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Drug shortage frustrates chronic disease patients

Avatar: Nigist Berta
Nigist Berta November 27, 2021
City: Addis AbabaHealth
Drug shortage frustrates chronic disease patients

Seifu Nadew, a resident in Addis Ababa, had been struggling with diabetes and hypertension for years. He was told by doctors not to stop taking the prescribed drugs. However, starting from last August he faced a day-to-week interruption in the provision of his medication since he couldn't find the medicines in the drug stores he frequently visited. Sometimes he said he finds the medicines on sale at high costs at some pharmacies. 

Even if he tried to continue his medication buying with the high costs for two months, he was unable to find the medicines for weeks. And at the time he managed to find some in rare pharmacies, he couldn’t afford to buy. As a result, his health deteriorated, until he finally passed away a month later. 

Seifu in his mid-forties, a father of three children, passed away last month due to a lack of medicine and left his three children and his wife.

“Nowadays it costs ETB 9,500 a month just to buy the medicines, which previously cost 5,300.00. My husband used to earn a living as a carpenter at a woodshop, and I am a housewife. How could we afford to buy such expensive medicines?” wonders Zemenay Dagne, Seifu’s wife, whom Addis Zeybe talked to.

After a month Seifu stopped taking the medicine, he started feeling unwell and was told that his kidneys were failing due to uncontrolled hypertension and diabetes. Even though his relatives and friends raised ETB 80,000 to cover his medical expenses, the medicine couldn’t be found on the market. 

“We searched everywhere, even on the informal market, but we could not find the medicine, especially the one he took for his diabetes,” Zemenay recalls.

This is not an exceptional story. Nowadays several patients are complaining about drug shortages over the last few months. While many attribute the shortage to the ongoing conflict in the country, drug importers said they faced a critical forex shortage.

Patients like Seifu have to rely on luck if they are looking for imported medicines for critical illnesses. They either need the right connections to the informal market, or they need sources that can access medication from abroad. And these situations became normal after the country got into the ongoing conflict.

Mulugeta Yalew, an assistant professor at the Pharmacoepidemiology and Pharmacology Department of the University of Gondar, stresses that failure to obtain drugs on time has severe consequences. 

“Even the price of standard medication suddenly jumps up. To the worst, it becomes challenging to find medications such as diabetes drugs and anticoagulants, that help to prevent blood clots. And this gets harder when there is a dollar shortage or alike.”

Some doctors told Addis Zeybe that they have been forced to turn to other sources to find medicines for their patients since imported medicines have become scarce. “These days, we are obliged to give medicines bought from the informal market, especially to chronic disease patients,” explained a doctor who works at Tikur Anbessa Hospital.

According to recent research conducted in 2020 by Ethiopian Pharmaceutical Supply Agency (EPSA), the annual pharmaceutical market in Ethiopia is estimated to be worth one billion dollars when the demand for pharmaceutical products grows by 25% annually. Steady economic growth, improvements in the delivery of health care, and the introduction of social health insurance coverage across the country all lead to increased demand.

Loko Abraham, former director-general of EPSA, admits that the agency can not supply medicine continuously due to a lack of foreign currency as well as capacity limitation. “We wait five to six months to get foreign currency approval. Then the procurement and shipment take additional time. All in all, the supply of medicine had been currently disrupted for four to five months. And now due to the ongoing war, getting the hard currency we requested is becoming hard.” 

According to Loko, medicine supplies and prices have fluctuated wildly due to the lack of foreign currency, especially over the last year due to the ongoing conflict. “But we are still doing our best giving priority to the sector,” he added.

The shortage of foreign currency has also posed a serious challenge for private importers of pharmaceutical products and medical consumables.“We always get in trouble when the country faces a dollar currency shortage,” explains Tsegaye Gebreyesus, general manager of Bicas International Trading, a private pharmaceutical import company.

“It has been four months since the company imported products from European and Middle Eastern suppliers and five months since we imported from the USA.”

Although the extent of the impact varies depending on the type of the disease and the condition of patients, the absence of pharmaceutical products has had devastating effects on people. The fate of patients who are struggling with chronic diseases hangs in balance. 

Asmelash Worku, a 56-year-old man who has been dealing with type-2 diabetes for five years, has to take medication daily to regulate his glucose levels. However, the increasing price and the scarcity of the medicine on the market, are putting his life at risk. “I used to buy drugs that are adequate for three months at once for 2,000 Br. a year ago. However, a few months ago, I was coerced to get drugs only for a one-month consumption with the price of 1,110 Br.,” says Asmelash in frustration. “Even worse, the medicine has now vanished from the market in recent months, which forced me to request relatives  to send it to me from abroad.”

In Ethiopia, diabetes is the leading cause of hospital admission. According to a 2019 study entitled “Diabetes Mellitus in Addis Ababa, Ethiopia”, out of the 8,048 people admitted to Black Lion Hospital between 2015 and 2018, 523 were diagnosed with different types of diabetes.

The other common chronic diseases deaths account for about 5.8Pct of total national mortality, according to the National Chronic disease control Plan document published by the MoH in 2015.

Doctor Gemechis Mamo, senior doctor of Internal Medicine at Tikur Anbessa Hospital sees 5000-9000 outpatients and up to 200 inpatients come through his department which treats most cases of diabetes, blood cancer, kidney failure, and heart disease, every month.

Despite the prevalence of chronic diseases, the unfortunate experiences of patients like Seifu and Asmelash show that the availability and affordability of medicines have reached a critical point. Following the scarcity of medicines in the formal market, people are forced to take smuggled tablets, which are unaffordable especially for average low-income consumers.

Yordanos Alebachew, Public Relation Directorate at the Ministry of Health, says “We always work on importing medicines to address patients in need no matter what circumstance the country is in, we have imported medicines over the last eight months in a significant rise which the worth will be disclosed sooner or later accordingly with the schedule of the ministry.” 

“In Ethiopia, the stagnant development of local pharmaceutical manufacturers has forced the health sector to heavily depend on imports. Despite all the incentives, which include pooled procurement of raw materials, technology acquisition grants, and human resource development facilitation, few companies are investing in the sector while the performance of the local pharmaceutical companies remains low.” 

According to Yordanos, the government is facilitating what is needed to provide incentives effectively and develop the local manufacturing capacity for the private sectors. “A technical committee is working on drafting a policy for the MoH, which will intend to regulate prices that are shooting up uncontrollably,” he said.

However, since the coordinated efforts said to be undertaken by the MoH are not seen tackling the problems, patients like Seifu are dying while those like Asmelash wait in fear of an unknown future.

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A PIECE BYNigist Berta

Nigist works at Addis Zeybe as a reporter while exploring her passion for storytelling and content creation.