As the cost of lifesaving treatments and medications skyrockets, many Nigerians are rationing and risking their lives. In this report, LARA ADEJORO chronicles the struggles of some patients in dire need of healthcare that remains out of reach for them
For Mr Oladeji Ifeoluwa, every day is a living hell. He writhes in excruciating pain from morning till night.
When he found the horrendous pain unbearable, especially at night, he resorted to self-medication for six months before he was able to afford to go to the hospital.
“I didn’t know what was wrong with me, so I had to start buying antibiotics and pain relievers before I decided to go to the hospital,” the 45-year-old photographer told our correspondent.
Ifeoluwa was diagnosed with a stomach ulcer at the State Hospital, Akure, Ondo State, in March 2022. Unfortunately, the drugs his doctors prescribed for him triggered more pain.
Speaking softly with his face contouring in pain, Ifeoluwa said, “I went back to the hospital and I was asked to undergo some tests. I did one test because I used to have back pain. When the pain starts, I roll on the floor. It comes with excruciating pain. I also have serious stomach pain to the extent that I won’t be able to talk. Once it’s getting dark, I always think of what the night will be like because the pain becomes extreme at night.
“They asked me to carry out an endoscopy test so I went to the Union Diagnostic Centre opposite the hospital and workers there said the tests will cost N68,000 but I’ve not been able to run the test because I don’t have the money.
Stomach ulcers, which are also known as gastric ulcers, are a type of peptic ulcer disease. Stomach ulcers are painful sores in the stomach lining. Complications from stomach ulcers can be severe and potentially life-threatening, according to experts.
Meanwhile, something else haunts Ifeoluwa. He could barely provide for his family of six.
He said, “It’s not even been easy with the demands of the children and coping with the treatment. I have not even been able to balance the fees of one of the children.
“The economy is draining. I can’t afford the drugs they say I should be taking. One finished last week, another finished yesterday, and they all cost over N7,000, but it’s hard to get money to buy the drugs.”
A heavy price
Nigeria’s inflation rate surged to 19.64% in July 2022, up from 18.60% in the previous month. This is the highest rate recorded since September 2005, according to the National Bureau of Statistics.
The inflation rate is taking a toll on Nigerians, especially indigent citizens. With the skyrocketing food prices, school fees, and thousands of Naira for medical bills, among others, Ifeoluwa and his wife, who is a petty trader, are falling behind financially.
With the rise in inflation, the costs of treatments and drugs are creating painful choices for patients and their families as many patients depend on out-of-pocket care.
A deadly decision
Just like Ifeoluwa, Mrs. Victoria Clinton is delaying getting medical help because of skyrocketing costs.
Meanwhile, there are medicines Clinton can’t live without and there are foods she is not supposed to eat, but with household finances, she cannot keep up with her doctors’ prescriptions and advice.
She is only able to afford her medications when she is paid her monthly salary. Sometimes, she opts for herbal concoctions or “Chinese drugs,” forgoing her medical needs to focus on meeting her family’s financial demands.
She believes the herbal concoctions and “Chinese drugs” help to control her sugar levels.
“I can’t afford to buy the drugs now except when I’m paid my monthly salary or when my husband is paid his salary. For now, we’re in the middle of the month and he doesn’t have the money.
“Right now, my blood sugar is very high, my head and body are aching, I urinate often now, and I am weak, but I don’t have money to go to the hospital. Sometimes, even if I have the money for the drugs or the types of food I should eat, with my family responsibilities, I have to eat whatever is available.”
She knew her blood sugar levels were dangerously high, and in the back of her mind, she was worried she might go into a diabetic coma.
Speaking with our correspondent, a professor of medicine and endocrinology at the College of Medicine, University of Lagos, Olufemi Fasanmade, says diabetes is a public health condition.
Fasanmade said, “In Nigeria, we have between three to five million people that have diabetes, and that number is much greater than the number of people that have HIV, TB, and malaria typhoid which makes it is a very big challenge.
He warned that the number might double over the next two decades.
“A diabetic patient in Nigeria who is knowledgeable, gets the appropriate drugs on time, and is motivated to treat and check himself regularly has almost equal life expectancy.”
“However, a person with diabetes who is either ignorant or poor or going to native medical practitioners, very few of them last for up to five years from when they get diagnosed,” he said.
But, because of the financial challenges many patients face, they turn to herbal concoctions to treat their ailments. High healthcare costs are causing many of them to get sicker from delaying, avoiding, or stopping medical treatment.
At first, it seemed like tuberculosis. But three months later, Mrs. Dada Oluwayomi was overcome by troubling symptoms. She coughs, sweats profusely, especially at night, and loses weight.
It was her boss who urged her to see a doctor. “This is not normal,” she recalled telling her. “Go get checked out,” she said.
“My boss gave me a week off work to rest, thinking it could be work-related stress. Then I went for a TB test at a diagnostic centre and it was negative. Later, one of my eyes was gouging, and I went to the hospital for another test. Thyroid disease was discovered in me.
“That test cost me N15,000 and they said I had to go for another test, but I haven’t done that. I didn’t bother going because they would call with another amount that I couldn’t afford, and I didn’t want to start worrying.
“But I have hope in God for a miracle because I don’t want anything that will make me start thinking if they call a ridiculous amount,” she said.
Her ordeal is common among Nigerians who struggle to afford healthcare. She is one of the millions of Nigerians who avoid medical treatment due to the cost.
Life on insulin
Mariam Pius, 22, has lived five years of her life treating a serious lifelong condition—Type 1 diabetes. Like everyone with type 1 diabetes, her life is ruled by the clock – with meals, blood tests, insulin injections, and rest – all on a strict regime dictated by diabetes.
However, adhering to the routine has been a struggle because of the skyrocketing prices of her medications.
The 22-year-old undergraduate at the University of Lagos depends majorly on her siblings to get her medications.
“Treating diabetes these days has been very difficult,” Pius, an orphan, said. Though my family members are trying for me, it has been hard. Everything is becoming more expensive.
“For instance, the glucometer I use was sold for N5,000 but now it is N8,900. My drug budget used to be N2,900 but now it has increased. I use the insulin morning and night and it lasts for one week and a few days.
“I’m a graphic designer and I don’t always get jobs,” Pius, who is a Lagos resident, lamented.
Many diabetic Nigerians who take insulin are stuck with debilitating costs.
Skyrocketing insulin prices
Findings show that insulin injections were averagely sold between N2,500 and N5,000 in January, but now they are sold between N3,500 and N9,000.
The inflation rate in Nigeria is affecting every layer and major player of the pharmaceutical industry in the country.
Sesan Kareem, a pharmacist and Chief Executive Officer of HubCare Health, says the cost of procurement has increased; hence, patients are feeling the brunt.
“For manufacturers, the cost of procurement has increased, while the cost of utilities has almost doubled. Many indigenous pharmaceutical companies’ business processes are currently affected because of inflation coupled with high foreign exchange rates and their unavailability.
“In addition, the importers, distributors, wholesalers, and retailers within the industry are also not finding the cost of doing business easy at all because of the increase in the cost of utilities and supporting activities of the business. They spend more to keep the business going while the purchasing power of their customers is dwindling.
“The patient is feeling the brunt of inflation. Medicine prices have risen by 20 to 50% in the market. Many individuals are finding it difficult to afford the necessary essential medicines, especially chronic care patients. Many families are making tough decisions between putting food on their tables or buying medications needed by their members.
“The truth of the matter is the current spike in inflation and the inability of many pharma businesses to easily and directly get forex is not good for medicine security in the country.
“Access to affordable, quality healthcare is a fundamental human right and not a privilege. Every Nigerian deserves to have access to high-quality healthcare. Therefore, the federal government must keep supporting the pharmaceutical sector in Nigeria across all levels in these difficult times,” he said.
According to a study titled, “Cost of illness among diabetes mellitus patients in the Niger Delta, Nigeria,” the average direct cost of illness per patient with type 1 diabetes mellitus alone was N100,032.89 (US$625.21). whereas the average cost for those with type 1 diabetes and hypertension combined was N114,109.36 (US$713.18).
The study published in the Journal of Pharmaceutical Health Services Research noted that the annual national direct cost of illness for type 2 patients is in the range of N262 billion (US$1,639,122,840.00), while that of type 1 is estimated to be N18 billion (US$112,537,001.25).
The study, authored by Dr Ismail Suleiman and Joseph Festus of the Department of Clinical Pharmacy and Pharmacy Practice, Niger Delta University, Bayelsa State, noted that the cost implication of diabetes mellitus is huge, and policies to ensure evidence-based, cost-effective management and strategies to reduce the sky-rocketing prevalence should be put in place.
Poverty amidst plenty
Nigeria’s gross domestic product is the largest in Africa, but its per capita income of about N770 000 (US$2000) is low with a highly inequitable distribution of income, wealth, and therefore, health, according to an article published in The Lancet.
According to The Lancet, approximately 40% of Nigerians live in poverty, in social conditions that promote ill health, and with the constant risk of catastrophic expenditures due to high out-of-pocket health spending.
“Even compared with countries of similar income levels in Africa, Nigeria’s population health outcomes are poor, with national statistics masking drastic differences between rich and poor, urban and rural populations, and different regions,” it said.
While many Nigerians struggle to pay medical bills, only 753,999 Nigerians from 24 states can access free health care.
Speaking during the quarterly Ministerial Oversight Committee meeting held in Abuja recently, the Minister of Health, Dr. Osagie Ehanire, said 1,042,890 indigent Nigerians are enroled in the Basic Health Care Provision Fund but only 753,999 Nigerians access free care.
The BHCPF is enshrined in the National Health Act 2014 to improve the national health indices and achieve universal health coverage.
The BHCPF comprises one percent of the Federal Government’s Consolidated Revenue Fund and additional contributions from other funding sources. It is designed to support the effective delivery of primary health care services, the provision of a basic minimum package of health services, and emergency medical treatment to all Nigerians.
Dr. Ehanire said since the launch of the fund in January 2019, the Federal Government has released a total of N89.0 billion to the fund and of this amount, a total of N56 billion has been disbursed to all the 36 states and FCT.
Frank Muonemeh, Executive Secretary of the Manufacturers Association of Nigeria’s Pharmaceutical Manufacturers Group, told our correspondent in July that inflation is choking the pharmaceutical industry.
He said, “The industry is taking excruciating pains to absorb the incremental cost of production; especially when you look at the smart investments at stake. If you transfer the high cost of production to the patients, they will not buy drugs again and they will continue drinking alternative local herbs, which will lead to a decrease in access to medicine for Nigerians as out-of-pocket expenses are still at a very high percentage.
“We are not even talking about inflation. We are talking about diesel, which is at an all-time high, the gas for energy. Some of the facilities use diesel because there is no steady supply of electricity due to the consistent failure of the national grid. If you look at the future, it only belongs to those that have invested smartly, those that are innovating, and doing something different; the competition is tighter, and members have put up such huge investments with a view to innovate and become globally competitive.
He revealed that several countries are lobbying companies registered and operating in Nigeria to leave the country and relocate to their land in view of the African Continental Free Trade Agreement.
Way forward
An oncologist at the Lagos University Teaching Hospital, Idi-Araba, Lagos, Prof. Francis Durosinmi-Etti, says cancer drugs prices are on the increase.
“Cancer drugs prices, before the increasing inflation rate, have been high and it’s becoming higher because many drug companies are complaining and threatening that they might have no choice but to close down. The inflation is affecting cancer drugs as well.
“Americans have insurance for something like this, but in Nigeria, everybody pays out-of-pocket and it shouldn’t be so. The government is supporting some cancer patients now, but the people they are supporting are few and the money they are giving them can’t help them. As far as I’m concerned, it’s political language to say they’re supporting cancer patients.
“The government can help to cut the prices of these drugs and treatments if they want to do it,” Durosinmi-Etti said.
Also, the President of the Nigerian Medical Association, Dr. Uche Ojinmah, urged the government to fix the health system.
Ojinmah said, “The government should fix the system because some of the drugs they (patients) are spending so much money on are fake and of poor quality. The increase in the prices of drugs is a result of the fallout from the economy because we import most of our drugs.
“Obviously, as the naira-dollar disparity continues, the cost of imported materials in producing drugs will also continue. It is important to acknowledge that they have some funds in the Central Bank of Nigeria that will help in developing the pharmaceutical and health sectors.
“The government needs to reduce the unnecessary bottlenecks because to assess the funds, you may have to get your grandfather who is dead to give them to them, and that makes it difficult to access.
“They should speed up the process to get the funds to establish private pharmaceutical companies. They can use the Pharmaceutical Society of Nigeria as collateral. Because NMA can provide collateral for doctors to access the funds, if we have functional pharmaceutical companies in the country, some of these medications can be produced locally and will be cheaper.”
