Asthma patients face spiralling costs as big pharma exits Nigeria

 When Gloria Mofifoluwa’s friend informed her in March that the price of inhalers had risen in Nigeria, she did not think much about it.

The following week, when she went out in Ibadan city to replace her old Ventolin inhaler, the asthma sufferer was shocked to see that many pharmacies were out of stock and the only place it was available sold it for 7,500 naira ($5) – more than double the 2,800 naira ($1.86) she had paid months before.

This price jump – which followed the departure from Nigeria of a major health pharmaceutical – was a shock for the 24-year-old undergraduate student who earns a bit of money designing clothes. And the ripple effects were even worse.

Last month, while alone in her room at the university hostel and consumed by thoughts of her economic challenges, Mofifoluwa started hyperventilating and struggled to catch her breath.

Her roommate was away and there was no one to take her to hospital. All she had on her was an Aeroline inhaler, which she explained does not work as fast for her as the Ventolin she now struggles to get.

“I was just scared because not only was I alone in my room, I was also on my floor [and without the medicine I most needed],” she told Al Jazeera, adding that all she could do was pray until she fell asleep, hoping she would regain her strength by the time she woke up.

The pharmaceutical scarcity and rising prices causing stress for asthma sufferers like Mofifoluwa cap off a chain of events that began in May 2023, when Bola Tinubu was elected president.

During his inauguration ceremony, Tinubu announced the removal of a fuel subsidy, which resulted in an unprecedented increase in petrol prices. This also affected the cost of various goods and services and contributed to an inflation rate of above 27 percent. The cumulative economic effects have been harsh, especially for the vulnerable – including students and low-income earners.

The hardships worsened as the president’s monetary policies pushed the naira to an all-time low against the United States dollar, further leading to a downward trend as manufacturers struggled to meet production targets.

Amid the downturn – which included exchange rate volatility, declining revenues and a general worsening of the investment climate in Nigeria – a significant number of businesses including international pharmaceuticals exited the country.
 

GSK exit

Among those that left was British company GlaxoSmithKline (GSK), which ceased direct business in Nigeria in August 2023 and transitioned to a third-party distribution model. The company had operated in the Nigerian market since 1972.

“We believe the move to a third-party distribution model, a strategy we’ve successfully implemented in other markets, will enable more sustainable access to our medicines and vaccines for patients in Nigeria in line with our global strategy,” said GSK spokesperson Dan Smith.

However, Nigerian doctors and patients Al Jazeera spoke to said GSK’s departure has contributed to rising prices and increased the scarcity of some medicines. As a major supplier of inhalers – including the type Mofifoluwa depended on – the company’s exit has not been good news for asthma patients.

According to the World Health Organization (WHO), asthma cannot be cured but common treatments like the usage of inhalers which deliver medication to the lungs allow patients to live normal, active lives.

The global health body recommends that people with asthma get access to proper healthcare, but in developing countries like Nigeria, the situation is complicated. This has been worsened by the exit of companies like GSK.

While asthma inhalers were easily available and more affordable when the company was around, many now find the medication is out of reach. Despite there being alternative options, Nigeria relies largely on imported medicines, meaning high operational costs get added to the price tag for consumers.

For the average patient, an inhaler lasts about two months, depending on usage, which makes it a pricey regular cost in a country where the minimum monthly wage is 30,000 naira (about $20).

Like Mofifoluwa, 21-year-old Joseph Biyi also struggles with asthma. The library, archival and information science student was diagnosed in the middle of last year, and has since been confronted with the rising prices of inhalers.

The first time he bought a Ventolin inhaler, it sold at 3,500 naira ($2.30) but by his next visit to the pharmacy this year, the price had jumped to 7,500 naira ($5).

While Biyi has his parents to help him with money for inhalers, especially since the prices have skyrocketed, he said he now also forgoes some essential items, like groceries, to save the extra money for medicine, “just to avoid risk”.
 

High asthma rates

The Nigerian Thoracic Society says that, as of 2019, 15 million Nigerians were asthmatics while a nationwide study put the number at 13 million – one of the highest rates in Africa. With less than accurate data in Nigeria, because those in rural areas have limited access to quality healthcare or medical tracking, the number could be even higher.

On World Asthma Day in 2023, the president of the Nigerian Society of Asthmatics, University College Hospital (UCH) Branch, Professor Olusoji Ige, said more than 10 million Nigerians have asthma and about three-quarters of them risked dying due to poor asthma control.

Mrs Tinubu, the Matron of the University of Ibadan’s Asthmatic Club who prefers to be identified only by her surname, said there are several factors responsible for asthma. However, she noted that the ill-equipped healthcare system worsens the condition over time.

Due to the poor state of the public healthcare system in Nigeria, after diagnosis, most people take charge of getting their medication themselves.

Meanwhile, in Ibadan, some enterprising young Nigerians have been trying to help fill the health gaps that exist.

Temitope Omosebi, a postgraduate psychology student, told Al Jazeera that after having an encounter with an asthma sufferer in 2023, he understood the full gravity of the condition and wanted to do something to help.

That’s when he launched the #AttackAgainstAsthma campaign at the University of Ibadan, to help at least some patients get access to interventions. The campaign helps provide various types of inhalers, including Sivobutamol, Aeroline, Ventolin and Fortide, to those who need them. Last year alone, 40 inhalers were distributed and this year, an additional 60 were disbursed for free; all were procured with funds from Omosebi himself.

“The campaign is important as it addresses self-care medication for asthmatic patients which has become highly costly in the recent time,” Omosebi said. “Our focus is specifically on varsity students – and on individuals in low socioeconomic communities hopefully soon – because of the known financial challenges among these groups of people.

“In Nigeria, the government isn’t doing anything it’s meant to do,” he added.
 

‘All inhalers are expensive’

Olabitan Odunola, a doctor and the lead at The Health City, a tech-enabled platform that focuses on preventive services and education, bemoaned the scarcity and cost of GSK products since the company exited the Nigerian market.

She said that especially for asthmatic patients who depended on GSK’s inhalers, the new circumstances are disturbing and even alternative medicines are out of reach for most patients.

“Across the board, all the inhalers are expensive,” Odunola said.

Patients have switched to alternatives like Longlife Pharmaceuticals which mostly sells Aeroline inhalers, to find relief. There are also other options like Symbicort inhalers, manufactured by AstraZeneca, and Fortide inhalers, distributed by Pakistani pharmaceutical company Getz Pharma. While all are recognised and available, they are also largely unaffordable.

Odunola said the limited access to these preventers could worsen healthcare outcomes for asthmatics. Since the condition is long-term, she also feared that it could lead to more deaths, especially in instances when someone has an asthmatic attack.

The poverty rate in Nigeria, according to the World Bank, was estimated at 38.9 percent in 2023, and considering the relatively high prices of inhalers, patients may even resort to unproven asthmatic treatments out of desperation, experts fear.

There is a correlation between limited access to quality healthcare services and the number of asthmatic patients in Nigeria, said Bello Wada, a physician and the current public health rirector of the State Ministry of Health in Kano.

“This leads to delayed diagnosis, inadequate treatment and poor management of asthma, exacerbating the condition and increasing the number of patients,” he said.

Wada also pointed out that GSK leaving Nigeria further puts those who have been diagnosed at a disadvantage, as inaccessibly priced inhalers could lead to increased morbidity and mortality rates.
 

Finding solutions

In January, the value of drugs imported into Nigeria was estimated at 900 billion naira ($606m), showing a high dependency on imported medicines.

In February, the federal government announced a $240m investment in the local manufacturing of pharmaceuticals, but while this is yet to materialise, Wada wants the government to do more to address the situation.

“They need to implement policies to make essential medicines more affordable, increase funding for healthcare infrastructure and personnel, develop programmes to improve access to quality healthcare services, especially for vulnerable populations, and also engage with international organisations to secure donations or discounted prices for essential medicines,” he stressed.

Nigeria’s Coordinating Minister of Health and Social Welfare, Professor Muhammad Pate, met with representatives and chief executive officers of pharmaceutical companies in Nigeria last year and said the government is concerned about the high cost of medicines and finding solutions to the crisis.

“The Federal Ministry of Health & Social Welfare, @Fmohnigeria, is working towards policy actions that may address the high prices of medicines especially for the most vulnerable Nigerians,” he said on the social platform X in November.

Until that happens, to help her asthma and manage costs, Mofifoluwa said she will continue to use Aeroline, which at 6,500 naira ($4.30) is slightly cheaper than Ventolin. Even though it does not work as well for her, she feels the lower price makes a difference and allows her supplies to last longer.

“I normally don’t use Aeroline because Ventolin works faster. I had to start buying because it’s less costly,” she told Al Jazeera. “But I still have to manage when I buy it and use it based on calculation [and only when necessary].

“During examinations period, I consume a lot because anxiety and stress are all over me,” she added.

Now, with the high cost of essential medicine she needs, school is not the only thing adding to her stress.

Al Jazeera

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Nigeria announces plans to acquire 50 military aircraft

The Nigerian air force said Tuesday it will acquire 50 new aircraft to strengthen its capabilities against armed gangs and terrorists in northwest Nigeria.

Nigerian Chief of Air Staff Marshal Hassan Bala Abubakar made the announcement at the opening of new military facilities, including two aircraft hangars in northwest Katsina state.

Abubakar said the aircraft would include 12 AH-1 attack helicopters, 24 M-346 combat planes, 12 AW109 multipurpose helicopters and a pair of Casa 295 transport aircraft. He did not disclose the cost, nor did he say who would provide the aircraft.

He said Nigeria is expected to receive them by next year.

The aircraft will be used to bolster offensives against jihadist groups and armed gangs that have terrorized northwest and central states in recent years, Abubakar said.

But security analyst Mike Ejiofor says acquiring 50 aircraft is overambitious and possibly misdirected.

"I know it will bolster the fight against terrorism, but I believe that we should concentrate more on land than air. We're not at war,” Ejiofor said.

The money, he said, should “have been channeled to training and provision of welfare for the ground troops. I think we would've achieved more results."

Abubakar’s announcement came as Kaduna state authorities announced Tuesday a partnership with the military to set up three new operational fronts within the state.

Kaduna state Governor Uba Sani said, "We concluded with the military to set up forward-operating bases in southern Kaduna, and another one in the Giwa and Birnin-Gwari axis. All the arrangements are being concluded."

The Nigerian air force came under heavy criticism in December after more than 80 people were killed and dozens wounded during an airstrike in Kaduna state that was intended to target gangs.

Nigerian authorities have promised to operate with more precision to avoid future accidents.

Nigerian Chief of Defense Staff General Christopher Musa told journalists in Abuja, "The armed forces of Nigeria are highly professional. We're here to protect innocent citizens, not to harm them. Whatever it was that happened there was a mistake, but we're addressing such issues."

Ejiofor said authorities should focus more on boosting the ability of the air force to gather and process accurate information about the activities of armed groups.

"These strikes are intelligence-driven, so we must get the intelligence before they're guided to the areas,” he said. “I think what we should've done is to deploy more drones that will be sending this data."

By Timothy Obiezu, VOA 

Related story: Analysts Doubt Boost in Military Spending in Nigeria will Improve Security

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Nigerian car dealers report a surge in demand for locally-used cars over the past year, driven by the naira's devaluation, which has made imported cars more expensive. As a result, many dealers are now focusing exclusively on selling locally-used cars to meet the growing demand. (This was all over the place, the web, the news in late May.

CGTN

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Nigeria Spends $600m Importing Palm Oil Annually

The National Palm Produce Association of Nigeria (NPPAN) says Nigeria spends $600 million on palm oil importation annually.

Alphonsus Inyang, the national president of the association, stated this in an interview with NAN yesterday in Abuja. He described the expenses as unhealthy for national development.

Inyang said the money could be saved and injected into the economy if the palm oil sub-sector was given due attention by successive governments.

The president regretted that Nigeria, which was self-sufficient in palm oil production in the past, now spends a huge amount to import the same product.

Inyang recalled that in the 60s, Nigeria was number one in palm oil production and exportation globally, controlling over 60 per cent of world palm oil.

He said that the reverse was the case at the moment as over 50 percent of what we consume is imported.

“At the moment, the country occupies the fifth position in the league of palm oil-producing countries after Indonesia, Malaysia, Thailand and Colombia.

“Nigeria may even lose the position to smaller countries who are investing heavily in the sector.

“Indonesia occupies the first position, producing 50 million metric tons, Malaysia second with 19 million metric tons, Thailand 3.28 million and Colombia 1.9 million metric tonnes,” he said.

The president attributed the challenge to the neglect of the sector by successive governments.

Inyang said that based on the U.S. The Department of Agriculture, Nigeria currently occupies fifth position in the league of palm oil-producing countries with 1.5 percent or 1.4 million metric tonnes of the world’s total output.

“Nigeria was overthrown as the world’s largest palm oil producer and exporter by Malaysia and Indonesia in 1966.

“Currently, Nigeria is the largest consumer of the product in the continent, consuming approximately three million metric tons yearly.

“Domestic production stands at less than 1.4 million metric tons, leaving a deficit of over 1.6 million metric tonnes,’’ he said.

Inyang specifically called on the federal ministry of agriculture and food security, to support NPPAN members with seedlings to develop 250,000 hectares per year.

“Our members can plant up to 250,000 hectares per year through the association’s National Oil Palm Strategy Development Plan; all we want are inputs.

“The government does not need to give and develop land for us, we need seedlings, fertilisers, logistics and implements to close this gap within four years.

“We will also create new millionaires in 28 states of the federation,” he said.

Leadership

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The all-women church groups helping people in Nigeria

On a warm Thursday afternoon in May, the ululation, drumming and singing of a choir of two-dozen women can be heard across Gan Gora, a village so small it barely appears on the Nigerian map.

“We are happy you arrived safely,” they sing in Hausa welcoming the visitors to the community branch of the Evangelical Church Winning All (ECWA), hidden in the hilly Zangon Kataf, an area of half a million residents in the state of Kaduna.

A congregation of about 100 women dance and sway alongside the choir, including Rifkatu Dauda Kigbu, 53, their spiritual adviser, hobbling on a fractured knee, a crutch in her left hand.

This is a weekly meeting of zumunta mata (Hausa for “fellowship of married women”), a clan that has banded together for almost a century, sisters in times of surplus and of scarcity. Their visitors are zumunta mata members of an ECWA, one of Nigeria’s largest churches, in Gonin Gora, a suburb of Kaduna city.

The first zumunta mata was formed in 1930 after a woman almost died during childbirth in Miango, a town more than 50 miles away in what is now the neighbouring Plateau state. Women in the ECWA Christian church contributed to buy a bicycle so future patients could be ferried to the nearest medical facility. It began a fellowship that now has millions of members in northern Nigeria, across a multitude of denominations both Christian and Muslim.

For years, outsiders have primarily known the zumunta mata for their colourful abayas, singing, which has garnered millions of YouTube views, and provision of spiritual guidance to young women and mothers.

Godwin Ogli, head of theatre arts at the Federal University, Lokoja, has been researching the group in Plateau state and says the original motive was to “provide a space for women to learn more about the word of God” and to be “an outreach arm of the church” to bring more women in.

That role expanded as Nigeria’s economy has stuttered and pastoralist violence has intensified across Kaduna and Plateau, and throughout the Sahel.

The Armed Conflict Location and Event Data Project estimates that at least 2,600 people were killed by conflict in Nigeria in 2021. Villagers and local researchers say the casualty count is higher, as some incidents in Zangon Kataf, one of the hotspots, were undocumented.

Tensions over land have led to conflict between nomadic herdsmen and Indigenous farming communities. The herdsmen, mostly Fulani Muslims, have said they are acting in self-defence, stemming from rustling and killing of their cows and kinsmen. The farmers, who are mostly Christian, say they are protecting themselves from ethnic cleansing and land grabbing rooted in British colonial excesses.

Analysts say the climate crisis and overpopulation have exacerbated religious and ethnic differences between neighbours who coexisted peacefully for decades. “The relationship is [now] sour,” says Stella Amako, a local politician and elected chapter head of the visitors from Kaduna.

Conversely the bond within zumunta mata has strengthened. The fellowship is the first responder during crises. They have sleepovers, cook, offer small cash gifts and when necessary, bathe new babies or bodies of the dearly departed. When gifts come from NGOs, distribution is managed by the mama zumunta, who is elected every three years for a maximum of two tenures.

“We are even currently handling two cases of women on the brink of divorce,” says Amako.

While WhatsApp groups have become an important self-help tool in some parts of the global south, in Gan Gora even £5 (10,000 naira) smartphones are a luxury. So women attend meetings in person to listen to gospel lessons and give testimonies.

After the dancing, Kigbu advises the women in a brief lesson. “Any woman with dignity is respected. Her husband is blessed because of her and always boasts about her. Her good habits are contagious,” she says, her crutch resting next to her bible on the table.

Outside, her husband, Rev Luka Kasai Kigbu, shakes hands with local pastors who have come to thank the women for helping them out on a recent farming day. The couple are still recovering from a car jacking by the region’s marauding herdsman that led to Kigbu’s knee injury. They had been returning from a visit to family in a neighbouring state when they were attacked. The reverend managed to escape but the bandits dragged Kigbu out of the car and fractured her right knee. Eventually she was released, and is grateful, despite her injuries.

“I have to give thanks for every situation,” she says.

The women are proud of their support system. Mary Bawa, 68, joined as a new bride in 1976. “What gives me peace of mind and joy is knowing Christ and [having] these people around me,” she says.

A widowed mother of seven, Bawa passes on to young widows what she knows about farming soya beans to make tofu to trade.

One is Magdalene Israel, 32. Halfway into recanting how her husband and mother-in-law were killed on the same day, caught up in a firefight between herdsmen and farmers in September 2022, she stops to bend her head and weep.

She escaped from their farm that day by running non-stop to the next village, bullets whizzing past her ear. “I was just screaming holy ghost fire,” says the mother of three.

“Life has not been easy but zumunta mata and God Almighty have been behind me,” says Israel, who is praying for the ability to let go of her abiding anger and forgive the killers.

For now, conflict has paused and Gan Gora is a picture of serenity. In front of the church, the long tarred road connecting the community to others is flanked on either side by mango, neem and baobab trees and small fields of maize.

Multiple checkpoints dotting the road are held by young soldiers in khaki sitting on sandbags. It is a departure from the scarce government presence for years in an area where people remember other violent episodes, including a 1992 communal clash and a 2011 election crisis that both left hundreds dead.

The checkpoints were introduced after an army general from the region, Christopher Musa, was appointed a service chief last year. A barracks is being built to reinforce security around the hills. At state level, the new governor, Uba Sani, is seen as less divisive than his predecessor, Nasir El-Rufai, who proscribed a community association in Zangon Kataf for being an “unlawful group”.

Still, some are afraid to return to fields and villages.

In the relatively safer Gonin Gora suburb of Kaduna, the women enjoy regular sessions like learning how to make homemade liquid detergents to help cushion their households from the effects of Nigeria’s cost-of-living crisis. The choir rehearses songs about subjects such as forgiveness and heaven.

“They look out for one another, supporting one another, sometimes financially or emotionally, psychologically … this goes beyond the church,” says Ogli.

One such session helped Grace Friday, 33, with the art of food presentation that her husband now loves. Afterwards, he overheard her chatting with a friend about a forthcoming wedding as he ate and later told Israel he would buy her an outfit to the ceremony, to show his appreciation for the benefits the fellowship had brought to his family. She was overjoyed.

Eunice Shola, a 47-year-old civil servant who runs the cooperative union’s low-interest loan system, says the fellowship has helped her to try public speaking.

“When I started this, I couldn’t even stand and pray in the presence of two or three people … but this fellowship has really built my self-confidence,” she says.

Those in the city remember their sisters in the countryside. For the past 13 years Lucy Stephen, 48, has led Gonin Gora’s 57-woman choir, whose music helps members to show solidarity with their Zangon Kataf sisters and “build their faith”.

One song references the cry of a prophet in the Bible’s book of Habakkuk. “Oh Lord, how long must I call for help?” the first verse goes. “There is pathos everywhere.”

Eromo Egbejule, The Guardian