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 < 0.05). People’s attitude (selection,
organization, and interpretation of health related information to form a
meaningful picture of their health care needs) were considerably affected by
the use of FD in HCDS.
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
- Increase
the level of commitment of people to their health care needs.
- 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.