The Initiative for Public Policy Analysis, a Nigeria public policy think tank, Africa Fighting Malaria and American Enterprise Institute, a Washington DC think tank, have published a working paper: Drug Use in Nigeria.

The paper indicates there is prevalence of sub-standard and fake drugs in Nigeria but this is on decline. The paper also discovered irrational drug use and healthcare personnel acknowledged patients purchasing medicines from unregistered channels, and without valid prescriptions.

For decades, Nigeria was plagued by counterfeit and poor-quality medicines. In 2002, the World Health Organization reported that 70 percent of drugs in Nigeria were fake or substandard; the National Agency for Food and Drug Administration and Control (NAFDAC) estimated that 41 percent of drugs alone were counterfeit (Yankus, 2006; Akunyili, 2007). Throughout the late 1990s and early 2000s, other peer-reviewed studies estimated the number between 36 and 48 percent (Shakoor et al., 1997; Taylor et al., 2001). Like many other developing countries, corruption in the healthcare sector was rife: drugs were routinely “leaked” from public facilities into the private market. Plum healthcare positions were bought and sold (Lewis, 2006; Gupta et al., 2004). Intellectual property rights remained among the world’s most poorly enforced.

According to the International Property Rights Index 2009, Nigeria ranked 94th out of 115 countries (Property Rights Alliance, 2009). Fake and substandard drugs levied a heavy cost in both economic terms and in lives lost.

In 1990, 109 children died after being administered fake paracetamol. Reports in the Nigerian media suggested that there was growing resistance to common first-line antimalarials likely driven by both irrational drug use (patients using the wrong medicines, in the wrong way) and the prevalence of substandard medicine (Reef, 2008).

Improvements have been made in the past decade, driven in part by the leadership of a reinvigorated NAFDAC, under then Director General Dora Akunyili (current Minister of Information), which improved policing and prosecution of counterfeiters. By 2006, the number of substandard and counterfeit medicines circulating in Nigeria’s market had fallen to around 16 percent, NAFDAC reported, and Nigerians were consistently ranking NAFDAC as among the most effective of Nigeria’s government agencies (Bate, 2008; NOI-Gallup, 2007-2008).

But problems remained. Fifty-one percent of Nigerians told Gallup-NOI in November 2008 that corruption in the country was higher than it had been five years earlier (NOI-Gallup, 2008). Thirty-two percent of a small sample of antimalarial drugs collected from Lagos area pharmacies in September 2007, as a part of a study of six African countries, failed thin-layer chromatography (TLC) and/or disintegration tests (Bate et al., 2008). Eighty-four children reportedly died between late 2008 and early 2009 from diethylene glycol-contaminated teething medicine “My Pikin Baby Teething Mixture” distributed by the NAFDAC-licensed Barewa Pharmaceuticals (Polgreen, 2009). Nigeria’s drug distribution system remains largely informal (Chiejina, 2009), and it is common knowledge that consumers routinely buy drugs from unregistered sources.

While analysts have explored institutional answers to the problem of counterfeit and substandard drugs—improving laws, increasing criminal penalties for counterfeiters, and making enforcement stronger and more consistent— few have explored consumer demand (Erhun et al., 2005; Wong, 2004). It was often assumed that consumers would purchase counterfeit and substandard drugs because they were cheaper—product appearance, prestige associated with use, perceived quality, a consumer’s general attitude toward counterfeiting, and prescription requirements were generally not considered even though some evidence suggested these variables were important (Lai et al, 1999; U.S. Food and Drug Administration, 2007).

The aim of this study was to assess the extent healthcare personnel in Nigeria are aware of the problem of counterfeit and substandard medicines, and how this influences their professional behavior. In addition, researchers explored how these attitudes contribute to, or else impede official regulatory initiatives to eliminate counterfeit and poor-quality drugs.

Read the full paper  here