Adebayo Alonge: Improving Access To Quality and Affordable Health Solutions in Nigeria

Aside low health care facilities, self-medication and inaccessibility of quality drugs are one of the dangers facing health development in rural parts of Nigeria and the world in general.

According to Tanimola Akande, a professor of Epidemiology and Community Health at the University of Ilorin, Kwara State in his the delivery of the 142nd inaugural lecture of the University of Ilorin entitled “Population with Ill-health Burden: Faced with a Sick Health System”; Nigeria loses N81 billion annually to importation of fake and counterfeit drugs, especially from Asian countries –contributing to Nigeria’s ill health system.

An official statistics from the National Agency for Food and Drug Administration and Control (NAFDAC) also shows that over N20 billion worth of counterfeit drugs and other substandard products had been destroyed by the agency since 2009.

In order to improve the conditions of the healthcare system, concerned young people like Adebayo Alonge are taking the lead, working towards making sure that Nigerians have access to quality drugs.

Adebayo Alonge is a healthcare entrepreneur with professional training in pharmacy, business and entrepreneurship at the University of Ibadan, Lagos Business School and the Yale school of management. He is the founder of Lusoy Investments Limited, a pharma distribution company that distributes healthcare solutions to rural communities.

According to him, “Our (his company) emphasis is on ensuring that low income markets can afford healthcare solutions and we use a variety of means including cross-subsidies, contracts and donated outreaches to deliver these solutions.”

Adebayo spoke with Rural Reporters on healthcare delivery issues in rural Nigeria and the possible solutions on how quality healthcare can be achieved.

What has been your contribution(s) towards health development in Nigeria?

Adebayo Alonge: My work has been focused previously on volunteering with multilateral health organizations to work in rural areas with low healthcare capacity. This volunteer work saw me provide free healthcare services with the Global HIV/AIDs Initiative to communities in Oyo and Bayara located in southwest and north east Nigeria. In 2010, I also was involved in conducting a campaign that helped raise awareness in Bauchi town about HIV and its negative social impact. The campaign was conducted over 90 days and involved multi-stakeholder discussions aimed at generating community buy-in, media interviews, secondary school debates and culminated in the organization of a fund-raising dinner for children orphaned as a result of AIDs.

You are into the business of providing quality pharmaceutical drugs. How is sub-standard drug affecting a business such as yours and what practical approach would you suggest to stop sub-standard from eroding the market, especially in rural parts of the country?

Adebayo Alonge: My business provides healthcare solutions which include high quality pharmaceuticals. A recent study put the current level of substandard anti-malarial medicines in Lagos at over 80 percent of anti-malarial medicines in circulation. If the level is that high in Lagos which has a high level of regulation, you can imagine how bad the situation is in rural areas where many regulatory task forces never get to. Many rural communities lack professionally run health facilities. Government owned primary health centres are often dilapidated with many of the staff not turning up at work. Nigeria has too few healthcare professionals, most of whom prefer to set up practice in urban centres whose inhabitants can pay higher rates for their services. This gap in healthcare provision has been filled in rural communities by unscrupulous quacks that set up chemist shops where they double both as doctor and dispensers. Most run non-sterile wards where they conduct minor surgeries. As these quacks aim to maximize profit, they make use of the cheapest medical supplies and medicines which they often sell at above market rates. Rural dwellers patronize them due to the absence of choice. There is no gainsaying the number of people who have died from these quack services.

Substandard medicines have eroded the rural markets and my suggestions will be aimed at creating market incentives that roll back the patronage they currently enjoy. The following constitute actionable steps that can be taken:-

1. Roll back regulatory barriers that prevent healthcare professionals from running chains of healthcare centres. This prevents them from setting up more than one health centre and reduces the spread of their impact.
2. Rural healthcare task forces reporting to the regulatory agencies should curtail quack practices and ensure that licensed rural health centres maintain high standards of professional care.
3. Private sector run rural health centres should be the basis of healthcare provision in rural areas. The government cannot efficiently deploy these centres and it needs to incentivize healthcare professionals to set up centres within 6 miles of every rural community. Incentives should be built around mobile phone- based healthcare micro-insurance subscription for every rural dweller which the local governments have a responsibility to pay for.
4. Extension services through community health workers should provide free diagnostic services in rural communities. This will help create health seeking behavior in serviced communities and will help create sustainable context in which health centres can better succeed.
5. Toll free lines to the regulatory agency that helps rural dwellers report instance of poor service delivery and drug adverse effects. This will ensure high service quality from healthcare professionals whose professional licences are used to run these centres and who risk disciplinary action for failing to deliver appropriate standards of care.

These actions will create centres whose medical supplies pipelines can be traced and secured thereby eliminating channels through which substandard medicines get to rural end users.

From your experience, what are the factors mitigating against quality medicines in rural Nigeria?

Adebayo Alonge: The single most important factor is the absence of professionally run health centres. This has led to a situation where pharmaceutical distributors such as my company- Lusoy Investments find it difficult to identify sustainable demand points in rural communities. As a result, cost of sales is high and since well-established quack channels have a penchant for low priced substandard medicines, purveyors of high quality medicines like me have no incentives to get their products to rural dwellers.

Other factors such as accessibility and affordability of professionally run health centres derive from the first. Difficult in accessing high quality healthcare raises the cost for those who eventually do, thus making it too expensive for them.

Solutions should centre on creating incentives for private healthcare entrepreneurs through reduction in regulatory barriers, improvement of regulation, improvement in rural infrastructure-roads and electricity. Health-subsidies (provided by local governments) are also required to improve health seeking behavior and affordability for rural communities.

 Many people in rural areas prefer to use traditional herbs to cure their aliment. How much does this affect your work as a health worker in Nigeria?

Adebayo Alonge: Many use traditional herbs when their healthcare condition is not yet acute requiring urgent medical attention. Most people in rural areas know that western medicine is more effective but the chief reasons why they have remained heavily reliant on herbs is because of  difficulty on accessing low cost western-styled healthcare. It is a challenge of both access and affordability as well as in the remotest places of a tradition of community based care as against health seeking behavior. In the communities in which we have been directly involved we have seen very easy acceptance of our free offerings. However through primary health centers we see lower consumption rates even when the offerings are subsidized because rural people are used to having healthcare however substandard provided free. It has been a real challenge creating sustainable business models built around rural communities. What we have seen that works is service contracts and medical outreaches that help rural communities get healthcare for almost free.

What can be done to improve the access of quality drugs in Nigeria and other developing countries?

Adebayo Alonge: The sustainable way to improve access to quality drugs in developing countries is to create market incentives that increase availability of high quality medicines and reduce patronage of substandard medicine.

Low price is often the major driver of demand for sub standards. In addition, poor health education makes it difficult for poorly informed consumers to differentiate between professional and quack channels of care. In absence of this information, price becomes the only priority when making purchases.

Actionable steps to improve access are:

• Eliminate regulatory barriers that prevent establishment of chain health centres using single professional licenses. Professionally run chains will serve as training centres for health technicians who can man even more locations under supervision of a primary healthcare professional. The spread of these centres will also raise awareness where quality healthcare and products can be purchased and will improve convenience in accessing quality healthcare.
• Efficient regulatory control should eliminate and prevent quack channels. Better control should also help create a structure that ensures secure pipelines link manufacturers and end users. These pipelines will reduce the probability of substandard medicines getting to end users by improving accountability and trace-backs in the pharmaceutical industry.
• Extend universal health coverage to reduce out of pocket payments which usually encourage patronage of low quality medicines and exploitation.

As an experienced health worker and pharmacist, why is it important for people living in the rural area to have adequate access to quality health care and pharmaceutical service?

Adebayo Alonge: The bulk of agricultural activities take place in rural areas. National self-sufficiency and industrialization plans are built around the agricultural output of rural communities. However mechanized, agricultural activities require a healthy workforce without which productivity will remain low. If access to high quality healthcare is ensured, agricultural productivity will improve, commodity prices will reduce, industrial competitiveness will increase and livelihoods will be better from new jobs created and wages earned. It is important for rural healthcare provision to be improved due to the multiplier effect on the national economy as a result of the positive outcomes that result from having a healthier rural populace.

Self-medication is sky-high in Nigeria especially among people who live in rural communities where there is limited access to quality medical facilities. How can this issue be addressed?

Adebayo Alonge: Self-medication is high due to poor health education, limited access to professional healthcare and difficulty in affording quality health services.

Actionable steps to address this include:

• Increase health extension services as this will raise health awareness and improve knowledge about the benefits of seeking professional healthcare services.
• Reduce the regulatory barriers that prevent the establishment of chains of health centres as this will improve convenience of accessing professional care.
• Expand universal health coverage as this will reduce out of pocket payments and raise standards of healthcare delivery. These outcomes will enable low income rural dwellers easily access healthcare without needing to have money in their pockets. As a result they will have limited incentives to self-medicate.

What is the single most important lesson you have learnt as a health worker in Nigeria?

Adebayo Alonge: You need to have a theory of change for the work you do. A theory of change is what you have defined as the change, improvement and legacy you want to bring about and leave behind from your work. My theory of change is that I can improve rural livelihoods through improving access to high quality and affordable health solutions. This change theory gives you focus and empathy. Otherwise you will get distracted into maximizing your monetary returns and treating badly the very people you should care about.