Interview: Dangers, Opportunities and Solutions of Healthcare Delivery In Rural Nigeria

Aside from low health care facilities, self-medication and inaccessibility of quality drugs are one of the dangers facing health development in rural parts of Nigeria and the world in general.

According to Tanimola Akande, a professor of Epidemiology and Community Health at the University of Ilorin, Kwara State in his the delivery of the 142nd inaugural lecture of the University of Ilorin entitled “Population with Ill-health Burden: Faced with a Sick Health System”; Nigeria loses N81 billion annually to importation of fake and counterfeit drugs, especially from Asian countries –contributing to Nigeria’s ill health system.

An official statistics from the National Agency for Food and Drug Administration and Control (NAFDAC) also shows that over N20 billion worth of counterfeit drugs and other substandard products had been destroyed by the agency since 2009.

Now, concerned young people such as Adebayo Alonge are not sitting back to watch the health of vulnerable people in Nigeria deteriorate. They are working towards making sure that Nigerians have access to quality drugs to improve their health.

Adebayo Alonge is a healthcare entrepreneur with professional training in pharmacy, business and entrepreneurship at the University of Ibadan, Lagos Business School and the Yale school of management. He is the founder of Lusoy Investments Limited, a pharma distribution company that distributes healthcare solutions to rural communities.

According to him, “Our (his company) emphasis is on ensuring that low income markets can afford healthcare solutions and we use a variety of means including cross-subsidies, contracts and donated outreaches to deliver these solutions.”

What has been your contribution(s) towards health development in Nigeria?

My work has been focused previously on volunteering with multilateral health organizations to work in rural areas with low healthcare capacity. This volunteer work saw me provide free healthcare services with the Global HIV/AIDs Initiative to communities in Oyo and Bayara located in southwest and north east Nigeria. In 2010, I also was involved in conducting a campaign that helped raise awareness in Bauchi town about HIV and its negative social impact. The campaign was conducted over 90 days and involved multi-stakeholder discussions aimed at generating community buy-in, media interviews, secondary school debates and culminated in the organization of a fund-raising dinner for children orphaned as a result of AIDs.

You are into the business of providing quality pharmaceutical drugs. How is sub-standard drug affecting a business such as yours and what practical approach would you suggest to stop sub-standard from eroding the market, especially in rural parts of the country?

My business provides healthcare solutions which include high quality pharmaceuticals. A recent study put the current level of substandard anti-malarial medicines in Lagos at over 80 percent of anti-malarial medicines in circulation. If the level is that high in Lagos which has a high level of regulation, you can imagine how bad the situation is in rural areas where many regulatory task forces never get to. Many rural communities lack professionally run health facilities. Government owned primary health centres are often dilapidated with many of the staff not turning up at work. Nigeria has too few healthcare professionals, most of whom prefer to set up practice in urban centres whose inhabitants can pay higher rates for their services. This gap in healthcare provision has been filled in rural communities by unscrupulous quacks that set up chemist shops where they double both as doctor and dispensers. Most run non-sterile wards where they conduct minor surgeries. As these quacks aim to maximize profit, they make use of the cheapest medical supplies and medicines which they often sell at above market rates. Rural dwellers patronize them due to the absence of choice. There is no gainsaying the number of people who have died from these quack services.

Substandard medicines have eroded the rural markets and my suggestions will be aimed at creating market incentives that roll back the patronage they currently enjoy. The following constitute actionable steps that can be taken:-

1.       Roll back regulatory barriers that prevent healthcare professionals from running chains of healthcare centres. This prevents them from setting up more than one health centre and reduces the spread of their impact.

2.      Rural healthcare task forces reporting to the regulatory agencies should curtail quack practices and ensure that licensed rural health centres maintain high standards of professional care.

3.      Private sector run rural health centres should be the basis of healthcare provision in rural areas. The government cannot efficiently deploy these centres and it needs to incentivize healthcare professionals to set up centres within 6 miles of every rural community. Incentives should be built around mobile phone- based healthcare micro-insurance subscription for every rural dweller which the local governments have a responsibility to pay for.

4.      Extension services through community health workers should provide free diagnostic services in rural communities. This will help create health seeking behavior in serviced communities and will help create sustainable context in which health centres can better succeed.

5.      Toll free lines to the regulatory agency that helps rural dwellers report instance of poor service delivery and drug adverse effects. This will ensure high service quality from healthcare professionals whose professional licences are used to run these centres and who risk disciplinary action for failing to deliver appropriate standards of care.

These actions will create centres whose medical supplies pipelines can be traced and secured thereby eliminating channels through which substandard medicines get to rural end users.

From your experience, what are the factors mitigating against quality medicines in rural Nigeria?

The single most important factor is the absence of professionally run health centres. This has led to a situation where pharmaceutical distributors such as my company- Lusoy Investments find it difficult to identify sustainable demand points in rural communities. As a result, cost of sales is high and since well-established quack channels have a penchant for low priced substandard medicines, purveyors of high quality medicines like me have no incentives to get their products to rural dwellers.

Other factors such as accessibility and affordability of professionally run health centres derive from the first. Difficult in accessing high quality healthcare raises the cost for those who eventually do, thus making it too expensive for them.

Solutions should centre on creating incentives for private healthcare entrepreneurs through reduction in regulatory barriers, improvement of regulation, improvement in rural infrastructure-roads and electricity. Health-subsidies (provided by local governments) are also required to improve health seeking behaviour and affordability for rural communities.

Read more: http://ruralreporters.com/adebayo-alonge-improving-access-to-quality-and-affordable-health-solutions-in-nigeria/