I have always wondered why Nigeria is the only country that pay lip service to regulation of therapeutic drugs, yet we complain about poor healthcare system! Is it that our health policy makers are too ignorant to see the link between poorly regulated drug distribution system and poor healthcare delivery system

When regulation of drug market is poor, it negatively impact the healthcare system in the following ways:

1. Fake drugs--- one of the consequences of not regulating therapeutic drug distribution is that merchants of fake drugs would operate freely. Fake drugs lead to treatment failures, injuries and death. Imagine a situation where a patient is being treated of malaria with a fake antimalarial medication, the doctor believes that he is giving the right medication but the patient would rather continue to deteriorate until the sickness gets complicated and eventually death follows. This case also applies to other diseases. Nigeria is one of the countries with very low life expectancy. Even Ghana has higher life expectancy compared to Nigeria. Fake drugs contribute greatly to high death rate and low life expectancy! Is it that our health policy makers can't connect the dots or what If they understand all these things, why then is it that they don't take drastic measures to curtail the menace of fake drugs distribution Why would they choose to play politics with something as critical as human life

2. Health tourism: Nigeria has the potentials to become a health tourism destination not only for other African countries but even for people from other continents. This is because, just like India, we have the best brains in medicine and other healthcare professions. However, because we haven't gotten things right with our drug distribution policies, people don't have confidence in our healthcare system. Nobody wants to die in our hospitals due to fake drugs.

3. It encourages Criminal activities: Some of the drugs used for therapeutic purposes have the ability to act on the brain and alter the mind, example is the class of drugs known as the Benzodiazepines which is used to treat conditions such as anxiety, convulsions and insomnia. Rapists use such drugs to sedate their victims before raping them( Recall the case of Cynthia Osokogu). Kidnappers also use such drugs. Unfortunately, these drugs are sold in Nigeria even without prescription, no thanks to open and unregulated drug markets which makes it possible for everybody to have access to these drugs. Another example of such drugs is tramadol and other opioids which have the ability to numb the mind and body thereby making users to act without emotions. The "highness" caused by this class of drugs also give criminals courage to carry out operations without fear of security agencies. These mind-altering drugs are supposed to be dispensed only by qualified Pharmacists upon prescription by qualified medical doctors. After dispensing such drugs, the Pharmacists ought to fill out a form that helps the authorities keep track of use of such drugs. The Pharmacist is also supposed to retain the prescription form in the pharmacy because that will save him from prosecution in case of any eventualities.
All these things were taught to us while in Pharmacy school, but when I left school and started practising, I discovered that people don't even pay attention to all the regulatory processes, not even medical doctors! Tell me why Nigeria would not have high crime rate and increasing number of mentally ill individuals

4. Difficulty in product recall in the event of serious adverse drug reactions: Usually, when a drug product is discovered to cause serious adverse reaction along the distribution chain, a recall process is activated to take such drugs off the shelves and return them to the manufacturers. This process is supposed to be initiated by NAFDAC through what is known as PHARMACOVIGILANCE. However, due to the chaotic nature of the Nigerian drug distribution system, this recall process is ineffective in Nigeria. This is because the majority of the people involved in the value chain of drug distribution in Nigeria are charlatans who have zero knowledge about drugs. So, they don't even know what to do in the event of such adverse drug reactions. MY PIKIN teething product killed many innocent kids before it got completely recalled because of this poor distribution system. I wonder what will happen if a deadlier product enters the market in the future. It'll be bloody!

The list goes on!

All over the world, the Pharmacist is the only trained health professional with the mandate to make, distribute, regulate and dispense drugs. He is under oath to ensure that the drugs getting to the end users are wholesome and meets all the regulatory standards. But here in Nigeria, people believe in cutting corners and there's always this believe that "anything goes" in Nigeria. So, instead of going to Pharmacy school to train as Pharmacists so they can gain knowledge of drugs or employing Pharmacists to man their business, they rather evade all regulatory standards specified by the drug laws and official books thereby making a mess of the system and sending many unsuspecting Nigerians to their early graves.
This problem is worsened by the fact that the majority of the people are ignorant of the fact that drugs can actually kill as much as it treats diseases. Drugs kill subtly and there's hardly a forensic mechanism in place to enable patients and their relatives seek redress from the courts in the event of injury or death arising from use of therapeutic drugs.

Another problem that militate against proper drug regulation is the unnecessary rivalry between Nigerian Pharmacists and medical doctors. In the developed nations, the Pharmacists and medical doctors work in agreement to foster good healthcare but here in Nigeria, the two professions seem to be in unending rivalry to the detriment of the patients. The Nigerian medical doctors have refused to stop being insecure and concentrate on the broad field of medicine. Instead, they want to usurp the duties of the Pharmacists even with their limited knowledge of drugs. Medicine is so wide and Nigeria is grossly lacking experts in the various specialties of medicine, but our medical doctors would rather drag space with Pharmacists and other healthcare professionals instead of striving to meet up with the nation's need for experts in the various specialties of medicine. This unnecessary bickering between the two professionals contribute to the problem of poorly regulated drug distribution system because the majority of those at the helm of affairs in the health sector are medical doctors and since pharmaceutical sector is under the ministry of health, the doctors have continued to be a stumbling block to the progress of Pharmacy in the country. Take for instance, the national drug distribution guideline (NDDG) which was initiated by the federal government. That policy was well thought out and was arrived at after a thorough engagement of experts in the pharmaceutical sector, but till today it is yet to take effect just because some uninformed medical doctors in the ministry of health and NMA are not in support of it. They are not in support of it because they had been taking advantage of the chaotic drug distribution system for their selfish gains and at the detriment of Nigerians.

Therefore, it is very important that every well meaning Nigerians should rise up to the occasion and prevail on the Nigerian medical doctors to focus on medical practice and leave the issues of drugs and drug regulation to Pharmacists! Nobody else can regulate drugs better than the one who makes the drugs and which is the Pharmacist! The rivalry is uncalled for because the Pharmacists know their scope of work, and right from Pharmacy schools, they're made to understand the need not to go beyond their scope.

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This is a critical matter.

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