a certain amount and then you must pay import duty on medications which is about 20 percent. And after that, a certain amount must be paid for it to be inspected,” he said.
This adversely affects the cost of medicines in a country where about 33 percent of the population wallows in multidimensional poverty and an additional 16.6 percent is classified vulnerable to poverty, according to the 2023 poverty index by the United Nations Development Programme.
Worse still, the majority of Nigerians finance roughly 80 percent of their healthcare out-of-pocket due to very low social health insurance coverage. Data from the World Bank reveal that more than 100 million people are plunged into extreme poverty annually due to healthcare expenditure.
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Experts have repeatedly called for more targeted interventions such as parallel importation of single-source products and price negotiations and provision of incentives and capacity building in rational procurement.
As of 2004, patients paid between two to 64 times international reference prices for medicines in various facilities in the public and private sectors of Nigeria, according to a joint study of medicine prices by the Federal Ministry of Health and the World Health Organization.
Private health clinics were shown to charge up to 184 percent more than public health facilities and 193 percent more than private retail pharmacies.
Branded drugs were found to cost between two to seven times the lowest-priced generic equivalents.
Medicines were unaffordable to the majority of Nigerians (90.2 percent) who live below the income level of $2 a day as well as the government workers who earned a minimum wage of $1.4 per day.
It has grown worse in 2023. A worker earning the minimum wage of N30,000 ($37) will require 16.7 days of wages to purchase a tablet for hypertension treatment which costs N25,000 ($30.9), depending on where it is purchased.
“I was speaking with a colleague and he said when he started treating his hypertension, he was buying medication for N2,000. That medication now costs N25,000 for one tablet monthly. The minimum wage is how much? You will eat and you probably have a family to maintain,” Bamigboye said.
The prevalence of non-communicable diseases (NCDs) such as cardiovascular diseases, cancer, diabetes, and chronic lung problems has increased significantly partly due to poor living standards and lifestyle choices.
Nigeria spends very little on NCDs care (0.17 percent of GDP), despite a high mortality rate of 900 per 100,000, according to a 2021 analysis by Defeat-NCD Partnership, an organisation that facilitates the bulk purchase of drugs and diagnostics for governments of low/middle-income countries.
Its data show that the actual market demand for essential medical drugs and diagnostics in Nigeria is about $1.2 million, while the market demand gap is $12.6 million.
This emphasises the need to increase spending on the management of NCDs and efficiently use available resources to effectively achieve Sustainable Development Goal 3.
Several studies indicate that the out-of-pocket costs for counselling and drug therapy for cardiovascular disease and related conditions such as hypertension, angina, or diabetes imposed a significant economic burden on households, driving some into poverty and, in many cases, were a reason for not seeking or adhering to care.
Bamigboye, while urging the minister of health to exert required efforts to lower drug prices, lamented that many individuals rather than come to the hospital end up going for alternatives that deliver inappropriate care.
With kidney care, for instance, he said most cases are presented at a late stage when damage has been done.
“I am a nephrologist and I can tell you that kidney failure in 80 percent of the patients we see coming are already in the end-stage. They come at a stage where you can’t do anything, except place them on more dialysis,” he said.
Ife Bakare, head of strategy and innovation at Medplus, a retail online pharmacy in Nigeria, said people now look for a cheaper alternative in the area of primary care.
“So for example, people buying foreign Panadol now buy locally-made Panadol, or they will buy Emzor paracetamol because it is cheaper. It has the same efficacy because it has the same active ingredient,” he said.
However, alternatives are very limited with NCDs care.