By Dara Ajala-Damisa and Sunday Ehigiator (Lead Writers)
Access to quality essential medicines is not only a human right, but also crucial to realising the Sustainable Development Goals (SDGs) as set out by the United Nations. While the Nigerian government is putting in place programmes to improve the health of Nigerians and deliver priority health interventions, challenges still exist within the pharmaceutical sector, such as the inconsistent availability of essential medicines as well as their high cost. The incorrect use and storage of essential medicines remains a challenge, especially with regards to life-saving maternal medicines used to manage complications. A recent study found that healthcare workers lacked sufficient knowledge about the storage practices for maternal medicines, with only 46% of healthcare workers being aware of the correct temperature at which to store the widely used uterotonic, Oxytocin.
Procurement and supply challenges
The supply of maternal medicines, as with all other medicines, in Nigeria is guided by a National Drug Policy (NDP) which was introduced in 1990 and reviewed in 2005. According to a 2004 study assessing medicine supply strategies in Nigeria, the major procurement methods are open tender and direct procurement. Some of the challenges experienced with these methods include late placement of orders and delayed payment, causing delayed supply of these life-saving medicines.
These delays can be fatal when health facilities run out of medicines to prevent and treat maternal complications. This is known as ‘stock out’ or as this article put it, ‘E no dey, come tomorrow’. One of the most common pregnancy related complications in Nigeria is haemorrhage or blood loss and studies have shown that it can kill a woman within 2 hours if not properly managed with the right medication. These women do not have until “tomorrow” to come back for medication that will save their lives, so it is critical to ensure that health facilities have regular supply of quality maternal medicines.
National Drug Policy (2005)
Nigeria’s 2005 National Drug Policy aimed to ‘make available, at all times, adequate supplies of essential drugs that are effective, affordable, safe and of good quality to ensure the rational use of such drugs and to stimulate increased local production of essential drugs.’ However, a recent survey revealed that compliance with the policy was inadequate as medicines are meant to be procured in bulk through the central medical store, based on an expressed need by facilities.
The survey report revealed the challenges with current procurement processes which include the fragmented and uncoordinated management of medicines between programs, states, and facilities. It also indicated that despite the existence of the policy document, most programs devised their own selection, procurement and distribution systems which are intended for the same public facilities and managed by the same health workers.
This has led to a duplication of efforts, wastage of scarce resources, weakening of the health system, and undermining the existing national supply system. The report highlighted the need for procurement, warehousing, and inventory management, as well as distribution to be managed by an autonomous drug management agency.
Impact of lack of direct policy on maternal medicines
Quality maternal medicines are vital in reducing maternal deaths. However, in Nigeria, due to the challenges associated with policies for medicine procurement, women continue to die or experience adverse outcomes when giving birth because they do not have access to quality, lifesaving medication. Women in especially hard-to-reach communities are hardest hit when it comes to accessing quality healthcare and medicines.
Policies determine strategies and the effective implementation of the policies should be a key outcome of policy development. Policy gaps exist in Nigeria’s national drug procurement landscape and the issues include the proliferation of substandard medicines as well as poor service delivery. Identifying and addressing these key policy gaps are important first steps in ensuring that medicines that are used for a woman who is giving life, are of the right quality to save her life and that of her unborn child, as well as enabling her to have a full recovery after giving birth.
A Senior Drug Procurement Officer with the Federal Medical Centre, Abeokuta, was asked about the challenges in the procurement of quality medicine and mentioned that “having too many players in the procurement chain gives more room for circulation of substandard and fake drugs, especially in rural areas”. The lack of adherence to the 2005 National Drug Policy and subsequently the lack of a national policy that directly addresses the procurement, supply, and sales of maternal medicines in Nigeria has given rise to the proliferation of substandard maternal medicines and falsified medicines.
Improving the procurement of maternal medicines
To curb the proliferation of fake and substandard drugs, the federal government must develop a policy that gives them autonomy over the national and sub-national procurement of drugs, including maternal medicines. According to the Procurement Officer, “There must be a policy that gives the federal government full charge and control of what drugs come into the country and what drugs are manufactured in the country and circulated in our hospitals. The policy must be developed with provisions that address current lapses in availability and affordability of quality maternal medicines”.
This policy should include the following components:
- Provisions that ensure a memorandum of understanding (MoU) with manufacturers and a stringent accreditation system for suppliers, ensuring the regulation of prices while ensuring adherence to quality standards.
- A streamlined and monitored system for private sector involvement in distribution where needed, to ensure last mile distribution of life-saving medicines.
- Provision made for annual procurement plans as determined by service providers, who are trained in quantification and forecasting of drug supplies; and strict guidelines that stipulate that procurement is done according to the annual procurement plans.
- The drug policy in Nigeria should back legislation for autonomous procurement agencies.
- It is best practice for national drug policies to include a medicines and supplies management information system, linking federal medical stores, state medical stores and health facilities to ensure functional audit, trail of movement of medicines and generate information for use in the selection, quantification and forecasting of medicines.
Taking steps towards improved policies — Ekiti and Kaduna States
In a recent post, Honourable Commissioner for Health and Human services, Ekiti State, revealed that the state Governor had signed the Drugs & Health Commodities Management Agency Bill into law in Ekiti State. This means that the state now has legislation backing the establishment of an agency responsible for the procurement, supply, distribution and sale of medicines.
A few weeks before the signing of the drug policy in Ekiti State, the Kaduna State government partnered with local pharmaceutical companies to ensure the appropriate and seamless supply of essential medicines. The government, through the Kaduna State Health Supplies Management Agency (KADHSMA), signed an MoU with the companies under the Pharmaceutical Manufacturers Group of Manufacturers Association of Nigeria (PMG-MAN), to ensure the supply of quality and affordable essential medicines to the citizens of the state.
Ultimately, a collaboration among core technical and policy partners is essential to develop a strong national drug policy for Nigeria, one that ensures that every woman has access to quality life-saving medicines during delivery.
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