Leading the Way? The State of Health in Nigeria

Today we’re talking about the Nigerian story. The upcoming Presidential election has the country buzzing with speculation about a tight 3-way race. ATMs have long, chaotic lines leading up to them as people hope and pray to get their hands on the newly redesigned currency notes, which are in short supply, making it difficult for people to pay for food and other daily necessities. The year-long fuel scarcity is doing nothing to help the economically-stressed population – the largest in Africa.

Amidst this economic turmoil, Nigeria’s healthcare systems are also in a bit of trouble. According to the WHO, the country’s healthcare system ranks 163 out of 191, among the poorest in the world. Only about a third of Nigerian hospitals have basic hygiene services. The nation relies heavily on imports and donations to meet its pharmaceutical requirements; just about 30% of drugs are produced locally. This has a number of ramifications for healthcare access in Nigeria: highly costly drugs in a country where most healthcare expenses are out-of-pocket, the prolific spread of falsified medication, and the increased adoption of herbal treatments over conventional medicine.

African Union members have pledged to allocate 15% of their yearly budgets to healthcare, but Nigeria is falling far behind with its healthcare allocation at just 4.2% of its GDP. Nonetheless, the potential for growth here is exponential, with the pharma market predicted to reach $56-70 billion by 2030. Be it prescription drugs, OTC ones, generics or medical devices, the forecasted growth is promising.

Covid has had lessons to teach all countries. Lagos, Nigeria, is all set for its new Infectious Diseases Research Institute to encourage collaboration in research and surveillance. The Lagos State Biobank has some capacity strengthening to look forward to. The state is also developing a molecular biology sequencing suite to gather genomic intelligence more quickly and locally. The Nigerian Federal Government last year launched the Nigeria National Essential Diagnostics List with support from the WHO to improve access to diagnostic testing in the country. Nigeria is also one of the beneficiary countries of the South Africa-based mRNA vaccine tech transfer hub.

And as with most other economies, the West African nation has also heightened focus on localisation. In August last year, President Buhari announced that the Federal Government had released ₦100 billion to pharma manufacturers and healthcare investors to promote indigenous medical production. The month after, the Nigeria Sovereign Investment Authority invested a further $100 million in healthcare infrastructure. While the government-backed Bio-Vaccine Nigeria Ltd. teamed up with India’s Serum Institute to produce vaccines in Nigeria, the investment banking arm of PanAfrican Capital Holdings – PAC Capital Ltd. – entered into a $50 million deal for a Construction and Medical Tourism Relay Facility (CONMED).

Afreximbank signed a $300 million host country agreement with Nigeria to build a first-of-its-kind medical facility in Abuja – an African Medical Centre of Excellence (AMCE) which is expected to open next year and will serve as the headquarters for future AMCEs in the continent. UZ Carlson Pharma has invested €10.7 million in the Nigerian Army Drugs Manufacturing Company to produce generics and biosimilars, Nigeria and Cuba are partnering on vaccine and drug production, and the UAE’s Burjeel Medical City announced its willingness to collaborate with Nigerian healthcare institutions.

Medtech ventures also got a boost, with at-home lab test startup Healthtracka raising $1.5 million in a pre-seed round and Kenyan startup AfyaRekod launching its blockchain-based medical history portal in Nigeria. Pharmacies, too, stepped into the online space to get patients the meds they need: Med-Direct Africa launched a nationwide e-pharmacy, startups like Remedial Health and GoMed assisted pharmacies in their digital transitions, and even drone company Zipline made a foray into medical deliveries in the country.

Nigeria had some help from international agencies and foreign governments. The country’s Nasarawa state joined hands with the Clinton Health Access Initiative (CHAI) in a 5-year plan to end viral hepatitis C. Nigeria was also a beneficiary of CHAI’s $25 million support to oxygen supply infrastructure and its HIV drug rollout programme. Nigeria and China shook on a healthcare knowledge and expertise transfer agreement; the US extended support in the form of an upgraded biorepository lab at the Nigeria CDC; Nigeria is working with the WHO and CEPI to develop treatments for Lassa fever; in Kano, government and philanthropists are uniting to build the National Digestive Disease and Liver Transplant Centre, the first such centre in all of West Africa.

Investments in Nigerian healthcare have been encouraging, but nonetheless, the path of Africa’s largest economy towards universal healthcare has been fraught with challenges. The climate hasn’t been on their side (or anyone’s, for that matter), with severe flooding killing hundreds and adding to the nation’s infectious disease burden (more on this later).

But in the more man-made problems, countermeasures have steadily trickled in. The Pharmacists Council of Nigeria stepped up enforcement of regulations, cracking down on 311 pharmacies and patent medicine shops for offences ranging from operating without licences to unauthorised sale of certain drugs. In a country where only 23% of people are covered by some form of health insurance, the new National Health Insurance Authority Act now provides a ray of hope, especially in terms of health financing for the 83 million vulnerable Nigerians who cannot afford to pay premiums; the WHO is helping the government to fast-track the operationalisation of the Act.

There’s also the counterfeit drug problem plaguing Nigeria. Still, several innovators and startups are coming to the rescue with mechanisms to verify the legitimacy of medical drugs at the point of purchase. The government, for its part, is relying on the Pharmacy Bill to limit unregulated drug distribution channels in Nigeria. Localised production of APIs, excipients and allied materials could also improve the monitoring of the entire pharmaceutical value chain.

One of the most pressing issues facing Nigerian healthcare is the exodus of healthcare professionals we’ve covered frequently in The Kable. The country has an abysmal doctor-to-population ratio of about 1:5000, and without intervention, this proportion is on a further downward trajectory. According to the Nigerian Medical Association, more than 10,000 doctors trained in Nigeria have made an exit to the United Kingdom. Poor pay, infrastructure and opportunities cast doubt over the success of the government’s one-for-one replacement plan.

As for the country’s disease burden – where to begin? Mpox and Lassa fever continue to rage across the West African nation. Though the country is certified Wild Poliovirus-free, Vaccine Derived Polio Virus type 2 (cVDPV2) is still circulating, thankfully in declining numbers; the goal is to reach zero cVDPV2 in 2023.

Unfortunately, Nigeria tops the leaderboard for malaria, accounting for 31.3% of all malaria deaths globally. The country hasn’t been spared the cholera outbreak sweeping Africa either, especially due to the recent floods. Nigerians also face the threats of yellow fever and neglected tropical diseases and suffer a disproportionate share of the global TB burden, but a new treatment regimen for the latter may change things for the better.

You know the situation is terribly deficient when people have to make a choice between feeding themselves and getting essential medicines. When falsified medicines are making their way to patients more than real drugs are. When faith in the system is low. But all is not lost. The new Gavi CEO is a former Nigerian health minister; hopefully, this will mean that the African region is no longer at the back of the line when it comes to accessing important vaccines. The push to produce therapeutics locally is strong. Whatever the material realities in the country, Nigerians’ perceptions of their own health are not too bad. And ultimately, if all other measures fail, there are always influencers.

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