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Nigeria must take drastic measures to end drug abuse -Dr. Nkere Ebube, former NAPPSA President (Part 2)

Nigeria must take drastic measures to end drug abuse -Dr. Nkere Ebube, former NAPPSA President (Part 2)In this edition we conclude the media chat between PharmaTimes Correspondent, GABRIEL IFINNWA and Dr. Nkere Ebube – former President of Nigerian Association of Pharmacists and Pharmaceutical Scientists in the Americas (NAPPSA) which began last month. He dwells much on how drug abuse among young people can be curbed, as well as how the country can urgently attain sustainable health coverage for all in the nearest future.

How can we stop the menace of drug abuse, especially among the youths in Nigeria?
As mentioned earlier, the threats of drug abuse transcend age group, gender, sex, ethnic group, political affiliation and economic class. It is a fight that we must win. It would require a collective effort and collaboration between the regulatory agencies, healthcare institutions and professional bodies, religious organisations, government and private institutions. Some of the proposed measures would include –
Youth programmes – we must provide a better alternative to the youth. Every local government or city should establish a community centre where the youth can engage in sports or vocational programmes that would help to keep them engaged and challenged. There is a popular saying that an idle mind is the devil’s workshop. The community centre can be equipped with intramural sports complex, computer and technology centres, etc. to provide positive alternatives to the youth.
Faith based initiatives – organise youth camps and programmes tailored to educate, engage and empower the youth. Create and sponsor volunteer programmes for the youth to engage in community development initiatives and services. For example, clean water programme, home renovation initiatives for the elderly, building of community library, etc. The church and religious organisations can truly put the money they raised to rebuilding the society and creating opportunities for the youth.
Health education programme – the health professional organisations such as Pharmaceutical Society of Nigeria (PSN), Nigeria Medical Association (NMA), Nigeria Nursing Association, etc. should work collaboratively to embark on schools’ visits to educate students on the dangers of drug abuse. They should also offer free drug screening, provide referrals and any other help required to rehabilitate drug abusers.
a. The government must create jobs for the youth, reward states with lowest incidence of drug abuse problems and create drug abuse treatment and rehabilitation centres. Graduates from these programmes must learn and be proficient in a vocation. The government should partner with non-profit organisations or faith-based institutions to help the abusers to systematically re-integrate into the society. A team of social workers should assist in monitoring their progress and creating a conducive and accepting environment to help them thrive and succeed without utter feeling of shame and guilt.
b. Effective drug laws & regulation – the regulatory agency must control and effectively monitor & track the manufacturing, importation, distribution and dispensing of opioids and other drugs of abuse. It is important to invest in creating a comprehensive and effective data base, drug surveillance apparatus, and prompt prosecution of offenders.

You are a major stakeholder in the Pharmaceutical Industry. If you are in position to make policies for the sector, what would be your priority areas?
I would emphasise on initiatives that would make safe and effective drugs available and affordable to the citizens. In several countries such as India, the Pharmaceutical Sector contributes significantly to the GDP of the nation. Precisely, I would focus on the following:
Generic drug manufacturing – establish regulations, infrastructures and processes required to promote manufacturing of generic drugs. Work collaboratively with the government and private sectors to create conducive landscape to attract investors including multinational pharmaceutical companies to establish manufacturing plants and R&D centres in Nigeria.
Active Pharmaceutical Ingredients (API) & Excipients Manufacturing – take advantage of the petrochemical industry to promote internal manufacturing of common APIs and excipients required to fuel the generic industry and make drugs cheap and affordable to Nigerians. Stimulate synthesis of new chemical entities and make Nigeria a significant Pharmaceutical Hub in Africa. Nigeria is blessed with enormous human and material resources. It is also strategically positioned as an emerging global pharmaceutical market.
Research & Development (R&D) – create R&D centres of excellence to support innovation and novel technology platforms; establish clinical drug testing centres to support clinical trial and product development; fund NIPRD adequately to promote translational research, development of herbal and alternative medicines.
Engineering & Subsidiary Firms – promote establishment of engineering firms that would focus on fabricating local pharmaceutical equipment and instruments such as tablet presses, blenders, granulators, coaters, fluid beds, milling equipment, hardness testers, HPLCs, etc. Similarly, encourage creation of analytical and bioanalytical testing laboratories to support virtual companies and other pharmaceutical companies. These companies would provide enormous jobs, create competition, drive down drug prices and stimulate growth of the pharmaceutical sector.
Pharmaceutical education – help to structure the academic curriculum to offer career development pathways to support diversification in the pharmaceutical sector; create bachelor’s degree programme in pharmaceutical technology, pharmaceutical analysis, computer technology, software engineering, etc; create training or certificate programmes in pharmaceutical unit operations to develop expertise to drive innovation, new technology platforms, etc.
Intellectual Property & Patent Office – offer opportunity to patent innovations and reward companies and institutions that invest in new technologies.
Private/ Public Partnership Institute – would serve as conduit to provide funding, stimulate entrepreneurship and sustainable growth of the pharmaceutical sector.
Partnership with NAFDAC – explore partnership opportunities with NAFDAC and other regulatory bodies to effectively streamline the drug regulation, offer training programmes, and effectively monitor drug manufacturing, importation, and distributions.

What advice do you have for the nation in our march towards achieving vision 2020 for the health sector?
Vision 2020 programme is a bottom-up strategic initiatives designed to make Nigeria one of the first 20 economies in the world by the year 2020. According to the World Bank classification, approximately 206 economies (with population > 30,000) are ranked per their Gross National Income (GNI) as low income (GNI – ≤ $766), low middle income (GNI – $766 – $3,035), upper middle income (GNI – $3,035 – $9,385) and high income (GNI – ≥ $9,386). Nigeria is amongst 59 countries (28.6%) classified as a low-income country. Absolute poverty is one of the indicators to characterise low-income countries. It is measured by malnutrition, poor health, clothing, shelter and lack of education. The daily calorie intake in underdeveloped countries per capita hardly exceeds 2,000 compared to more than 3,300 in advanced countries. Over 1,200 people in developing countries do not have safe drinking water and more than 1,400 have no sanitary waste disposal.
It is estimated that out of every 10 children born within a year, 2 will die within a year, 3 before the age of 5 and 5 will survive to age 40 years. These are due to poor nutrition, unsafe water, poor sanitation, uninformed parents and lack of immunisation. The Vision 2020 initiative involves the economic, health, education and social components, as well as strategies to address issues associated with each sector. It is important to point out that these segments or barometers, though they may appear as discrete, they are inter-related. For the rest of this discourse, the focus would be on the health sector. Although the population of Nigeria was growing at a rate of 3.2% in 2006, it is estimated that this would supersede the pace of development as only 13% use contraceptives. This implies that poverty would continue to override development.
Approximately 30.7% of children under the age of 5 were underweight in 1999. The number only decreased by 1.7% in 2003. Life expectancy at birth was 46.6% in 2005 compared to 77.8 in advanced countries. Neo-natal mortality rate was 48 per 1000 live births in 2003. Infant mortality rate was 133 per 1000 live births in 2005 compared to 41 per 1000 live births in 1970 and 9 per 1000 live births in developed nation. Mortality rate among children under 5 years was 257 per 1000 live births in 2003, 54 per 1000 live births in 1970 and 11 per 1000 live births in developed country. Reported cases of deaths from preventable diseases increased from 11,854 in 2006 to 15,680 in 2007. Births attended by skilled medical personnel was 35% compared to 95% in advanced nations.
There is a doctor for every 410 persons in advanced countries compared to 2,536 persons per doctor in Nigeria. Over 13 million children were orphaned by HIV/AIDS in 2000 and 23,868 – 27,802 died of road accidents from 2003 – 2007. These statistics are very depressing and suggest that we still have a long way to go. I am not optimistic that Nigeria would achieve its vision 2020 goals in 2020 given the above statistics.
However, I feel that to continue to make good progress in improving our healthcare delivery system in Nigeria, we should invest in good medical infrastructures including well equipped diagnostic centres, hospitals, etc; make safe drugs more available and affordable by enhancing generic drug manufacturing; adequately fund universities including medical, pharmacy and nursing schools to train more healthcare personnel to provide specialised services to the patients; create opportunity and environment to foster inter-disciplinary collaboration and professional excellence; provide economic opportunities and improve the quality of life of the citizens.



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