ABSTRACT
This study was conducted to assess the relationship between
fake drug (FD) use and people’s attitude towards healthcare delivery system
(HCDS). Participants (n = 103) were both healthcare providers (56) and
consumers (47). 36 were males and 67 were females above eighteen years. They
were selected through a random sampling technique. The mean ages were 37.2,
34.2 and 42.8 for all the participants, female participants and male
participants respectively. All testing took place in Onitsha General Hospital,
Community Pharmacies, medical Laboratories and classroom environments in
Onitsha urban. Results revealed significant relationships (r = 0.6, p
CHAPTER ONE
INTRODUCTION
The usefulness of a
good health
care delivery system to any population is an obvious fact that cannot be
over emphasized. A healthy individual is a valuable asset not only to himself,
to his family, but also to his society.
The World Health Organization (WHO) (1948) defined health as a state of complete physical,
mental, and social well-being and not merely the absence of disease or
infirmity.
In 1986, the WHO in the Ottawa
Charter for Health Promotion said health is “a resource for everyday
life, not the objective of living. Health is a positive concept emphasizing
social and personal resources, as well as physical capacities.” Overall
health is achieved through a combination of physical, mental, emotional, and
social well-being.
To
achieve an overall health, we need health care delivery systems (HCDS) that can
provide high quality medical care, that are responsive to the health needs and expectations of the
populations they are intended to serve, and at affordable costs.
On the other hand, the efforts geared toward achieving
overall health, that is, health care
delivery is the prevention, treatment, and management of illness and the
preservation of mental and physical well-being through the services offered by
the medical, nursing, pharmaceutical, dental, clinical laboratory sciences and
allied health professions (Wikipedia, 2009).
According to WHO, health care delivery embraces all the
goods and services designed to promote health, including “preventive, curative
and palliative interventions, whether directed to individuals or to
populations”. The organized provision of such services constitutes a health care delivery system. When fake
drugs are used in health care delivery the main purpose of health care delivery
system, which is an overall health will not be achieved.
The relationship between fake drug use in healthcare
delivery system and how people perceive health care delivery system will better
be appreciated by looking at the levels of health care delivery systems.
All health care systems contain four essential levels of
care (Lunde, 1990):
1. Lay
self-care
2. Primary
professional care.
3. General
specialist care, that is, secondary care.
4. Super
specialist care, that is, tertiary care.
And there is a fifth
level of care – quaternary care.
The WHO defines self
– care as “activities individuals, families, and communities undertake with
the intention of enhancing health, preventing disease, limiting illness, and
restoring health. These activities are derived from knowledge and skills from
the pool of both professional and lay experience. They are undertaken by lay
people on their own behalf, either separately or in participative collaboration
with professionals.” The skills and knowledge of self – care will be manifested
in an individual’s ability to take appropriate action(s) to achieve overall
health. Such actions include the ability to know when to seek for professional
care, gather information on what type of care to seek for and where to get
desired medical service.
Reports of the media (print and electronic), and lay
information on incidences and effects of fake drugs can influence an
individual’s decision on how to access health care. Therefore, it becomes
necessary to determine the relationship between fake drug use in HCDS and how
such use affects people’s perception of HCDS.
Primary health care
(PHC) as defined in Alma – Ata Declaration (1978), is essential health care
based on practical, scientifically sound and socially acceptable methods and
technology made universally accessible to individuals and families in the
community through their full participation and at a cost that the community and
the country can afford to maintain at every stage of their development in the
spirit of self-determination.
Primary health care is promotive, preventive, and rehabilitative.
Health services based on PHC include at least immunization against the major
infectious diseases: measles, whooping cough, diphtheria, polio, tetanus, and
tuberculosis and other components of National Health Policy.
When fake vaccines were used and no immunity conferred on
the immunized, such individuals would be highly disposed to developing the
specific disease.
The term secondary
health care is a service provided by medical specialists who generally do
not have first contact with patients, for example,
cardiologists, urologists and dermatologists. A physician might voluntarily limit
his or her practice to secondary care by refusing patients who have not seen a primary care provider first, or a physician
may be required, usually by various payment agreements, to limit the practice
this way (Wikipedia, 2009).
Tertiary health care
is a specialized consultative care, usually on referral from primary or
secondary health care personnel, by specialists working in a centre that has
personnel and facilities for special investigation or diagnosis and treatment (
Wikipedia, 2008).
Quaternary health
Care –Quaternary health care is the advanced level of medicines which are
highly specialized and not widely used (Intota, 2009). It is the provision of
health care to patients in cardiac care, orthopedic, neurosciences, oncology,
renal care, and so forth.
Given the present situation in Nigeria, the environment is
intensely stressful and virtually everyone’s health is dangerously threatened
in one way or another. In periods like this, our health care delivery system
should provide relief to Nigerians, so many of whom are daily on edge
(Adelusi-Adeluyi, 1995). Unfortunately, this painful situation has been
compounded by the use of fake drugs in our health care delivery. It is
worthwhile to note that decisions as to the genuineness of drugs one consumes,
appropriateness and competence of both the health care facilities and personnel
deserve a great attention.
In Nigeria, because of chaotic drug distribution, possibility
of one becoming a victim of counterfeit drugs is very high. After all, it is
more difficult to secure a house with over a thousand doors than the one with
one or two doors. There are so many handlers (intermediaries) in drug
distribution in Nigeria. Each intermediary is a potential entry point for fake
drugs.
According to WHO (2006), “a counterfeit drug is one which
is deliberately and fraudulently mislabeled with respect to identity and / or
source. Counterfeiting can apply to both branded and generic products and
counterfeit products may include products with the correct ingredients or with
the wrong ingredients, without active ingredients, with insufficient active
ingredients or with fake packing.”
In the Nigerian counterfeit and Fake Drugs
and Unwholesome Processed Foods (Miscellaneous
Provisions) Decree 1993 as amended,
a fake drug is defined as “a. Any drug
or drug product which is not what it purports to be; or
b.Any
drug or drug product which is so colored, coated, powdered or polished that the damage is concealed or
which is made to appear to be better or of greater therapeutic value than it
really is, which is not labeled in the prescribed manner or which label or
container or anything accompanying the drug bears any statement, design or
device which makes false claim for the drug or which is false or misleading;
or
c. Any
drug or drug product whose container is so made, formed or filled as to be
misleading; or
d.Any
drug product whose label does not bear adequate directions for use and such
adequate warning against use in those pathological conditions or by children
where its use may be dangerous to health or against unsafe dosage or methods or
duration of use; or
e. Any
drug product which is not registered by the National Agency for Food and Drug
Administration and Control (NAFDAC) in accordance with the provisions of the
Food, Drugs and related products (Registration, etc).
The consumption of counterfeit drugs is worst error that
can occur in HCDS. It is an error because both the health care provider and
consumer do not know they are using the wrong drug. Fake drugs are eroding both
the essence of health care delivery system (HCDS) and confidence people have in
the system. Counterfeiters are into everything the pharmaceutical industry
produces – from life saving drugs, for example, HIV/AIDS, antituberculosis,
anticancer, antidiabetic, antihypertensive to recreational drugs. The existence
and functionality of our HCDS is being threatened, as many pharmaceutical
manufacturers who spend large amounts of money on research, production and
supply of genuine drugs are being edged out of business by fake drug
manufacturers.
The relationship between fake drugs and
people’s perception of health care delivery system can be looked at from two
perspectives: Health care consumers’ perspective
Health care providers’ perspective
STATEMENT OF THE PROBLEM
Counterfeit drugs
are believed to be poisonous, toxic, threats to life, health risks, without
therapeutic usefulness, with insufficient therapeutic benefits; and can cause
treatment failures, death, disease complications, worsening of disease
conditions, development of drug resistance, delayed recovery and human organ
damage. Because of these effects, the confidence of both the health care
professionals and consumers in our health care delivery system is in
doubt.
In the past, Nigerian government through her regulatory
agencies such as NAFDAC had made serious efforts toward solving this problem.
The regulatory agencies have increased public awareness on fake drugs, ensured
that drugs in use in Nigeria are approved and registered, known fake drug
manufacturers are banned from marketing their products in Nigeria,
re-inspection of production facilities to ensure that such facilities still
conform to appropriate standards, and persons caught with fake drugs were made
to pay heavy penalties. Also, the agencies have interacted with some foreign
governments to ensure that such countries’ pharmaceutical industries export to
Nigeria only genuine products.
This study will investigate the
relationship between fake drug use in health care delivery system
and people’s perception of health care delivery
system.
PURPOSE OF THE STUDY
We might have heard,
we might have observed, and we might have read reports on problems of fake
drugs. Unfortunately, what is known to the public as regards to the problem of
fake drugs is a tip of the ice bag. The true situation is far from known or
reported. The cause(s) of most deaths are not identified or confirmed through
autopsy.
But how do these problems affect people’s perception of our
health care delivery system? This question is what this study intends to
answer.
SIGNIFICANCE OF THE STUDY
It is my belief that this study will
1.
Increase the level of commitment of people to their
health care needs.
2.
Motivate people to ensure that the quality of drugs,
health care services and qualification of their health care providers are as
prescribed and regulated by government.
3.
Encourage people to acquire self – care knowledge and
skills that they need to
participate more actively in fostering their own health and in shaping
conditions that influence their own health.