The quality of health care a woman receives during pregnancy, childbirth and postpartum is critical as it determines whether she lives or dies. Evidence shows that the majority of maternal medicines used to treat the leading cause of maternal death (postpartum haemorrhage) circulating in Nigeria are of substandard quality. Consumers of substandard drugs may never realize they have been victimized, and consequences such as treatment failure, prolonged illness, or side effects may lead to worsening health outcomes.
During a policy dialogue on “Leveraging Public-Private Partnerships to Improve Access to Quality Maternal Medicines,” organized by Nigeria Health Watch to advocate for sustainable quality-driven mechanisms in maternal drug supply in Nigeria, there has been a push for sustainable public services. -private partnerships that guarantee medicines of guaranteed quality. In her opening remarks, Vivianne Ihekweazu, Managing Director of Nigeria Health Watch, spoke about the importance of quality health care and the critical impact of quality maternal medicines on maternal outcomes. Healthcare should be patient-centred, safe and effective, but it can’t be any of these things if there’s no quality.
She expressed dismay that the high number of maternal deaths recorded in Nigeria has not prompted an increased sense of urgency. “The private sector is a critical player in the health sector and can really be a key partner to improve capacity, access to information, work with the public sector in different ways and be guided by very strong government mechanisms “, she added.
Health Surveillance in Nigeria
In his keynote address, Dr. Kayode Afolabi, Director of Reproductive Health at the Ministry of Health, discussed lessons learned from previous government engagements with the private sector on reproductive and maternal health. “We have a private sector engagement strategy which was endorsed and launched recently by the Honorable Minister of Health. This has been articulated from the experiences we have had over the years and also the need we have recognized to ensure that the private sector is well integrated in partnership with the government on our health system, in particular sexual, reproductive and maternal health,” he said.
We may not be able to measure the true impact of poor quality maternal medicines on maternal mortality rates in Nigeria, however, from the experiences shared at the meeting, there is no doubt that poor quality maternal medicines are a real and present danger in Nigeria. During a presentation on the “Quality Landscape of Maternal Medicine in Nigeria”, Dr. Chioma Ejekam, Consultant and Public Health Physician, discussed her research work on poor knowledge and practices around oxytocin among health care providers. “Understanding and solving the problem of poor quality medical products requires a more interdisciplinary approach than has been evident to date,” she said.
Strategies to combat the circulation of substandard and falsified medicines
The Nigerian National Agency for Food and Drug Administration and Control (NAFDAC) has developed strategic plans to reduce the prevalence of substandard and falsified medicines to a maximum of 5% in Nigeria by 2025. Current prevalence of substandard and falsified medicines in Nigeria is 16.7% compared to the global prevalence of 10%. However, a new study is overdue because this data is 14 years old.
After correlating poor quality maternal medicine with negative maternal health outcomes, based on their experience and knowledge of the drug landscape in Nigeria, the panelists offered solutions to curb the flow poor quality drugs. A proposal put forward was the need for Nigeria to build a robust pharmaceutical manufacturing ecosystem. As Pharmacist Frank Muonemeh, ES/CEO, Pharmaceutical Manufacturing Group of Manufacturers Association of Nigeria (PMG-MAN) put it, “Except the country or the people are in control of how the drugs they consume are products…access to quality medicine…will continue to be a mirage”. For this to happen, three things must be in place;
a regulatory framework
As a private practitioner who has faced the consequences of administering substandard oxytocin to his patients, Dr Kay Adesola, President of the Association of Nigerian Private Physicians (ANPMP), has spoken very strongly about putting introduction of penalties for importers of substandard products. “You cannot say that Nigeria should continue to be a dumping ground, sanctions should also be part of the measures that we can use to curb the flow of bad maternal medicine in this country,” he said.
Responding to the call for a regulatory body, Andrea Nwachukwu introduced the National Commodity Supply Chain Management Program (NPSCMP) which is housed in the Food and Drug Services Department of the Federal Ministry of Health. One of the primary mandates of the NPSCMP is to coordinate and integrate public health program supply chains. “We have developed the first-ever national health product strategy and its implementation plan (2021-2025) that will address some of these issues that we have all been discussing,” she said, adding that, among other things, the plan was designed to promote an efficient supply chain of essential medicines and they are open to partnerships to achieve their goals.
Addressing quality supply gaps through public-private partnerships
Sharing lessons from his experience with public-private partnerships (PPPs), Azuka Okeke, CEO, Africa Resource Center for Excellence in Supply Chain Management (ARC-ESM) said there must be trust, accountability, clarity of vision and strong governance. “It’s important to understand the language of the public and private sectors to be successful in bringing them together to work and broker that trust for partnerships. Public-private partnerships need to stem from trust and alignment of vision.”
According to Dr. Chibuzo Opara, CEO of DrugStoc, “Clear identification of responsibilities in a public-private partnership is critical to the success of the partnership.” DrugStoc’s success lies in providing essential services to the last mile. Using drone technology, within 30 minutes, DrugStoc is able to deliver essential medicines to areas of Cross River State that would typically take nine hours to deliver. Beyond manufacturing, regulating the supply, distribution and storage of medicines is key to ensuring quality and Professor Chimezie Anyakora, CEO of Bloom Public Health, expressed his delight at seeing how organizations like DrugStoc innovatively solve the age-old problem of drug dispensing and storage.
Prof Anyakora said there was a need for regulation that safeguards the quality of drugs until they reach the end user and organizations like ARC-ESM, DrugStoc and Bloom Public Health are already putting systems in place to secure the supply chain. “It should be noted that the quality of medicines goes beyond manufacturing, but also in the supply, storage and distribution of these medicines, which is very important,” he added.
Key takeaways from the meeting include:
Access to health care is not synonymous with quality. You cannot achieve Universal Health Coverage (UHC) without access to quality medicines, because quality is critical to results.
Most maternal deaths are preventable. One of the most important ways to prevent postpartum hemorrhage is the quality of the medications women receive. Expanding access to quality maternal health care is key to reducing maternal mortality in Nigeria.
The supply chain – from manufacturing to when the medicine reaches the healthcare facility – is very critical to ensure that the quality of the medicine is maintained. Build an efficient and effective supply chain system to improve the availability of medicines and health products.
Raise awareness among policy makers and stakeholders, at national and state level, on the need to establish processes and regulations to ensure quality standards are met and on the need to establish sanctions to combat the use and the sale of substandard drugs.
Improve digital technology and leverage innovations to ensure access to quality healthcare for hard-to-reach communities.
Research is essential as it provides factual data to help understand and solve the problem. It also provides evidence of policy change and future actions.
Improve the capacity of local partners to integrate pharmacovigilance activities at all levels of the health system in order to improve internal and external reporting systems for falsified medicines.
Raise public awareness and health awareness among Nigerians.
Sustainable Development Goal (SDG) 3.1 aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. According to Dr Afolabi, this is a mission critical for Nigeria “because this translates to reducing our maternal mortality by about 94% by 2030.” Private organizations, with their ability to act quickly and effectively, in partnership with government, with its broad mandate, are probably the most powerful for positive change in society.