Reflecting on the Nigerian Health Sector in 2023
As we round up the year, Sunday Ehigiator took a retrospective look at major events that shaped the Nigerian health sector in the year 2023
As the year 2023 draws to a close, many significant health interventions and events have taken place throughout the year that shaped the Nigerian health sector and may extend its impact on the sector to the New Year, as the country builds back better and looks to strengthen its health systems in preparation for future public health emergencies.
Departure of Multinational Pharmaceutical Companies
Arguably the biggest news in the sector for the year 2023, the year has been one of the toughest years for Nigerian businesses this decade.
It took only two months after the petrol subsidy removal in May for a reported 4 million small businesses to shut down because of a harsh economy.
In October, the Nigerian Association of Small-Scale Industrialists said that Micro, Small and Medium Enterprises were shutting down daily. But small businesses are not alone. Several big names have scaled back their operations this year, citing harsh economic conditions.
According to the Manufacturers Association of Nigeria, the value of unwanted products held by Nigerian producers jumped by 22 per cent to N470 billion ($1 billion) by the end of 2022. That’s the highest in the last five years except for 2020.
Problems like lingering foreign exchange scarcity, poor power supply, port congestion, multiple taxation, insecurity, poor infrastructure, etc., have forced these companies to stop operating in Nigeria.
Unilever Announces Departure
This year, Unilever was the first household name to shed its Nigerian production. In March, the company announced changes in its business model to exit the home care and skin cleansing categories. That meant famous brands like OMO, Sunlight and Lux would no longer be on retail shelves.
According to Unilever, it ceased production of homecare category products in June and ended sales in September. However, it extended the production and sale for the skin cleansing category to December 2023.
GSK’s Departure
In August, GlaxoSmithKline Consumer Nigeria Plc, the country’s second-biggest drug producer, told the public it was halting operations. This decision was because the company’s UK parent terminated exclusive marketing and distribution agreements.
According to a statement published on the Nigeria Exchange, GSK Plc, which owns a majority stake in the Nigerian unit, said it will appoint third-party distributors to sell its prescription medicines and vaccines in the country.
GSK’s consumer-health arm, Haleon Plc, also informed GSK Nigeria of its “intent to terminate its distribution agreement in the coming months” and appoint a third-party distributor. GSK also said it planned “an accelerated cash distribution and return of capital” to minority shareholders.
The company gave no reason for its decision. However, GSK Nigeria had previously said it was struggling to maintain supplies of its pharmaceutical and vaccine products in Nigeria due to a shortage of dollars to import ingredients.
Sanofi’s Exit
On November 8, Sanofi, a French pharmaceutical multinational, subtly announced its exit from Nigerian operations. The company said it has appointed a third-party distributor to handle its commercial portfolio of medicines from February 2024.
Just like GSK, Sanofi didn’t state any reason for its decision. Sanofi General Manager (General Medicines) and Country Lead, Folake Odediran, only said: “This strategic move is driven by our commitment to continually improve access to our medicines and to better serve our patients and the Nigerian health system.”
However, the company’s numbers indicate that it’s been struggling to keep its margins in Nigeria.
In 2019, May & Baker Nigeria announced a contract manufacturing agreement to produce four brands from Sanofi. This deal was an effort to boost local production. It enabled May & Baker to use Sanofi’s facilities to manufacture flagyl tablets, suspensions, anti-infective medicines and anti-malaria drugs.
By then, May & Baker’s revenue slowed by 9.57 per cent to N5.9 billion in the first nine months of 2019. Gross profits also fell by 9.36 per cent due to a sharp decline in sales.
High Cost of Drugs and Other Pharmaceuticals
Arguably, the consequence of all these exits is the inflation of prices of drugs and other pharmaceutical consumables in Nigeria in 2023.
Considering the economic realities in Nigeria, over-the-counter medications may soon be out of reach of people who cannot afford hospital facilities in Nigeria.
According to a new report by SB Morgen Intelligence, titled: “Paying the Price on Health,” the Nigerian economy and foreign exchange crisis have had a huge impact on the prices of essential medicines in the country.
Between 2019 and 2023, the group said it gathered data on the prices of medicines across four broad categories of Antimalarial, Antibiotics, Painkillers and Common Cold medicines.
The report indicates that antibiotics recorded the highest price increases, with 500mg Ampiclox capsules recording the highest jump. The cost price is said to increase by 1,390 per cent and the selling price increasing by 1,100 per cent between 2019 and 2023.
Antimalarial drugs saw the slowest price increase in the period under review, while only one (Novalgin) in the painkiller category has maintained its 2022 price in 2023, following a 25 per cent increase in price in 2022.
SBM noted that 19 per cent of respondents who participated in a 2023 survey reported spending a significant amount of their income on healthcare and 67 per cent of respondents who reported making lifestyle changes due to a high cost of living, listed cutting back on healthcare bills.
Across all drug categories, the highest jump in the cost and selling prices was recorded in the antibiotics section, which was attributed to the continued demand for antibiotics.
Between 2022 and 2023, Amoxil recorded the fastest rate of increase, jumping by over 400 percentage points. This was followed by Ampiclox, which saw an increase of 240 percentage points.
Surge in Healthcare Workforce Immigration
The immigration (aka Japa) of Nigerian healthcare professionals to more developed countries is a pressing concern with significant consequences.
2023 saw a significant rise in many skilled healthcare workers in Nigeria seeking opportunities abroad due to factors such as better pay, improved working conditions, and a desire for professional growth. This phenomenon is exacerbating an already strained healthcare system in Nigeria.
The ongoing departure of these professionals creates critical shortages within the country’s healthcare workforce, resulting in longer waiting times for medical services, reduced accessibility to quality care, and additional stress on the already burdened healthcare infrastructure.
It also disrupts the transfer of knowledge and skills to the next generation of healthcare workers in Nigeria, hindering the delivery of high-quality healthcare and medical education.
Furthermore, the emigration of healthcare professionals represents a significant loss of human and financial resources that have been invested in their education and training within Nigeria.
Addressing this issue in the Nigerian context requires a comprehensive approach that seeks to retain and nurture healthcare talent within the country, thus strengthening its healthcare system and improving healthcare access for the Nigerian population.
Diphtheria Outbreak
The National Center for Disease Control and Prevention (NCDC) reported the outbreak of the Diphtheria disease in late December 2022. By the third week of January 2023, a total number of 111 cases had been reported by the NCDC as testing positive for the Diphtheria Virus with 89 cases confirmed within the first three weeks of 2023.
UK Commits £2 million to Strengthen Health Workforce in Nigeria
In June 2023, the World Health Organization (WHO) welcomed a new funding commitment made by the United Kingdom’s (UK) Department of Health and Social Care to support Nigeria in strengthening her health workforce in the vision of achieving Universal Health Coverage
The grant amounting to £2 million will cover two years to support the government of Nigeria to optimize the performance, quality, and impact of the health workforce through evidence-informed policies and strategies.
The UK provided a multi-million-pound boost to support healthcare staff recruitment and retention in three African countries – Kenya, Nigeria, and Ghana – supporting resilience against global health challenges.
The Nigerian health system, like many countries in the global south, has been beset with challenges in having a resilient health system that can provide quality health services, promote health and prevent diseases. The challenges have been further exacerbated by the recent COVID-19 pandemic which directly impacts the availability of health workers to provide quality services across the country.
Outbreak of Monkeypox also Known as Mpox
The World Health Organisation (WHO) declared Monkey Pox a global emergency as the disease whose origin is from animals and formerly limited to certain regions had become a global concern with a total number of infected persons standing at 86,986 with 111 deaths and a prevalence of 110 countries.
Monkeypox is said to be an infectious viral disease that occurs in animals and humans with symptoms including rash, fever, and swollen lymph nodes and may disappear within ten days of occurrence without vaccination.
In an April report by NCDC, there were at least 70 cases of Money Pox in Nigeria with Lagos ranking the state with the highest number of patients with 21, followed by Ogun with nine cases. Other states with cases across the county include; Rivers, Bayelsa, Abia, Delta, Imo, Ondo, Fct, and Edo amongst others.
President Tinubu Unveils Plan For Massive Investments in Health Sector
President Bola Tinubu says his administration is prioritizing and improving Nigeria’s health sector through massive investments and the allocation of increased funds to the sector in the proposed 2024 budget.
The President made this declaration at the unveiling of Nigeria’s Health Sector Renewal Investment Initiative and the signing of the Health Renewal Compact by Federal, State Governments, and Development Partners in Abuja.
According to the President, “Delivering improved quality health is an underpinning factor in my promise of Renewed Hope to Nigerians. That hope is ignited here today with the support of all multilateral partners and agencies; health is back on the front burner.
”This occasion marks an opportunity for collective reflection and action as we recommit ourselves to the noble pursuit of health for all. The theme for this year ‘Health for All: Time for Action’ encapsulates the urgency and the determination with which we must approach this noble goal.
“Health is not merely the absence of disease but the embodiment of physical, mental, and social well-being. It is a fundamental human right and Nigeria’s commitment to achieving Universal Health Care Coverage is reflected in the unwavering dedication of my administration to uphold this right for every individual, young or old, in rural or urban areas.”
Meningitis Outbreak
Meningitis is a disease affecting the membrane covering the brain and spinal cord. Of the 1,686 cases recorded in Nigeria from October 2022 to March 2023, 961 cases were tested positive with 57 per cent of the being males. The age demographic of those affected falls within ages 0-15 years
Experts say that the disease is caused by many different pathogens including bacteria, viruses and fungi with the highest recorded cause being bacteria. Meningitis can be spread by droplets of throat secretions usually from an asymptomatic carrier.
In August 2023, the NCDC collected 638 samples from 2765 suspected cases and 303 tested positive. Children aged 5-14 were the most affected with 54 per cent of the total number affected being males. Nineteen local governments across five states reported more than 20 cases each.
Managed Naira Float’s Impact on the Healthcare Sector
The managed float (devaluation) of the Nigerian Naira has triggered notable changes in the healthcare sector.
Increased costs of outbound medical tourism due to currency devaluation have prompted more Nigerians to opt for local healthcare services and incentivised investments in local capacity for interventions in cardiology, orthopaedics and oncology, the major drivers of outbound medical tourism.
Additionally, the rising prices of branded proprietary drugs have led to a growing acceptance of generic drugs as substitutes for proprietary drugs. This shift towards generics is a practical response to economic realities and alleviates the financial burden on both patients and healthcare providers.
It also encourages competition and innovation in the pharmaceutical industry, enhancing accessibility to essential medications in Nigeria. These adaptations reflect the healthcare sector’s resilience in the face of economic fluctuations.
Growing Adoption of Healthcare Technologies
The Nigerian healthcare sector is undergoing a remarkable transformation with the rapid adoption of healthcare technologies in 2023. Digital healthcare startups are at the forefront of this evolution, aiming to bridge long-standing gaps in the system and enhance overall efficiency within the healthcare value chain.
Moreover, these innovative startups are challenging traditional healthcare players by enabling direct interactions between patients and providers, fostering transparency and patient-centric care.
However, they still face challenges, including regulatory obstacles, data privacy concerns, and ensuring the quality of digital healthcare services. Despite these hurdles, these startups are driving a fundamental shift in the Nigerian healthcare ecosystem towards greater efficiency and patient-centric care.
These startups are gradually disintermediating traditional players and, in some cases, disrupting the fragile healthcare ecosystem as they search for product-market fit.
Resurgence of Lassa Fever
The World Health Organisation in May 2023 reported that the Lassa fever epidemic had peaked at about 4,702 suspected cases in Nigeria since its resurgence in January 2023 with a total of 106 cases. The disease which experienced a drop in February to 69 cases peaked in May with 877 confirmed cases and 152 deaths with a fatality rate of 17 per cent.
The disease is carried in the urine or droppings of the multimammate rat and spread by contamination with the broken skin of an infected person or direct contact with materials contaminated by the urine or dropping of a contaminated rat.
Spread of Diphtheria
By June 2023, the World Health Organisation had declared the spread of Diphtheria to 21 of Nigeria’s 36 states with a large number of the affected population being children between ages 2 and 14.
With fresh findings suspecting that the spike in the cases may have been caused as a result of poor vaccination culture, unavailability and inaccessibility of the vaccine to the areas of critical need, discussions are ongoing to intensify the level of awareness among the people majority of whom are in the core northern states of Kano, Yobe, Plateau and Jigawa.
In July alone, 579 new cases tested positive for Diphtheria bringing the number of infected persons to 1,536 with 137 deaths.
Escalating Non-communicable Diseases
2023 saw Nigeria grappling with a concerning rise in non-communicable diseases (NCDs) like cancer, diabetes, and cardiovascular conditions.
The lack of widespread screening programs and limited access to treatment pose significant challenges in addressing the increasing number of cancer cases. Diabetes prevalence is also surging due to lifestyle changes, requiring effective management programs and education on prevention. Cardiovascular diseases, linked to urbanization and dietary patterns, contribute to the growing NCD burden.
The World Health Organization predicts a 27 per cent increase in NCD prevalence in the African region, including Nigeria, over the next decade.
To address these challenges, Nigeria must implement comprehensive strategies that emphasize prevention, healthier lifestyles, and strengthened healthcare infrastructure, while international collaboration can aid in mitigating the impact of NCDs in the region.
Outbreak of Dengue Fever
The Dengue Fever, first confirmed by NCDC on December 16 2023, to have broken out in November at Sokoto, has reported 71 suspected cases with 13 confirmed cases so far.
The virus has been reported in three local government areas (LGAs): Sokoto South, Wamako and Dange Shuni with affected age demography between ages 21- 40.
Dengue fever is a viral infection caused by the dengue virus (DENV) and transmitted to humans through the infected mosquito’s bite. Human-to-human transmission of the virus has not been established.
In conclusion, the Nigerian healthcare sector is at a crossroads, facing both opportunities and challenges. The ability to embrace these changes while maintaining a commitment to high-quality care and accessibility will determine the success of Nigeria’s healthcare transformation beyond 2024.
As the nation moves forward, it is vital to strike a balance between expanding access to care and ensuring that healthcare quality remains paramount, ultimately fostering a healthier and more vibrant future for all Nigerians.
