CURTAILING THE MONSTER  OF CHAOTIC DRUG DISTRIBUTION SYSTEM  IN NIGERIA:ECHOE FROM THE NEW NATIONAL DRUG DISTRIBUTION GUIDELINES

 

The pharmaceutical sector enjoyed an appreciable media  coverage during the last week of june  2015, but this time on a cheering note, away  from  the previous episodes of deaths due to errors in compounding medication, or  discovery of another huge batch of fake and  counterfeit  drugs etc, rather it was the news of an attempt at taming  a monstrous  situation that has bedeviled  us as professionals  and has become a national  embarrassment to every Nigerian. The effort that has been put into the process so far needs to be commended and supported in order to achieve a long lasting victory over this common “public enemy”.

 

Though it may  be viewed as futuristic in expectation, however there is the need to do a little reflection on the past,  while appreciating it’s  imperatives  in the  present. The current  scenario could be traced to the emergence of non-professional s as part of the chain in an attempt  to solve the problem of access to pharmaceuticals by the vast  majority  living outside the  few  urban centres then next is the near comatose state of  regulatory  activities in the sector over the years, such that  it took a change in the leadership of one of  the regulatory agencies  in the early 2000s before Nigerians began to appreciate  the gravity of the fake drug menace in the country! ,also the almost cancerous proliferation of  imported brands of medication, that  has  brought a lot of “shunts” into the distribution network, making a good  number  of   wholesale outlets(and i dare say some retail outlets) pharmaceutical importers overnight. 

 

Last and definitely not the least is an apparent lack of integration of this critical process (drug distribution) in the various health policies that have been put forward in the recent past.

 

The above  factors, though not exhaustive  of  the possible reasons for the chaos we are presently witnessing  in the network, they may as well serve  as a spring board  to be used in launching a final  onslaught on the present challenge of chaotic  system . when the non –professionals were officially let in to the network, the  prevailing circumstance  of gross shortage of manpower  was  obvious, it was then meant to be a stop gap arrangement to be  used while effort was  made to shore up the gap, however and unfortunately too, such temporary  arrangement has now found a life of its own and  become a force we all now are reckoning with, so sad!, therefore in addressing this there is a need to put into the right perspective, the time frame linked to their existence. this will ensure that the custodians of pharmaceuticals will  be people who can be trusted with their proper care and will be accountable for every action and inaction.

 

On the regulatory activities within the sector, there is no gainsaying the fact that the entire framework needs to be totally reworked with a fresh, detailed and measureable mandate given to them, backed up with the political will to succeed from the peak of government and made transparent enough to the masses of the populace being the owner of every sovereignty and for whose interest they were set up to protect! This has to start with the reorientation of the personnel  to be used for these activities from the governing boards, to the management and the entire staffers in such a  way that they will appreciate  the fact that the well being of over 150 million human being rest wholly on the way they carry out their functions. this is expected to guide them in the discharge of their duties, it should be made clear that theirs is not  a revenue generation  mandate and that whatever revenue that may accrue to them should only serve as part of the means to carry out their mandate …..all these will be taken care of in the rework process. 

 

I digress; now back to the main topic of the day. Even though efforts were made to get a detailed document about this novel idea and all i could lay hands on was the document stating the guidelines for setting up the distribution centres   and what i could glean from the news media. this piece was therefore prompted by the frustration encountered trying to get details of the idea, after  all  as a  stakeholder in the sector, it is expected that i arm myself with information  much  more  detailed than what is obtainable in the media, but alas this was not  forthcoming!  And from hindsight, previous beautiful ideas have being  rendered either moribund, ineffective or out rightly becoming a flop by destroying whatever good that was on ground before their advent.  One cannot imagine that this noble idea is allowed to suffer the same fate as those of the past. 

 

for instance, for a process that started since 2010,a lot must  have gone into different forms of engagement  with stakeholders where i believe certain inputs in the form of concerns, suggestions, modifications etc must have been made and this will provide a pool of  ideas that can even  form a textbook, the  interest really is not in a bogus write up  but  rather a piece that will encompass all  shades  of ideas and will exclude any discretional  powers to those that will implement the system. at this point,i will like to state that i have refrained from  referring  to this process  as  a policy because, the most critical questions of what, how, when and where have not been adequately addressed in the document i got and the implication of  this is that the task of implementation  is largely left to the whims and caprices of those saddled with it, this to me is absolutely undesirable, and will render it at best ineffective.  

 

If at take off there is no documented work plan that will serve as a manual to the entire stakeholders in network, what we have now is that for the owners of the centres, what of the buyers, the generality of the people, the economy by this i mean how do we intend to align this idea with the economic goals of the nation in terms of growing the  indigenous capacity in  the sector making it impact better on the national GDP  because  as it presently stands this idea relies largely on importation which does very little to the national economy unlike when we have those products manufactured in house ,of more  importance is the social impact  the idea will have  on  the employment status within the present state of affairs. all the points raised now ought to have been addressed adequately in the policy document for this idea. another point of concern is the speed that is involved in the roll out. going by the reports, as at the time of reporting, less than 10% of the federating units of Nigeria were ready for the new concept with another 10% waiting for  inspection as state players  leaving  about 80%  totally unprepared for  the roll out!, as for the private players only three (3) of them are awaiting take off and i gathered that they  can only take off with one point in one state at a time, this is for  a nation with thirty seven units and each unit should have  a minimum of two mega centres for easy accessibility, so ideally we expect  like seventy four (74)  centres  nationally  this is even less than 5% of our requirement!.

 

In all honesty, while  agreeing that the nation has suffered  tremendously  from the unregulated and illegal distribution system ,it should be clear in our mind that the mess was created over five decades and we cannot expect   to fix it in the five years that this idea came up (though a lot could have been achieved within the period prior to the roll out),that is why i said earlier that it is futuristic. moreso we as a nation are in a peculiar situation of change of guard in the national polity, and here is an idea which  was not even implemented by the government  that initiated it  for five years, and the same idea is now being pushed down to a new government whose policy thrust is yet to be enunciated ,moreover it has gained less than 10% acceptance….while not claiming to be a policy expert, my  basic democratic ethos tells me that there is more work to be done in the direction of cleaning up the existing system using this  proposed alternative.

 

Even though the present state of affairs is totally unacceptable ,we cannot afford to attempt  to dislodge an illegal mess and replace it with a legal one, being fully aware that drugs gives credence to the healthcare system in any society, i am in full support of the imperative of elucidating a more professional, transparent, accountable and sustainable alternative to the present chaos in the distribution system as represented in the proposed system, i hereby throw my full weight behind it upfront ,what  however needs to be done is in the marshalling out  of  a lethal arsenal making use of all the resources available in the society which will include advocacy, cajoling and i dare say blackmailing if necessary. 

 

In conclusion, as the great scientist (albert eistein)said ”we cannot solve a problem at the same  pedestal that it was created”, there is need to move higher in our intellectual engagement  to curtail this monster. while thanking those already involved for their effort, the reality on ground suggests that there is need to build more consensus among the political  class  and the lawful stakeholders, while the regulatory framework should  be strengthened and made more proactive to meet up with this new challenge, we cannot regulate the sector now the way we did few decades ago, this is because there are new challenges as well as new opportunities to deal with them. I look forward to a more robust and clear policy that will midwife this new dawn in the drug distribution system.

Femi awotunde, B.Pharm (oau) , [email protected]