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.
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
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.
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.
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Item Type: Project Material | Size: 34 pages | Chapters: 1-5
Format: MS Word | Delivery: Within 30Mins.
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