Nigeria health sector really in bad shape- PSN president
Pharm Ahmed Yusuf is the president of Pharmaceutical Society of Nigeria (PSN). In this interview he speaks on the need to make strategic and deliberate policies that can change the face of health care in Nigeria, and make Nigeria into a pharmaceutical hub in Africa
As the president of PSN, what would be your thoughts on what an ideal medical system in Nigeria should look like?
Some people when they talk of a medical system they mean pharmacy, nursing, others mean only medical doctors, but I hope this question includes the entire medical sector which talks about the pharmaceutical sector.
Our budget allocation for health should at least be as agreed by Nigerians being signatory to the convention in Abuja which is 15% for health care.
The National Health Care Act if implemented, that is getting the 1% allocation from the consolidated revenue fund, and put in calabash; the international donors would bring their own, and a method is instituted wherein the primary health care funds is available for emergency situations, the National Health Insurance Scheme fund is accessible, monies are also allocated for pharmaceutical, medicine and consumables.
But I do not know what is happening, it seems like the leadership that come and go do not see health as a priority. Our health budget use to be 5.4% to 5.6% but in this regime it has reduced from 5.4% to 4. Something and this year, it came down to 3.6% which generally is affecting the medical landscape in Nigeria.
Nigeria is bedeviled by issues of manpower, all these rivalry among professionals is because of poverty, they are not well paid. Many have checked out of the country including doctors, nurses, pharmacists, lab scientists in search of greener pastures.
I just came back from North Carolina, we have more than 8000 pharmacists in America and the United Kingdom from Nigeria and they are doing well.
So with this kind of attitude definitely to me we are encouraging medical tourism, brain drain, creating more inter-professional rivalry and disharmony in the system.
Health care is in a bad shape in Nigeria, it is a pathetic situation, but of course I always say that one should not bring politics into health care, Agriculture or education. Any government that is successful in agriculture, health and education, will get everything right, people will go out and look for whatever they can do to survive that is how you generate and create employment. In the pharmaceutical sector if we are encouraged, the about 178 manufacturing outfit can generate almost one million employment, but we are not encouraged.
Neighboring countries have created pharmaceutical hubs, we have heard of Ethiopia now, they created a export processes zone and they will come and dump their products here. Ghana is trying to be a hub and where is the market, it is Nigeria, so we have to make a deliberate, attempt and come with the ways and means of encouraging the system, even though the CBN governor said there is a window for a loan of upto one or two billion, with the interest rate of 9%.
But before you get it, it is another thing, I do not think it is going to be easily accessible, but I will encourage other to go and apply and see if we will get it. But once there is Nigeria factor,that you must know one politician or another before it is approved then it is a problem.
We are in an election year, what would be your advise to Nigerians on choosing leaders that would take some of these candid issues you have raised to bear in their manifestos?
You see the way things are going in Nigeria, we are not developed to the idea that you cannot vote somebody if he does not have a transparent agenda which shows you the direction, or road map, ideology, or what he can offer.
Just like what Professor Lamuba said, he went round and realized that in Africa, you can only get elected through their stomachs, not through fresh ideas. Because he contested in an election and he organized about 250 town meetings, he went round talking about those ideas, then somebody went and shared money on the day of the elections and he won. Honestly anybody that will come with a blue print on health care as a priority, on agriculture, education should be our leader because he knows what can bring about human development.
Of course the GDP through these areas can easily grow, so in leadership one has to look for those who have fear of God, are ready to be accountable, tested and trusted ,not corrupt, but unfortunately the system does not allow honest leaders to emerge. From the primaries up to now I cannot see internal democracy even within the parties. It is filled with tricks and everyone wants to install someone. This Godfatherism and God son, is still killing the system, it creates more avenue for corruption, I thought that before we elect any new leader, either local government, state or federal, we should insist on getting their blue print, what they intend to do before we vote for them, but in Nigeria it does not work. The party would decide on who would stand for elections, and people just follow the party not the individual, even if the individual is corrupt. If the party clears him, he will be voted for and unfortunately some will tell you that if so so persons is in the party, even if he install a dog for us, we will vote for the dog, so it is that bad.That question is not for Nigeria because we still have a long way to go.
What interventions does the pharmaceutical companies need to make Nigeria into a pharmaceutical hub in west Africa?
We have the National Drug Policy in Nigeria which was published in 2005 and it stated there every five years, the policy would be reviewed and we are now in 2018, and there has been no revision of the policy.
Though I understand a committee was set up to work on the National Drug Policy. It was clearly stated in the policy that by 2010 we should be able to produce 70% of the medicines we consume locally, and source the other 30% from outside, but the reverse is the case, we are getting 70% from outside and 30% from within. Even with the 30% of the medicines, 98% of the raw materials are imported, so you can see that at the end of the day we are nowhere.
Because most of the raw materials are derived from petrochemical industries, while others are processed in the lab, for commercial quantity we have the API industries but they still use chemicals and little amount of raw materials from natural herbs, but unfortunately we have been calling for donkey years to have a petro chemical industries in Nigeria, but to no avail. But Dangote is coming up, with a petro chemical industry, by 2021, though if we have the petro chemical industry and we do not have the API industry, it does not make sense we still cannot produce.
Some countries do not even have crude oil or petrol, they buy them and go have a petrochemical industry apart from a refinery, they get a lot of chemicals from there, and they now export it to Nigeria. So it is not only about the money, but having an enabling environment is very fundamental, if we can have the raw materials at reasonable rate, Nigeria will grow in that sector.
Secondly the issue of tariff, we have what they call the common external tariff by West African Countries (ECOWAS),which was agreed and Nigeria signed. Most of the countries do not have industries, they said all imported products should attract 0% but raw materials should attract duties from 5% – 20%, so those countries without manufacturing outfits, are happy importing to make medicines accessible at affordable rate, because they do not have industries.
We that have industries, we would become a dumping ground, and our locally industries would not be able to compete, so we complained and made noise and said that it does not make sense. We visited President Muhammadu Buhari, visited the Minister of health, and they were able to see through all the points I made.
My recommendations then was, lets make the raw materials 0%, just like what Ghana did just recently, they are not charging interest on raw materials, they removed BAT from many other components. I recommended that we remove duties from raw materials if we must maintain all standards as signatories to CAT. So what they did is to come up cleverly with another idea through the fiscal policy, by the Former minister of finance Kemi Adeosun, that we should pay import adjustment tax, duty is 0%, but the same amount of duty we pay is 20%, it was converted to import adjustment tax 20%.