The quality of healthcare a woman receives during pregnancy, delivery and postpartum is critical as it determines whether she lives or dies. Evidence shows that a majority of the maternal medicines used to treat the leading cause of maternal mortality (postpartum haemorrhage) in circulation in Nigeria are sub-standard. Consumers of sub-standard medicines might never be aware that they were victims and the consequences such as treatment failure, prolonged illnesses or side effects may lead to worsened health outcomes.
During a policy dialogue themed, ‘Leveraging Public-Private Partnerships to Improve Access to Quality Maternal Medicines’ organised by Nigeria Health Watch to advocate for sustainable mechanisms that focus on quality in the procurement of maternal medicines in Nigeria, there was a push for viable public-private partnerships that ensure quality-assured medicines. In her opening remarks, Vivianne Ihekweazu, Managing Director, Nigeria Health Watch, discussed the importance of quality in healthcare and the critical impact of quality maternal medicines on maternal outcomes. Healthcare must be patient-centred, safe and effective, but it cannot be any of these things if there is no quality.
She expressed dismay over the fact that the high maternal deaths being recorded in Nigeria haven’t provoked a heightened sense of urgency. “The private sector is a critical stakeholder in the health sector and can really be a key partner in improving capacity, access to information, working with the public sector in different ways and being guided by very strong government mechanisms,” she added.
Nigeria Health Watch
In his Keynote Address, Dr Kayode Afolabi, Director Reproductive Health, Ministry of Health, discussed lessons learned from previous government engagements with the private sector on sexual reproductive and maternal health. “We have a private sector engagement strategy that was approved and launched by the Honourable Minister of Health recently. This was articulated from the experiences we have had over the years and also the need we have recognised in ensuring that the private sector is well embedded into partnership with government on our health system, especially sexual reproductive and maternal health,” he said.
We may not be able to measure the true impact of poor-quality maternal medicines on Nigeria’s maternal mortality rates, however, from the experiences shared at the meeting, there’s no doubt that sub-standard maternal medicines are a real and present danger in Nigeria. During a presentation on the ‘Quality Landscape of Maternal Medicines in Nigeria’, Dr Chioma Ejekam, a Consultant and Public Health Physician, discussed her research work on poor knowledge and practice around oxytocin among healthcare providers. “Understanding and addressing the problem of poor-quality medical products requires a more interdisciplinary approach than has been evident to date,” she said.
Strategies to address the circulation of substandard and falsified medicines
Nigeria’s National Agency for Food and Drug Administration and Control (NAFDAC) has made strategic plans to reduce substandard and falsified medicines to not more than 5% prevalence in Nigeria by 2025. The current prevalence of substandard and falsified medicine in Nigeria is 16.7% against the global prevalence of 10%. However, a new study is overdue as this data is 14 years old.
Having established a correlation between poor quality maternal medicine and negative maternal health outcomes, based on their experience and knowledge of Nigeria’s drug landscape, panellists proffered solutions to curb the circulation of poor-quality medicine. A proposition put forward was the need for Nigeria to build a robust pharmaceutical manufacturing ecosystem. As Pharmacist Frank Muonemeh, ES/CEO, Pharmaceutical Manufacturing Group of Manufacturers Association of Nigeria (PMG-MAN) said, “except the country or the people are in the driver’s seat on how the medicines they consume are produced…access to quality medicine…will continue to be a mirage”. For this to happen, three things must be in place;
- efficient policies
- a regulatory framework
- innovative partnerships
As a private practitioner who has dealt with the consequences of administering substandard oxytocin to his patients, Dr Kay Adesola, President, Association of Nigerian Private Medical Practitioners (ANPMP) spoke very strongly about putting in place penalties for the importers of sub-standard products. “You cannot say Nigeria should continue to be a dumping ground, penalties must also come as part of measures that we can use to curb the circulation of bad maternal medicine in this country,” he said.
Responding to the call for a regulatory body, Andrea Nwachukwu introduced the National Product Supply Chain Management Programme (NPSCMP) which is domiciled in the department of Food and Drug Services of the Federal Ministry of Health. One of the core mandates of the NPSCMP is to coordinate and integrate the public health programme supply chains. “We developed the first ever national health product strategy and implementation plan (2021–2025) which is going to address some of these issues we have all been discussing,“ she said, adding that, among other things, the plan was designed to promote an efficient essential medicine supply chain and they are open to partnerships to achieve their objectives.
Bridging the quality supply gaps through Public-Private Partnerships
Sharing lessons from her experience with public-private partnerships (PPPs), Azuka Okeke, CEO, Africa Resource Centre for Excellence in Supply Chain Management (ARC-ESM) said there must be trust, accountability, clarity of vision and strong governance. “It is important to understand the language of both the public and private sectors to successfully bring them together to work and broker that trust for partnerships. Public-Private partnerships must stem from trust and alignment of vision.”
According to Dr Chibuzo Opara, CEO, DrugStoc, “Clear identification of responsibilities in a Public-Private Partnership is critical to the success of the partnership.” DrugStoc’s success lies in providing essential services at the last mile. Employing drone technology, within 30 minutes, DrugStoc is able to deliver essential medicines to areas in Cross River State that would usually take nine hours to deliver to. Beyond manufacturing, regulating medicine supply, distribution and storage is key to ensuring quality and Professor Chimezie Anyakora, CEO, Bloom Public Health, expressed his joy at how organisations like DrugStoc are innovatively solving the age-old problem of distribution and storage of medicine.
Professor Anyakora opined that there is a need for regulation that preserves the quality of medicine, until it gets to the end user and organisations like ARC-ESM, DrugStoc and Bloom Public Health are already putting in place systems to secure the supply chain. “It is worth noting that medicine quality is beyond manufacturing, but also in the supply, storage and distribution of these medicines which is very important,” he added.
Key takeaway points from the meeting include:
- Access to healthcare doesn’t equal quality. You can’t achieve Universal Health Coverage (UHC) without access to quality medicines, as quality is critical to outcomes.
- Most maternal deaths are preventable. The quality of medicines women receive is one of the major ways of preventing post-partum haemorrhage. Expanding access to quality maternal healthcare is crucial to reducing maternal mortality in Nigeria.
- The supply chain — from manufacturing to when the medicine reaches the health facility — is very critical in ensuring that the quality of medicine is maintained. Build an efficient and effective supply chain system to improve the availability of medicines and health products.
- Raise awareness among policy makers and stakeholders, at national and state level, on the need to establish processes and regulations to ensure quality standards are adhered to and on the need to establish sanctions to combat the use and sale of substandard medicines.
- Improve digital technology and build on innovations to ensure access of quality healthcare to hard-to-reach communities.
- Research is essential as it provides evidence-based data to help understand and address the problem. It also provides evidence for policy change and further action.
- Improve capacity of local partners to incorporate pharmacovigilance activities at all levels of the health system to improve internal and external reporting systems for falsified medicines.
- Raise public awareness and health literacy among Nigerians.
Sustainable Development Goal (SDG) 3.1 aims to reduce the global maternal mortality ratio to less than 70 per 100 000 live births by 2030. According to Dr Afolabi, this is a critical assignment for Nigeria “as it translates to our reducing our maternal mortality by about 94% between now and 2030”. Private organisations, with their ability to move fast and efficiently, in partnership with government, with its broad mandate, is possibly the most powerful force for positive change in society.