Why fund Pharmacy Networks?
Several studies have shown that when people, poor people in particular, first seek diagnosis and treatment for an illness, including those that contribute the most to the population disease burden, such as malaria, sexually transmitted infections, diarrhoea and respiratory tract infections, they visit a private pharmacist, nurse, patent medicine vendor (PMV) or traditional practitioner. People use these private sector providers (PSPs) because they are often easily accessible, and they are perceived to be less formal and cheap.
Studies have shown that a large proportion of the populace do really seek treatment initially by visiting a private sector provider of health care with the services paid for out of their own pockets. This include a recent study of health seeking behaviour of pre-school age children in three rural local government areas (LGA) in Southern Nigeria, which showed that 50% of parents had sought first time or subsequent care from patent medicine vendors compared with only 13% at government facilities and 14% at private clinics ( Salako LA, Brieger WR, Afolabi BM et al. 2001 . Treatment of Childhood fevers and other illnesses in three rural Nigerian communities. Tropical Paediatrics 47: 38-46).
Another review of treatment seeking behaviour for pre-school children with 'fever' in Lagos, a cosmopolitan city, found a similar pattern; 36% PMV, 22% private and 29% government (Brieger et al 2002). These findings do categorically suggest that pharmacies and patent medicine vendors are indeed contributing, in no small terms, to the attainment of public health goals in both rural and urban settings in Nigeria .
Unfortunately, almost every efficacious patent or prescription drug sold in Nigeria has either a fake or adulterated version. They range from common analgesics, through antibiotics to drugs for ailments such as diabetes and hypertension. Sources in Nigeria 's pharmaceutical industry estimate 40 percent of the drugs in circulation in the country are either fake or adulterated ( www.healthyskepticism.org/reports/2002/fakes ).
At the forefront in the battle against the menace in Nigeria is the National Agency for Food and Drug Administration and Control (NAFDAC). In the past few years, NAFDAC has on an almost weekly basis, published lists of newly identified fake and adulterated drugs in circulation, giving the public advice on how to spot them.
NAFDAC officials say some of the fake products either contain ordinary powder or starch, while others contain ingredients that may be poisonous. In other cases, the drugs had expired and were still kept in circulation. Often, especially antibiotics, the active ingredients in the fake drugs are well below the advertised doses printed on the packaging.
The menace of fake and adulterated drugs has been blamed on the chaotic distribution system and the paucity of registered pharmacists in the country. Drug distribution in pre-independent Nigeria was very orderly and lawful, but at post-independence, the few available pharmacists resorted to multiple registrations of pharmaceutical premises and outlets. Consequently, ordinary 'traders' with no knowledge of poisons or prescription drugs engage in the pharmaceuticals business without supervision, thereby defeating the purpose intended by the stipulations of the law.
Our research in Nigeria has shown that as at today, despite the best efforts of NAFDAC to regulate this sector, there are over 10 illegal drug markets in the country, which account for more than 20,000 drug outlets. A statement from the Pharmaceutical Society of Nigeria (PSN) Lagos State branch recently corroborates this finding. It was observed that of the 100,000 drug outlets in the state, only 810 are duly registered. In other words, over 99 percent of the drug outlets in Lagos State are illegal.
These unregistered premises are manned by non-pharmacists including illiterates, most of whom do not know the chemical composition of water, talk less of the potent medicines they are vending. Sadly, they are not amenable to any form of control or regulation. Not only is the health of the entire nation endangered, a lot of money that could have been put to good use is being spent by people on harmful drugs due to the activities of these 'traders'.
The atrocities committed by these impostors are incredible and indescribable. They include outright death, complication of illnesses, high cost of medication, embarrassing treatment failures in medical practice and drug abuse. The tragedy is that people still patronise these fake outlets because there are no widely available and easily recognisable branded outlets as an alternative.
With such an overwhelming majority of quacks in the drug trade, professional pharmacy services are alien to the society. The average pharmacist, while completing qualifying degrees from university never imagined that he would not have any opportunity to practice his profession or any opportunity to serve the society.
WISH for AFRICA believe it has the moral obligation and social responsibility to support, manage and train young pharmacists in basic business and management skills so as to compete effectively.
The ultimate aim of WISH for AFRICA is to help establish a strong and easily recognisable 'brand' presence by developing a network of micro-franchisees that can be easily regulated and modulated towards effective delivery of healthcare in the community.
