Self-medication is a common practice in Nigeria. It means using drugs to treat oneself without proper guidance or consultation from a healthcare professional. Many Nigerians can easily buy any medication they want without a doctor’s prescription from street corners or over the counter. This often surprises people in countries where there are stricter regulations on drug dispensing and use.
But why do Nigerians resort to self-medication? What are the factors that drive this behaviour? And what are the consequences of this practice for individual and public health?
One of the main reasons why Nigerians self-medicate is the poor state of the healthcare system and services in the country, especially in rural areas. Nigeria has one of the worst health system performances in the world, ranking 187th out of 191 countries, according to the World Health Organization (WHO). Many Nigerians struggle to access quality and affordable healthcare, due to high costs of healthcare services and drugs, which are often out of reach for many low-income earners, lack of experienced and qualified doctors, nurses, and other health workers, who are either scarce or have left the country for better opportunities, inadequate and obsolete equipment, facilities, and infrastructure, which hamper the delivery of effective and efficient healthcare, lack of essential drugs and supplies, which often result in shortages, and poor hygiene and sanitation, which increase the risk of infections and diseases.
These challenges all contribute to the high burden of diseases and mortality in Nigeria. The World Health Organization (WHO) estimates that Nigeria accounts for 19% of maternal deaths, 11% of neonatal deaths, and 9% of under-five deaths globally. Nigeria also faces a high prevalence of communicable diseases such as malaria, tuberculosis, HIV/AIDS, and COVID-19, as well as non-communicable diseases such as diabetes, hypertension, and cancer.
The shortage of trained medical personnel, especially doctors is also a significant factor. The number of doctors in Nigeria falls below the World Health Organization (WHO) standard of one doctor per 600 people. The World Bank reported that there were 0.395 physicians per 1,000 people in Nigeria in 2021. However, this figure does not reflect the reality of the brain drain of doctors from Nigeria to other countries, which has been a chronic problem in the Nigerian health sector. According to the Medical and Dental Council of Nigeria (MDCN), there were 74,543 registered medical doctors in Nigeria as of March 2020. But only about 42,000 of them were estimated to be practicing in the country, while the rest had either left or were planning to leave. This means that about 44% of the registered doctors were not working in Nigeria in 2020.If this trend continued at the same rate, it can be estimated that by January 2024, there would be about 48,289 registered doctors in Nigeria with only about 27,042 of them working in the country. This would imply a ratio of 0.124 physicians per 1,000 people, which is much lower than the World Bank estimate and far below the WHO standard. This means that Nigeria has a severe shortage of doctors that needs to be addressed urgently.
Another reason why Nigerians self-medicate is the low level of health insurance coverage and utilization in the country. Health insurance is a mechanism that protects people from the financial risks of ill health and provides access to quality and affordable healthcare. However, in Nigeria, only about 3% of the population is covered by any form of health insurance, while the rest rely on out-of-pocket payments or other sources of funding. The National Health Insurance Scheme (NHIS), which was established in 2005 to provide universal health coverage for all Nigerians, has faced many challenges in its implementation, such as low enrolment, inadequate funding, poor regulation, and corruption. Many Nigerians are either unaware of the benefits of health insurance, unable to afford the premiums, or distrustful of the scheme.
Some Nigerians also prefer to self-medicate because they believe they have the medical knowledge of what to use, they want to treat minor ailments without bothering a doctor, they want to save time and money, or they want to avoid the stigma and discrimination associated with certain conditions.
So why do Nigerians defer to self-medication? It is because they cannot afford professional healthcare, there are inadequate healthcare facilities, and they can easily obtain drugs without a doctor’s prescription. According to the World Health Organization, self-medication accounts for 60% of drug consumption in Nigeria, compared to 10% in developed countries. This shows the magnitude and impact of self-medication in Nigeria.
Self-medication has serious negative consequences for both individual and public health. Some of the risks include misdiagnosis, which can lead to the use of inappropriate or ineffective drugs, or the neglect of underlying or serious conditions, adverse drug reactions, which can cause side effects, allergies, or complications that may worsen the health condition or require hospitalization, drug interactions, which can occur when different drugs are taken together or with other substances, such as alcohol, food, or herbal remedies, and may reduce the effectiveness or increase the toxicity of the drugs, antibiotic resistance, which can develop when antibiotics are used unnecessarily, incorrectly, or excessively, and may render them ineffective against bacterial infections that can become life-threatening and addiction, which can result from the abuse or dependence on certain drugs, such as painkillers, sedatives, or stimulants, and may cause physical, psychological, and social problems.
It is important that Nigerian sare aware of the dangers of self-medication; it is also essential to improve the healthcare system and services in Nigeria by increasing the funding, staffing, equipment, and infrastructure, as well as improving the availability and affordability of clinics, drugs, and supplies. It is also necessary to expand the health insurance coverage and utilization, by addressing the barriers and challenges that hinder the implementation and uptake of the NHIS and other schemes. By doing this, all Nigerians can have access to quality and affordable healthcare, and would not rely on self-medication, which in turn will improve overall health outcomes and socio-economic development. After all, health is wealth, right?
– Article was written by Ommo Clark, founder of iBez, a software design business and a PhD student in Information Systems focused on Health Informatics.