As Nigeria’s pharmaceutical industry eagerly awaits the implementation of the Presidential Executive Order aimed at reducing the cost of essential medicines, and generally revamping the health sector, delays in the implementation process have pushed back the timeline for its takeoff. 

In June, President Bola Tinubu signed an Executive Order to strengthen Nigeria’s health system by exempting pharmaceutical machinery, equipment, goods, and accessories from tariffs and excise duties, reducing production costs and making healthcare products more affordable.

But two months after the pronouncement, checks by Vanguard revealed that the cost of items in the key categories of health equipment covered by the Executive Order remained prohibitively high.

Among these are pharmaceutical medications, medical devices such as diagnostic imaging machines, laboratory equipment, surgical instruments, ECG machines, ventilators, syringes, needles, gloves, medical dressings and diagnostic kits for malaria, HIV, etc.

Vanguard gathered that while the government set a 30-day deadline for development of a harmonisation implementation framework with the ministries of Finance and Industry, Trade, and Investment, the exact timeline for take-off of the Executive Order remains uncertain.

On when Nigerians can expect to start seeing the benefits of the Executive Order, Minister of State for Health and Social Welfare, Dr Tunji Alausa, said the government is working diligently to expedite action on the framework that will guide relevant agencies in operationalising and implementing the Executive Order.

What govt is doing, by Alausa

Alausa said: “We are developing a harmonisation implementation framework with the Ministers of Finance and Industry, Trade and Investment.

“Government agencies involved include the National Agency for Food and Drug Administration and Control, NAFDAC, the Federal Inland Revenue Service, FIRS, the Standards Organisation of Nigeria, SON, and the Nigeria Customs Service, NCS.”

He said the government is moving quickly to develop the harmonisation implementation framework within 30 days, adding that once completed, the Executive Order will go into effect quickly.

“We have met with the Attorney-General of the Federation about the need to move quickly on this. We are working night and day to get this effected so that Customs will start implementing the process as well as the FIRS. We are setting up a technical working group on this implementation framework so that the Executive Order will take effect immediately.

Worried by the apparent lack of progress as the 30-day window has elapsed, players in the health industry have expressed concerns about the potential impact of the delays on the cost of medications and the livelihood of Nigerians even as there is uncertainty regarding the immediate effects of the executive order on drug prices and are urging the government to step up action on the policy.

Delay not worth it, people are dying — Oladigbolu

On his part, the Immediate past National Chairman of the Association of Community Pharmacists of Nigeria, ACPN, Pharm Wale Oladigbolu, said the delay in implementation of the Executive Order is not worth it because people are dying, even as prices of drugs have continued to spiral up.

“We haven’t seen the impact of the Executive Order, that’s at the down end where I practice. Prices of drugs at the retail stores are still very high and we see a lot of people not being able to afford the treatment that they need. Health insurance which should have helped the people is not working in the Nigerian context.

“A whole lot of people who are in the informal sector are not covered by health insurance, so the prices of medicine are high. Affordability is not there, and people’s incomes are strained. And when I say strained, I mean strained. They need to choose between food with high costs, fuel with high costs, and drugs with high costs. So they need to juggle those factors. So people only come to the pharmacy for purely essential things.

So things like high blood pressure that does not have a warning, a lot of hypertension patients are dropping their medicines, especially those who have poor health education, they have dropped. They see hypertension as not troubling, so you see a lot of non-adherence to medication because of the high cost of medication. High cost of food. And indeed, high cost of work.

“The delay is not worth it because people are dying. We have not seen an impact or drop in the cost of medicines in Nigeria, so the Executive Order has not had any impact. This speaks to what the Federal Government should be doing.

“Before you issue an order, you need to check the baseline, you need to do a survey, conduct the baseline. And when you issue an order, two months down the line, you need to conduct another survey to compare the former with the new, and that has not been done, but I can tell you wholeheartedly that we haven’t seen an iota of drop in drug prices in this country. “

Implementation details must be properly worked out — Ifeanyi

Responding to the development, the National President of the Association of Medical Laboratory Scientists of Nigeria, AMLSN, Dr. Casmir Ifeanyi, said while the concerns about the delay are not misplaced, the details of the implementation of the Executive Order should be properly worked out.

Ifeanyi, an Infectious Diseases/Public Health Expert, noted that for effectiveness, the government should put turn-around time when Nigerians can begin to see outcomes.

“The concerns being expressed in certain quarters about the delay is not misplaced. We are equally concerned that the details as per the framework for the implementation of this Executive Order are still very sketchy. They are not readily available, and this leads us to a very big worry about the fate that befell the healthcare fund.

‘’So we are only worried that we hope that this Executive Order will not go the failed route of the $100 billion health fund that was made available, or said to have been made available during the President Muhammadu Buhari era.

“That said, I would also want to think that Executive Order is one thing, fleshing it out and providing the details is another, and therefore, 60 days is not too much a time for us to become overtly concerned and worried.

According to Ifeanyi, the Ministries of Trade and Industry, Finance, Federal Ministry of Health and Social Welfare, the Ministry of National Planning, the Ministry of Finance, and the Ministry of Trade and Commerce or Industry, need to work out the details worked out multi-sectorally.

“So you find out that there’s going to be a multi-stakeholder engagement to work out details for the implementation of the executive order, it is no longer on the desk of the president to do. Therefore, we will need to appeal to Nigerians and to stakeholders, to be a little more patient. It is important that people are expectant and excited because the cost of drugs

Lamenting the high cost of diagnostics, medications, consumables and healthcare services rising daily and compromising services, he said they have gone well beyond the means of the average person.

“The scarcity or near-absence of all these Therefore, individuals are using their bare hands to barely manage and care for patients. When things like the Executive Order come, we expect that for effectiveness, the government should set timelines, and there should be an obvious turn-around time when we expect Nigerians can begin to see outcomes.

“I think 60 days or thereabout is too short a time because production of any kind would have a planning phase, incubation phase, and a trial-and-error phase in which we run trials to see if we have got it right or not before you go full-scale for commercialization and distribution. So we need to still be patient. That means perfect time.

“The delay is necessary, but it is not yet time for us to begin to lose breath and become very much overtly concerned because if you hurry into such endeavour, you will feel it is about production and production will take time. You need to set up production lines, you need to allow it to incubate. You need to now turn off your first product. Let me use something to make an example.

“Caution must not be thrown to the wind. Due process and attention need to be paid to details. I do not think the government has forgotten about it. It’s in the works,” he affirmed.

Govt must intervene in high tariffs — Akintayo

On his part, past president, Pharmaceutical Society of Nigeria, PSN, Mr. Olumide Akintayo, said the inherent birthing of the Executive Order must trigger off a new pharmaceutical industry couched and laden with possibilities and fruitfulness.

“The Federal Government through the Federal Ministry of Health and Social Services must progressively intervene in the matter of unfortunate tariffs and unfriendly policies churned out by some of the key regulators in the pharmaceutical sector if prices of drugs will crash in the interim.

“These tariffs are a major reason drugs availability, accessibility and affordability can no longer be guaranteed in alignment with the National Drug Policy. While congratulating President Tinubu on this feat,it is sacred to once again make a case for the appointment of an Adviser, Pharmaceuticals to the President who will coordinate the plethora of endeavours that are pharmacy-based and inclined in the Tinubu administration.

FG must be more proactive — Okotie

The Managing Director, Engraced Pharmacy Ltd., Mr. Jonah Okotie, posited that the Ministry of Health should create awareness and enlightenment about its policies and how to appropriate them.

“The Executive Order is one thing, the preparedness of everybody, every stakeholder in the industry is another thing, and then the other thing we want to talk about is the people who are concerned. Do they understand how to appropriate the Executive Order, because sometimes the problem we have is not what to do, is how to do it.

“So how much is the Ministry of Health doing to make sure the stakeholders understand how to appropriate it? Because if they really don’t understand how to appropriate these things, they can have the best of policies, which amounts to nothing for everybody.

“Government officials themselves, do they understand that this policy exists, is there awareness on the part of the agents of government to ensure that this policy comes to light? How will implementing this policy bring down the price of drugs? Is it at the importation level, production level or whatever? So it’s about developing a trade or generating a trade that is going to run through the industry to ensure to pull down the prices of drugs to the end user at the end of the day.

“As for the delay, don’t let me preempt anything because sometimes what we don’t know, we can’t speak much to. I presume that at the manufacturer’s level, at the importation level, at the Ministry of Health level, there are engagements that are going on to see how to implement the Executive Order so that the price of drugs is going to come down, because I don’t want to take it for granted that people work to get the Executive Order, only for them to just be watching it.

Okotie said one of the things that led to the Executive Order was the fact that prices of drugs were going up abysmally, and then drugs were going up on the shelves, and these things were going on without anybody addressing it before the government began to pay attention.

“It is the Executive Order, but life does not work in isolation. What about the cost of transportation? What about the cost of so many other things? What about the cost of energy? As much as you want to be talking about the Executive Order, other factors affect the prices that are not constant. So for the Executive Order itself to work, we have to go back, sit down and try to come up with a trade that helps us to ensure that it really achieves what it’s intended to.”