Hawking Malaria

In wondering whether Nigeria’s health system is non-existent, Seyi Abimbola suggested that, “It is safe to assume that every country has a health system, no matter how dysfunctional.”  Seyi also addresses the potential role of patent medicine vendors whose neighborhood shops have become ‘trusted’ institutions.  But let’s take this one step further beyond the shop.

The other evening after food, I was sitting with friends out on an Abuja back street having drinks when a man came buy with a straw tray on his head selling medicines.  These ‘drug hawkers’ specialize in what the Yoruba term pa’se po, a combination of pills and capsules, often sold in a small clear nylon bag that taken at once should relieve one of a particular ailment. Some actually say this mix that literally ‘combines or brings together the work of all’ can be formulated to treat all kinds of diseases in one. Colorful mixes of analgesics, antibiotics and even valium have been common.

One person at a nearby table began to explain his aches and pains and was given a mix of pain killers and vitamins.  I called the guy over and asked what he had for malaria and was given the mix pictured here – sulphadoxine-pyrimethamine, paracetamol and big multi-vitamin caplet.  These two mixes cost only 100 Naira (about 67 US cents) each.  Like many, this man had mixtures for both chronic and infectious illnesses.

pasepo-2sm.jpgThis hawker was a bit more sophistocated than most in that he sold the medicines still in their blister pack, and the malaria medicine, though no longer approved as a treatment in Nigeria, at least was not expired.  Of course when he walks around the neighbourhoods during the day, the tray on his head is explosed to the sun!

Nigeria has long fought a battle against illegal sales of medicines, which often include fake or expired drugs. For example in 2007 the Federal Government “called for sanctions to be to put in place against persons who engage in unauthorised distribution, sale and dispensing of medicine or controlled substances.” While this article bemoaned the fact that, “Nigeria is one of the few developing countries in the world where medicines of all categories are sold in open market stalls, roadside kiosks, peddled in buses and hawked in basket along the streets,” the press from other countries also carry such stories as seen below from The Gambia

“… it is still a common practice for some people who have taken the sales of these drugs as a livelihood. This is no doubt a dreadful act and should be discouraged. It is sad to not e that the people who are hawking these drugs don’t even know the essence of the drugs, their indication, dosage, side effects or even their contra-indications. They just carry them in a transparent plastic bag and move with them from place to place particularly around the ferry crossing terminals.”

Efforts to bring down the cost of appropriate and approved malaria medicines such as those by the Clinton Foundation and the Global Fund’s new Affordable Medicines Facility for malaria, may not compete with the convenience and price of the drug hawkers. More regulation in a non-existent system will not do the trick. Maybe a more clever market-oriented consumer education approach would help? Let’s hawk ideas not expired medicines.

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