The first National Drug Policy was published in 1990. The objectives of the policy were set out to make available at all times, medicines which are effective, affordable, safe and of good quality in all sectors of the health care system; and to improve the quality of health care through the rational use of medicines. The extent to which the policy objectives have been met is yet to be evaluated. The policy is currently under review. This study is, therefore timely because it not only provides a baseline assessment of the current pharmaceutical situation in the country, but also helps to identify possible strengths and weaknesses in the sector and thus, contribute to the on-going review process.
The structures and processes in the pharmaceutical sector were assessed using structured questionnaires. In addition, 36 health care facilities at the primary and secondary levels representing the 6 geopolitical zones of the country were randomly sampled using a multistage sampling technique.
Results show that although a good number of structures and processes have been put in place for effective delivery of pharmaceutical services, some important gaps still exist. These include unspecified budgetary allocation for drugs, absence of fair financing mechanism for medicines, no legislation empowering generic prescription and substitution, high taxes on essential medicines, no drug donation guidelines, no national standard treatment guidelines, absence of well structured drug information services, little or no public education on rational use of drugs and inadequate human resources in the public sector
Assessment of facilities showed inadequate record keeping especially at the primary health care (PHC) level. Forty-six percent (46%) of key medicines were available at public health facilities. However, 7% of these medicines had expired. By comparison, no expired medicines were found on the shelves of private drug outlets. Measurement of affordability showed that to purchase cotrimoxazole and penicillin to treat uncomplicated pneumonia in a child, without hospitalisation, a worker receiving the lowest government wage would have to work for 3 hours and 6 hours, respectively.
Thirty eight percent (38%) of health facilities had Standard Treatment Guidelines (STGs) and 24%, the Essential Drugs List (EDL). More than 90% of prescribed drugs were listed in the EDL. However, with respect to appropriateness of prescriptions for specific diseases, only 2% of prescriptions for diarrhoea, 10% for acute respiratory tract infections and 21% for mild to moderate pneumonia were adjudged to be appropriate.
It was also observed that while drug storage was satisfactory in state-owned facilities and warehouses, it was poor in PHC facilities.
Rational drug use indicators showed that the average number of drugs per prescription was 4.7. 59% of patients were prescribed antibiotics and 55% were prescribed injections. More than 90% of prescribed drugs were listed in the EDL. Furthermore, with respect to appropriateness of prescriptions for specific diseases, only 2% of prescriptions for diarrhoea, 10% for acute respiratory tract infections and 21% for mild to moderate pneumonia were adjudged to be appropriate.
The household survey showed that medical consultations were sought mainly in public health facilities (38%), drug stores (23%) and private health facilities (16%). Results showed a higher private sector utilisation rate (62%) than the public sector (38%).
Twenty three percent (23%) of the average weekly expenditure of respondents went into the treatment of an episode of illness in a member of their household. Most of the respondents (89%) purchased all prescribed medicines. The main reasons given for non-purchase were financial incapability (36%) and unavailability of medicine in public pharmacy (28%).
The results underscored the need to re-engineer the system for better efficiency in the use of scarce resources. Some of the recommendations made towards improving the pharmaceutical sector included the following: improved procurement practices, better drug management especially at the PHC levels, better distribution of the EDL, establishment of structures and processes that would enhance rational use of medicines, better regulation of the activities of the private medicine providers, and building capacity in drug use and management. Implementing these recommendations would ensure that good quality, safe, and efficacious medicines which are used rationally are made available to the Nigerian populace.
