Dr Tom Frieden
High blood pressure, also known as hypertension, is one of the most common health conditions, affecting about 30% of adults in Nigeria. Uncontrolled high blood pressure leads to heart attacks, strokes and kidney disease, and kills 10 million people each year worldwide, making it one of the deadliest global health issues.
Treatment for HBP is extremely effective for most people; taking proven, high-quality medications can add years to your life and make those years more enjoyable. But in Nigeria, less than 3% of people with HBP have it under control. Hypertension is called the silent killer because there are no symptoms; many people do not know that they have hypertension. Many of those who are aware that they have high blood pressure are not taking medications regularly. Medication for hypertension needs to be taken every day.
My
organisation’s “Under Pressure” report shows that one important reason so many
people die from untreated hypertension, including in Nigeria, is high drug
prices.
Ms
Olabisi Obelawo, a patient advocate from the Nigeria Non-communicable Disease
Alliance, recently shared how high drug prices have negatively impacted her and
her community. “Both of my parents had high blood pressure when they were
young. They passed away and the same thing is happening to people in my
community. Paying for my high blood pressure medicine is difficult on top of my
household expenses. If we can get high-quality drugs more affordably, our lives
can be extended.”
Excellent,
safe and inexpensive medicines to control blood pressure have been around for
decades and are proven to prevent heart attacks and strokes. But prices for
anti-hypertension medicine vary substantially across countries, in some places
costing up to 40 times more than in others. For example, amlodipine (a great,
safe, effective hypertension drug generally used as a first treatment) has an
estimated generic price of N4.22 per tablet but the actual per tablet cost in
the Nigerian private sector is almost N11—more than twice the price! The prices
for other recommended standard hypertension medicines (hydrochlorothiazide and
losartan) are almost five times higher than the estimated generic price.
Why are drug
prices so high in Nigeria and elsewhere? Although the global market for
hypertension medications is very large, because of a lack of a standard
treatment approach, there are a variety of drugs provided in the Nigerian
market and sales volumes even for recommended essential hypertension medicines
are low. This local market fragmentation leads to higher medication prices for
Nigerians. For conditions such as HIV and tuberculosis—which affect fewer
people than hypertension does—standardised treatment protocols, which often
recommend medications that combine two or more medications in a single pill,
streamline the available options. This standardisation around a few essential
medicines allows countries to negotiate more affordable prices for HIV and TB
medications.
How can
this happen for anti-hypertension medications in Nigeria? Experience in other
countries shows that drug prices can be sustainably lowered by issuing a
standardised treatment protocol nationwide. When used for treatment of HBP,
protocols can streamline care and improve patient outcomes, whilst condensing
the market for hypertension drugs to the only three recommended protocol
medicines. Nigeria now has a standardised hypertension treatment protocol which
recommends specific medications, dosages and action steps for health care
providers and HBP patients. This protocol, which is currently used in the
Federal Capital Territory, Ogun and Kano (as well as the Healthy Heart Africa
program), should be rolled out nationally for the greatest positive impact on
health.
Secondly,
promoting national or regional pooled procurement, which reduces costs through
bulk purchasing, pooled negotiations and assurance of quality and stable
supplies. For this to happen, coordinating mechanisms such as the Nigeria
Governors Forum, the Federal Ministry of Health and the Manufacturers
Association of Nigeria must work together to ensure the supply of medicines
hypertension patients need and at affordable and transparent prices.
Thirdly,
strengthen the government Drug Revolving Funds. These funds—through which drugs
are sold at cost-price plus a small, transparent markup, with revenue used to
replenish drug stocks—enable cost efficiencies and uninterrupted drug supplies.
Fourthly,
strengthen the health insurance system to include robust and reliable primary
health care. Enabling patients with hypertension to benefit from national and
community-based health insurance coverage will increase the pool of insured
Nigerians, thereby reducing heart attacks, strokes as well as health insurance
premiums and health care costs
Affordable medicines will help patients with
hypertension prevent heart attack, stroke, and early death. All people in
Nigeria—regardless of where they live, or how much they can afford to
pay—should have access to affordable life-saving anti-hypertension medications.
Governments and non-governmental organisations,
as well as the pharmaceutical industry and health advocates, must work together
to address this urgent public health priority. Treating hypertension cannot
wait; delay will mean significant loss of life. By acting now, we can save
lives by making drugs more accessible and affordable.
*Dr Tom Frieden is President/CEO of Resolve to Save Lives and Dr Emmanuel Agogo is Nigeria Country Representative of Resolve to Save Lives
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