Life and social issues

Life and social issues

Quality medicines for all in Subsaharan Africa; fairytale or a possibility?

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Is it possible for the Sub-Saharan Nations to provide quality medicines for all citizens? What are the barriers to accessing quality medication by patients living in the African regions beyond the Sahara desert? What can we do to turn the slogan ‘Quality medicines for all’ into a reality in Sub-Saharan Africa?

A basic fundamental right of patients is access to good medical care as, and when required. The degree of quality of the healthcare provided is subjective, but I think we can all agree that ‘quality’ medical care must possess all the following attributes.

  • It must involve the patient in all aspects of the decision-making process at every stage of treatment. The patient needs to be aware of the impact of the disease on their quality of life, know the available treatment options and the cost of management for each option.
  • There should be a healthy relationship between the patient, caregivers, and health service providers. The patient’s caregivers have to be an integral part of the disease management process.
  • Last but not least, the health care services provided must be affordable, convenient, easy to access and up to the minimum acceptable quality standards. Going by the attributes listed above, the minimum desired quality criteria for any medicine are: it must meet the required efficacy and safety standards, be affordable, and readily available.

Unfortunately, this is rarely the case in sub-Saharan Africa and patients often have to resign themselves to sub-par quality medicines which may either cause a worsening in their disease symptoms or, ultimately, loss of life.

Alternatively, they could end up buying more expensive brands that carve deep holes in their pockets.

What defines quality in a medication?

For a medication to achieve the minimum desired quality parameters, it must meet the required efficacy and safety standards, be affordable, and be readily available.

Poor access to quality medicine kills an estimated six million people every year in sub-Saharan Africa, from communicable diseases such as malaria, TB, and HIV/AIDS. These statistics do not take into account the number of people who die from non-infectious diseases like hypertension, diabetes, kidney diseases, and heart failure.

There are several obstacles to accessing quality medicine in sub-Saharan Africa and we can broadly classify these into four groups:

1. Poor quality control standards

2. Supply-chain issues

3. Affordability

4. The people factor

Poor quality assessment controls for Medicines in Sub Saharan Africa

  • Inadequate regulatory facilities: The National Medicines Regulatory Authorities (NMRA) in the African region often lack the necessary equipment to conduct proper testing for the levels of active ingredients and contaminants. Tests for dissolution properties which would determine the bioavailability of the medicine in the body are often not carried out. Low-quality drugs, both locally produced and imported, are thus able to enter into circulation unhindered.
  • Porous borders: Due to the porous borders, drugs are smuggled in easily from other countries. The challenge with some of these medicines is the poor storage conditions in which they may have been held for a while during the shipping process. This poor storage could lead to degradation of the active ingredient, rendering the drug ineffective to the final user. Another challenge is that such drugs enter the circulation without undergoing the proper quality control tests and may prove hazardous to patients.
  • Improper storage of Medicines: This is often due to the frequent power outages in sub-Saharan Africa, especially in Nigeria. Medicines need to be preserved under ideal conditions to avoid loss of efficacy. Storage of vaccines, eye drops, and tetanus toxoids should always be at low temperatures.

Supply Chain and Availability Issues :

The availability issues affect both the multi-national pharma industries that import premium brands to sub-Saharan Africa as well as the generic companies that source raw materials for drug production from outside Africa. Most of these multi-nationals do not have direct trade rights within Africa and usually enlist third-party supply companies to get their brands into the country.

The unstable economic situation and fluctuations in the exchange rate often affect the availability of some of these medications. Unfortunately, because most of these multinationals sign exclusivity agreements with specific third-party agents, they are not at liberty to switch to an alternative source of supply in the interim. What this means is that a patient who has been on the medication has to find an alternative, which may or may not be of the same high quality. For locally produced drugs, availability depends on the supply of raw materials which are usually imported from outside the sub-Saharan region. Political unrest, import duties, and customs policies could affect the amount of these raw materials, and hence the production of the finished medicines.

Affordability issues impact access to quality medicines in sub-Saharan Africa

Statistics show that almost 3/4 of the population of sub-Saharan Africa live on two dollars per day. The average cost of medication for treating a common acute infection like malaria is 2-2.5 USD, which means the average person may have to forgo a day’s meal to afford common medications. The burden of managing chronic diseases like diabetes and hypertension that need regular medication could prove too much for the common man to bear. This prohibitive cost of treatment often leads to poor patient adherence to therapy and poor treatment outcomes.

The People Factor :

There is no gainsaying the fact that the human factor will always be involved in patient healthcare and contribute in no small measure to their ability to receive quality medications as at when due. The major human factors that may influence proper access to quality medications include:

  • Physician’s opinions: Physician inertia to prescribe a more effective medicine as a result of perceived cost or a knowledge gap may result in the poor quality of care. On the flipside, due to a vested interest in certain medications or companies, physicians may over-prescribe certain medications for their gain. Patients wrong priorities: Patients often prioritise other activities over health-related issues. Even when they can afford quality medicines, they may decide to go for cheaper alternatives which may be substandard.
  • Reduced Pharmacy involvement in Patient Care: The Pharmacist, as the custodian of medicines is meant to give unbiased advice to prescribing physicians on the quality and safety of medications. Unfortunately, more often than not, the Pharmacist is relegated to the role of mere drug dispenser in the hospital setting.
  • The Patent Medicine stores: This group of medicine dispensers have a significant role to play in the dispensing of inadequate quality medications. Some of these patent stores offer consultation services to patients for chronic diseases like diabetes and hypertension. The unwitting Patients flock to these stores in hopes of getting affordable solutions for their ailments. A lot of times the patient ends up in far worse conditions after taking these substandard medications.

Brilliant Initiatives that have Improved Access to Quality Medicines in Africa

Several laudable initiatives have been rolled out across the various regions in Sub-Saharan Africa that have improved access to quality medicines. Some of these are: The National Health Insurance Scheme, Roll-back Malaria Initiative, Subsidized And Free Medicine schemes, Promoting The Quality of Medicines program.

  • The National Health Insurance Scheme: Social health insurance schemes have been implemented in many countries in Sub-Saharan Africa to reduce the cost of medication to the poor. In Ghana, for instance, the health insurance scheme is designed to cover timpoverishedation costs for at least 50% of the impoverished population. In Nigeria, the National Health insurance scheme has distinct platforms for both the private and Government sectors. There is also a new insurance scheme in Nigeria for retirees and the elderly to reduce the impact of health cost to their caregivers. What these health schemes have in common is that they involve the pooling of funds by a majority. This central pool can then be used to provide adequate care for patients. Some of the challenges that the various Health insurance schemes have faced since their inception include: Inconsistent Government support. The Governing power may not have health care on its agenda. Mismanagement of the funds by corrupt administrators. The questionable Quality of some of the medications allowed on the NHIS scheme. The majority of the poor do not have access to these schemes either because they are not gainfully employed, or they live in remote and inaccessible areas.
  • The Roll Back Malaria Initiative. The Abuja declaration in 2000 was a convening of 53 heads of state to specify some milestones they planned to achieve in the eradication of malaria in sub-Saharan Africa. It was declared that by 2010, at least 60% of the population would have access to Artemisinin-based the d anti-malarial therapies within 8 hours of onset of malaria symptoms. Several laudable objectives include free antimalarial treatment for 60% of the at-risk population, free mosquito nets for the prevention of malaria infection, and free preventive medications for expectant women. The challenges experienced by this multi-national project are beyond the scope of this article. Suffice it to say that human factors and poor management decision led to the failure to attain the desired outcome.
  • Subsidized And Free Medicine Schemes. Some International bodies in partnership with State Governments provide access to free or highly subsidized medications for infectious diseases. The spread of diseases like HIV/AIDS, TB and Hepatitis has been checked as a result of the reduced burden of cost. In addition timmunisation by providing free vaccines and immunization for children, many infectious illnesses like polio and small-pox have been completely eradicated. The one-dollar access to medicine initiative by the Big Pharma companies aims to provide access to premium brands at a token cost to patients. This scheme is already in effect in certain Nations like Rwanda.
  • The Promoting the Quality of Medicines (PQM) is an initiative funded by the US Agency for International Development. The objective of this program is to support the Quality control bodies in the sub-Saharan region by providing the equipment and reagents to conduct proper safety and quality assessments. These assays are performed primarily for essential medicines like antimalarials and anti-infective medications. This program has been implemented in 13 African countries and has aided in the detection of counterfeit, parallel imports and fake medications.

What Needs To be Improved Upon to Deliver Better Access to Quality Medicines

There have been several suggestions regarding what needs to be done to improve the quality of health care and especially access to medicines for the average patient. I have included here some of the more feasible solutions and added a few, which from my experience in the hospital and private pharmacy sector may prove invaluable.

The Government needs to make Health care a Priority.

  • Without Government support, any medicine access scheme may not likely be sustainable. The ways in which the Government can help are: Partnering with the Big Pharma companies to subsidise the cost of chronic disease medications.
  • Improving access to NHIS schemes for the poor through better collaboration with MDGs to reach the remote areas of Sub-Saharan Africa.
  • Another method that may work is to create a disparity in contribution to the NHIS funds. The wealthier citizens could pay more than the stipulated percentage thus allowing the poor to access treatment at negligible costs.
  • The Quality control sector should either be better funded or privatised to enable the purchase of better equipment for quality assessment of imported and locally produced drugs.
  • There is also the need for constant quality checks at the pharmacy and patent medicine stores. Tightening up the borders and instigating stricter importation laws to check the illegal influx of medicines.
  • The Government should also look into providing basic amenities that could entice the Big pharma corporations into investing in the production of drugs in sub-Saharan Afric

Pharmacists have a significant role to play in ensuring proper storage of medications.

The pharmacists may need to step up their game to assume their rightful role as advisers to physicians and patients on medication quality and safety.Rather than bicker about policies and politics, the pharmacists in sub-Saharan Africa should create value in the pharmacy practice.Let’s assume our rightful roles as the custodians of medicines and the go-to knowledge base on anything about drugs.

It is the duty of prescribing physicians to protect the patient’s interests at all times.

Regardless of whatever incentives to specify a particular brand, quality of a medication should be the primary consideration( affordability, cost-effectiveness, and availability). Also, as much as possible the patient must be carried along in the decision-making process.

Could investing in herbal medicines aid access to quality care?

Alternative medicine provides another possible source of quality medications for patients. The term Alternative medicine as used here refers to herbal supplements and potions used to treat or prevent disease.

The advantages of these non-conventional forms of drug therapy are:

They appeal to the patients’ cultural and social beliefs and thus may improve adherence.

They are usually more affordable in the long-run than orthodox medicines.

They are generally perceived to be more natural and therefore are less likely to be linked with adverse effects.

These alternative medicines claim to heal from the root and do not offer symptomatic management of diseases.

The disadvantages include:

The Regulatory Authorities do not regulate them and as such their safety and efficacy are questionable.

Their side effects and drug-drug interaction profiles are unknown, and there could be harmful interactions if they are administered concurrently with other medications.

Limited Scientific Research in the field of Alternative Medicine means that the correct dose of the active ingredient required to elicit the therapeutic effect is purely guesswork.

Perhaps one innovative idea by which Sub-Saharan Governments can improve access to quality medicines is by investing in Alternative medicine.

References file:///C:/Users/user/Documents/sbitmart%20blogpost.pdf

Life and social issues

What Nigeria must do to survive past the year 2030

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My heart is stirred by a noble theme as I recite my verses for the king; my tongue is the pen of a skillful writer.

Psalms 45 v 1

Our Current Reality.

Many factions and political parties, over the last few decades since our embrace of democracy, have come out with their five-point agendas, six-fold strategies and all the other campaign gimmicks aimed at addressing our current economic challenges and building a better Nigeria; or to be blunt, get themselves elected by tugging at the heartstrings of the average Nigerian. From an analytical perspective, the two burning issues which need to be addressed urgently for Nigeria to survive past 2030 are -the high unemployment rate/poor job satisfaction among the Nigerian youths of today and the predicted population explosion by 2030; both of which will increase the level of poverty in the Country.

Quality Education is key to Our survival.
Quality Education is key to Our survival.

How did we Get here?

Some of the more brilliant ideas from our politicians and activists have touched on reviving our academic institutions by building more schools or upgrading the existing ones, creating more job opportunities, investing in farming and agriculture, building more industries, creating more entrepreneurship opportunities, and so on. In truth, we have seen some traction with quite a number of these projects especially in the area of education. Statistics prove that by the year 2030, the number of Nigerians with basic primary education would have increased to 78%, from the current state of 53%.

Despite this increase in the number of literate Nigerians, our current reality shows a consistent decline in the unemployment rate for the Nigerian Youth, educated or uneducated, in the last two years. If education truly provides the foundation for success, then what could be the reason behind this alarming trend in the rate of unemployment?

According to a 2014 Publication by ACF(Action against Hunger) in collaboration with IRIS, Nigeria is fast moving towards the position of the most populous country in the world and by 2030, would reach a new high with 261.7 million people.

Even though data shows a steady decline in fertility rates, it is predicted that by 2050, as much as one in every 10 births globally, would be from Nigeria; naturally, imposing a strain on the dwindling economic resources. On the surface, while this explosive growth may appear to be the obvious reason for the decrease in the number of available jobs and the forecast of dire poverty by 2030, It is pertinent to note that this may not necessarily be a disadvantage. The rapid growth in population size coupled with lower fertility rates would mean an increase in the number of people who fall into the workforce category(15-64 years.) The positive impact of this would be an increase in higher GDP, revitalizing the economy and reducing the level of poverty. As such, taking the expected population explosion in isolation, as the key driver of our Nations dire economic future may not be an entirely accurate conclusion. The exact combination of events that would trigger this abysmal decline in our economy by 2030 are:

  • Rapid growth in population size with high dependence on the available economic resources.
  • No long-term plans to provide concrete solutions to some of the basic challenges that would come with the rapid growth viz unemployment and poverty.

To quote one of the most authentic leaders Africa ever produced, Nelson Mandela, “Education is the most powerful weapon which you can use to change the world. It is the key to eliminating gender inequality, to reducing poverty, to creating a sustainable planet, to preventing needless deaths and illness, and to fostering peace. Apr23, 2013”.

Unfortunately, even though we have achieved some progress in establishing more academic institutions, one major Issue which we have not yet thrashed is our sub-par educational system.

The Average Nigerian Youth who graduates from a tertiary education would have spent about 16 years of his life learning a vocation, which should ideally prepare him for success. He graduates school and enters the Labor market, only to find that the job he wants is fiercely competitive, with more qualified people than he, vying for the same positions. The same is equally true for the Nigerian Youth who decides to acquire a skill rather than attend a formal educational institution. He comes out to face the harsh reality that the skills he thought would prepare him for entrepreneurship are mass-produced, and he has to innovate to survive in the choked market.

Perhaps, where we are getting it wrong is our approach to education. Our leaders seem to think that quantity alone (establishing more institutions and enlisting more students) is the efficient approach and the theme of their pedagogical strategies is ‘mass education, which does not translate to quality education.

Mass education does not constitute the foundation for success; quality education remains the key to good success. Quality education involves a multi-focal approach to learning, with an emphasis on life skills and capability building. The advantages of such a holistic approach are:

  • It provides the Nigerian Youth with the relevant skills to survive in a less than ideal society.
  • It provides them with the right leverage to impact positively on society.
  • By transforming them into Idea creators, this innovative approach creates youths who can readily adapt solutions for most situations.

What Are Our Neighboring African Countries Doing Right?

Let’s take a look at one of our closest Neighbors, Ghana. Even though they do not have the perfect system of education yet, they are getting there gradually. One major feat they have been able to accomplish is bridging the gap between the socio-economic classes and offering the poor the same quality of education as the children of their wealthier counterparts. How did Ghana achieve this? A very simple solution- Free education.

The then President, Kwame Nkrumah saw education as the key to reviving Ghana’s economy and set up a two-point agenda to resuscitate Ghana’s academic system and also her ailing economy. His objectives for the Ghanaian education system were:

1. Quality education for all through free education for all Ghanaian children up until Junior secondary school. This agenda helped improve the level of literacy among the Ghanaian Youths.

2. The school curriculum was designed to train students to become the resources the society needs.

The Presidents that came after Nkrumah built on this concept and as a result, Ghana has some of the best educational institutions in Africa today. Even more importantly, their economy has revived significantly to become much more stable than ours. Indeed the tables have turned!

Devising the Solution to Our Economic Challenges Through Design Thinking.

By using the methodology of Design thinking we can identify the root cause of our challenges and devise solutions that will address them once and for all. Also, because design thinking is a dynamic approach to problem-solving, the processes, ideas, and tools provided by this innovative approach are capable of being refined and modified to adapt to different situations.

Empathize: Let’s define, first of all, the reason why we are in our current situation. Should we blame the colonial masters, our past presidents, governors or senators? The humbling truth is that the fault lies with each one of us. Every Nigerian that has ever lived in this country has had a part to play in bringing us to this present economic situation. By accepting full responsibility, we lay the framework for forgiveness and healing and the ability to move on. There’s also a need to stop comparing our present to the good old days unless such comparisons will offer constructive solutions to our current challenges.

Identify: Next, we need to assess our current challenges viz corruption, unemployment, high crime rates, subpar health care, poor infrastructure, inadequate energy supply, and identify the root cause of all these. The common denominator they all seem to have is the Nigerian mindset-mediocrity. Ask the average Nigerian what they would do if they had a chance to rule the country and you’ll be disappointed with the answers you get. Rather than improve our knowledge and broaden our horizons through continuous learning, we are quite comfortable dusting mediocre solutions and handing them down to future generations.

Ideate: Based on the identified challenges, the next step would be to draw up a one-point agenda to address the fundamental flaw in our society – our mediocrity mindset. The institution that lays the foundation for this mindset, our educational system needs to be thoroughly analyzed and where necessary, overhauled. The revamping of our educational system will enable our Youths to become idea creators: strategic thinkers who can analyze situations critically from different perspectives, innovative risk-takers willing to step out of the confines of mediocrity and test uncharted waters, pacesetters who continuously upgrade themselves to become more relevant to Society.
The school curriculum should be designed to enhance capability, adaptability, and accountability in the Nigerian Youths using the methodology of Design-thinking.

  • Basic life skills should be taught in schools. First aid and basic life support should be made compulsory from elementary to higher institutions.
  • Compulsory Language Lessons: Every child must learn two foreign languages and one other Nigerian Language apart from his mother tongue. This would create more unity within the Nation and also provide ample opportunities for Nigerians to communicate with the outside world.
  • History and Government should be an essential part of the curriculum. History because we cannot move forward if we don’t have an idea where we went wrong. The history lessons should be designed to foster a sense of pride in our accomplishments as a nation.
  • Schools should shift focus from theoretical lessons which merely encourage students to revise for exams. Practical problem-solving situations that allow students to brainstorm and create their own solutions should be the way forward.
  • Our entire academic system should be revamped to inculcate a learning mindset in the Nigerian Youth with an emphasis on enabling them to think outside the box.
  • Vocational training centers should focus on developing individual creativity and innovation and not imparting the same skills
  • .Moreover, the educational system should effectively bridge the gap between the poor and the wealthy. Sustainable policies need to be put in place to ensure that quality learning is either totally free for all or highly subsidized.
  • There is also a need to train the trainers too. What stops schools from hiring teachers from among the best students in our tertiary institutions? What kind of training or motivation do you think we give to our children if they are being taught by half-baked individuals. Even after hiring the best from our academic institutions, they still would need to undergo a compulsory one-year training on the new teaching methods. Thereafter, occasional teacher training modules should be rolled out to ensure they are continuously up to date on innovative teaching methods.

Design Prototype, Test and Refine: The ultimate step would then be to construct several prototypes of what our model academic system should look like and test-run it in selected schools in the country. Depending on how easily implementable the ideas are in real- life we can go back to the drawing board and modify properly before launching it nation-wide.

Let’s build a Nigeria today that is free of mediocrity and filled with innovators, for a tomorrow that is free of poverty.

The concept of the ‘Idea creator’.

… strategic thinkers who can analyze situations critically from different perspectives, innovative risk-takers willing to step out of the confines of mediocrity and test uncharted waters, pacesetters who continuously up skill and upgrade themselves to become more relevant to their Society.

What’s your honest opinion?Please share in the comments section.

Will revamping Our educational system help our Economic situation?

  • Yes it will but it will take time and we should look at other suggestions first.
  • Yes it will and we should start now
  • No it won’t -there are other more pressing issues at hand.
Life and social issues

Let’s talk about where it hurts…

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Let’s talk about You!

Are you single and pining away; wishing you could project yourself into a future with a family of your own?
Do you sometimes wish you could be someone else or be born into a different time?
Are you divorced, separated and trying to start your life all over again?
Are you dealing with heartache over a breakup?
Are you struggling with an addiction that’s so hard to give up?
Are you married and hard-pressed to meet up with the constant demands of everyone around you?
Are you struggling to start up a business or trying to revive an ailing one?
Or have you got your life under control, and everything is going fine, superfine in fact, and yet a part of you can’t help wondering when the tables would turn?

Let’s talk About Life.

Let’s talk about life: Yeah, we know life can be pretty fickle sometimes. Today, you may be on top of the world, and tomorrow, the bricks come crumbling down taking you to the ground. Today, you may be nobody, and tomorrow, rise to become somebody, either by dint of merit and hard work or by a pure stroke of luck. Sometimes, life can make it easy for you to succeed and your hard work and determination equate to success. Sometimes, though, life throws at you convoluted patterns and the more you try to unravel them, the more entangled they get.

When life gives you lemons, make a smoothie!

Let’s Talk About Love

Let’s talk about love: What is love, if it’s not a guarantee that the hole in your heart will finally be filled? Would you instead settle for second best, or keep searching, even though people label you hard to please? Are your expectations from love realistic or is love a fantasy you built from watching too many romantic movies? When you find love would you recognise it? Have you defined what you want in a life partner, looked at yourself in the mirror and confirmed that you are the perfect fit? Are you ready to take the plunge and not look back, once your heart agrees?

Love is feeling that your happiness means the world to me

Let’s talk about limitations:

Have you consciously or unconsciously set boundaries for yourself? Conditioned by the society in which you live, have you given yourself reasons why you can’t succeed and blamed all your woes on Humanity?

Perhaps you believe in destiny and are ready to lie down and take the nasty blows fate deals you. Maybe you think you don’t deserve anything good and you somehow caused every bad thing that ever happened in your life.

Do you try to drown your sorrows in wine or hope the next shot of heroin will take away your low self-esteem? Perhaps they failed you one too many times; those who you looked up to, who should have made the road less rocky. Maybe they even took away the stepping stones from under your feet and told you no good would ever come out of this Nazarene.

Your destiny is not the cards fate deals you; its the hand you choose to play

Let’s Talk about Faith and Trust.

Let’s talk about faith, hope, and trust. Now faith is the substance of things longed for and the evidence of things not seen. Trust is putting all your eggs in one basket and placing that basket in the hands of another. Hope is the killer of many a dream, a purposeless desire for something you may never achieve. Until you’re ready to risk your heart to fall in love again or to trust again, be happy again and seize the day; you may be missing a vital piece of yourself that no one can give back to you.

What if Your healing only begins the moment You choose to Live; to beat the odds against you, and fight your way through the entangled weaves?

Your healing starts the moment you choose to forgive

Finally, let’s talk about dreams:

What is that burning desire in you: that idea that wakes you up in the morning and keeps you going all through the day -your passion, not your fear. “I have a dream that one day all my dreams will be made real, and I’ll ride on the back of the winds and reach for the sky with no boundaries to stop me”.

Look inwards, ask questions, find out what your life means.

Find your purpose, be yourself, dare to dream, be real.

Don’t be afraid to make mistakes, learn from your past, dust yourself up and move on again, but Never stop dreaming through it all.

Above all, forgive yourself for all your shortcomings, find your spirituality and your Maker, and make peace with your inner being.

I have a dream, and I know one day, it will become my reality