Relationship Between Fake Drugs and People’s Perception of Healthcare Delivery System in Onitsha Urban
Chapter One
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.
CHAPTER TWO
LITERATURE REVIEW
This chapter is organized into two sections:
Theoretical review and empirical review Theoretical Review
According to Wikipedia, the free encyclopedia, “healthcare systems are designed to meet the health care needs of target populations.” In some countries, the health care system has evolved and has not been planned, whereas in others a concerted effort has been made by governments, trade unions, charities, religious, or other co-coordinated bodies to deliver planned health care services targeted to the populations they service.
The aims of HCDS are to provide high quality care at affordable costs, and be responsive to the health needs and expectations of the population. The practical problem in health care policy is that the pursuit of any two of those goals aggravates the third. Thus, a more accessible system of high – quality care will tend to lead to higher costs, while low cost system available to everyone is likely to be achieved at the price of diminishing quality.
A HCDS can encompass a wide number of settings – from the informal (house calls, emergency medicine at an accident spot) to settings like nursing homes or rest homes, to typical medical settings like doctor’s practices, pharmacist’s pharmaceutical care, clinics, pharmacies and hospitals. The delivery of care refers to how and where medical services are provided.
Health care provision in Nigeria is a concurrent responsibility of the three tiers of government in the country (Rais Akhtar, 1991). However, because Nigeria operates a mixed economy, private providers of health care have a visible role to play in health care delivery. The Federal government’s role is mostly limited to coordinating the affairs of the university teaching hospitals, while the state governments manage the various general hospitals and the local governments focus on dispensaries.
Studies report that 80 to 95 percent of all health problems are managed at home through self-care and that most people who consult a physician have tried treating themselves before seeking medical advice (McGowan, 2009). The seriousness of the health problem and the extent and type of disability, including its affect on daily activities, are the best determinants of whether an individual uses self-care practices or seeks help from a professional.
At PHC level, immunization against the major infectious diseases is carried out. Immunization is a health promotion exercise achieved through vaccination. It is a process that confers immunity against a specific disease. However, not all vaccinated patients achieved the desired immunization. This may be due to factors such as poor vaccine storage (loss of potency), lack of adherence to schedule and fake vaccines.
When fake vaccines were used and no immunity was conferred on the immunized, such individuals would be highly disposed to developing the specific disease. Without success, people will shun or disdain the immunization process, seeing it as exercise in futility. Many diseases are better prevented than cured and hence immunization plays a vital role in health maintenance.
The world has not stood still since the Alma-Ata declaration in 1978 where it was agreed that providing PHC for the world’s population by the year 2000 was a realistic goal. Despite economic recession, continued urbanization with ecological degradation, wars and natural disasters, the overall picture in developing countries has improved (Sear, 2000). Globally, however, the new health threats are counterfeit drugs.
Maternal and child health care, including family planning. Maternal and child health care is important considering the complexities of childhood diseases, further compounded by the effects of fake drugs.
Looking at the features required for a healthy society, PHC provides about half of them. Among the features required for a healthy society include, in order of priority (Sear, 2000).
Peace, Comfortable shelter, Easy access to clean water, Adequate food supply, Employment with fair pay, Education for all, Stable judiciary and police force, Immunizations against common childhood diseases, Good quality obstetric care, Democratic governmental structure, Free press and freedom of speech.
The problem in Nigeria, according to Adeluyi (1995), is that secondary and tertiary health cares have not received enough funds. Facilities are now dilapidated and equipment are in dire need of refurbishment or replacement. Drugs which are vital to the credulity of health services are frequently in short supply. Ambulatory patients come and go without receiving attention, while emergency and critically ill patients die needlessly. At the tertiary level, he observed that the designated centers of excellence have faced severe problems in prosecuting their mandates. University college Hospital, Ibadan (for Neurosciences) and university of Nigeria Teaching Hospital, Nsukka (for cardiovascular Diseases) have their meager grants only for commencing the installation of facilities. Their programs are stalled by problems of inadequacy of funds and new staff development. Ahmadu Bello University, Zaria (for Oncology) and University of Maiduguri Teaching Hospital, Maiduguri (for Immunology and Parasitic diseases) have not substantially utilized their grants because they lack the expert staff to help establish their programs.
Unfortunately, our HCDS is performing below expectations. HCDS in Nigeria has suffered most severely from brain drain as numerous academic and health care professionals have traveled and remained abroad.
Many people die without knowing the true cause(s) of their death. In the words of Gani (2008), “why did it take so long to discover that I had cancer? It is Nigeria; it is the lack of medical system in Nigeria and the failure of our leaders to work on the medical needs of our people.” He further queried, “I don’t understand how the disease could not be discovered early. I spent so much on my health both in Nigeria and abroad. How come this thing was not discovered by my general doctors in Nigeria and general practitioners in England? The specialist said, this must have been on for years, and it was not discovered.”
The experience of Gani Fawehinmi is one out of a million in Nigeria. His case buttresses the importance of functional specialist hospitals and specialist health care providers in Nigeria. Existing ones are not meeting the needs of Nigerians. With such incidences occurring in the lives of the populace, their confidence and faith in our HCDS will be jeopardized.
According to Al-Mandheri and colleagues (2008), in spite of the high reported rates of medical errors (including use of fake drugs) in various health care systems, most studies of medical errors focus on either analyzing incidents reported or assessing health care professionals’ views. The relation between how people perceive HCDS and counterfeit drugs demands a critical attention.
LOOKING AT SOME PSYCHOLOGICAL THEORIES TO EXP LAIN THE RELATIONSHIP BETWEEN FAKE DRUGS AND PEOPLE’S PERCEPTION OF HCDS
In any situation we only pay attention to a few things. Even when we do become aware of these things, there is considerable pre-processing that is done by brain before it reaches our consciousness. Perception is affected by knowledge. Knowledge of what obtains or what is possible in HDCS affects people’s perception of HCDS.
All situations have behavioral norms that get internalized by participants so they know what they find to be unusual or special. For example, a person screaming and rolling on the floor after receiving an injection in a hospital attracts serious attention. But it will not be a big deal if after the injection the individual got better. The way people attribute effects of fake drugs and their view on HCDS can be looked at using social learning theory (social cognitive theory).
Social learning theory is the theory that people learn new behavior through overt reinforcement or punishment or via observational learning. People learn through observing others behavior. If people observe positive, desired outcomes in the observed behavior, they are more likely to model, imitate, and adopt the behavior themselves. It also suggests that the environment can have an effect on the way people behave (Wikipedia, 2009).
People wish to avoid negative consequence, while desiring positive results or effects. If one expects a positive outcome from a behavior, or thinks there is a high probability of a positive outcome, then they will be more likely to engage in that behavior. The behavior is reinforced, with positive outcomes, leading a person to repeat the behavior. This theory suggests that behavior is influenced by environmental factors or stimuli, and not psychological factors alone.
Psychological factors that can impinge on the consumer’s behavior include motivation, perception, learning, beliefs and attitudes.
Motivation is the force that drives a need that is sufficiently pressing to direct the person to seek satisfaction of the need, for example, health care services.
Perception in this context is the process by which the consumer selects, organizes, and interprets information to form a meaningful picture of his or her health care needs and appropriate health care settings.
Learning changes the health care consumer’s behavior arising from experience. Belief is a descriptive thought that a health care consumer holds about HCDS.
CHAPTER THREE
METHOD PARTICIPANTS
In all, 103 participants completed the questionnaire, of which 36 were male and 67 were females above eighteen years. They were selected through a random sampling technique.
One hundred and nineteen questionnaires (119) were given out to be completed. Nine (9) were not returned and seven (7) were not completely filled.
The health care providers who completed the questionnaire were pharmacists, medical doctors, medical laboratory scientists and nurses. The health care consumers were persons who were not members of the health care providers. The participants in study consisted of 56 health care providers and 47 health care consumers. 37 of the participants filled the questionnaire in pharmacies, 47 in Onitsha General Hospital and 19 in primary school classrooms.
The participants were drawn from Onitsha urban. As of 2005 Onitsha had an estimated disputed population of 561,106 (Wikipedia, 2009). The ingenious people of Onitsha are primarily of Igbo ethnicity, although there are other ethnicities such as the Hausa, Yoruba, Igala and a few foreigners.
46 participants were from Onitsha North, 49 from Ogbaru, 5 from Idemili North and 3 from Onitsha South Local Government Areas of Anambra State.
The mean ages are 37.2, 34.2 and 42.8 for all the participants, female participants and male participants respectively. Also, the standard deviations are 12.8, 10.3 and 7.6 respectively. Equally, the variances are 164.3 for all participants, 105.9 for female participants and 58.4 for male participants.
INSTRUMENT
A questionnaire was used for the study. It contained 32 items. The response format adopted for the instrument was the 5-point Likert scale by which the responses of the participants were
weighted positively thus: strongly agree 5 points, agree 4 points, undecided 3 points, disagree 2 points and strongly disagree 1 point.
CHAPTER FOUR
RESULT
Table 1 : shows The use of fake drugs in health care delivery system will have relationship with people’s perception of health care delivery system.
CHAPTER FIVE
DISCUSSION AND CONCLUSION
DISCUSSION
The study investigated the relationship between fake drug use in health care delivery system (HCDS) and people’s perception of health care delivery system. There was a significant relationship. This result was in an agreement with similar earlier works.
In the study on challenge of counterfeit drugs by Erhun and Babalola (2001), the availability of counterfeit drugs in HCDS was confirmed as over 71% of the respondents in the study indicated. Also, in the study by Odili, Osemwenkha and Okeri (2006), over 74% of the respondents considered counterfeit drugs as a major problem in Nigeria.
In 1998, a similar study by Ogori Taylor revealed that 49.6% of drugs sold in open market were fake, and that 12.8% of this number resulted in fatalities. The study also revealed that those drugs led to 10.8% therapeutic failures.
Looking at Pearson product-moment correlation coefficient study value, (r: 0.60), and Pearson critical value (r: 0.497; p < 0.05), there is a significant positive relationship between the use of fake drugs in HCDS and attitudes and behaviors of people towards HCDS.
Therefore, the hypothesis that there will be a relationship between fake drug use in HCDS and people’s perception of HCDS holds.
Also, the hypothesis, “Fake drugs as drugs with insufficient therapeutic benefits will have relationship with worsening of disease conditions” was confirmed. Furthermore, the third hypothesis, “There will be a relationship between disease complication because of fake drug use in HCDS and health care consumers’ confidence in HCDS” was supported by the results of the study.
Though the results of the study confirmed that people’s perceptions of the HCDS, disease complication and health care consumers’ confidence in HCDS were influenced by fake drugs, the relationships were not as high as expected. After all, fake drugs are both health risks and threats to life. People would be expected to react vigorously to HCDS where such drugs existed.
Perhaps, the amount information on fake drugs available to the public could be so low to push them to react significantly. The media coverage provided on the problem was inadequate. Most probably, they were denied such pieces information.
People have weaker schemas for fake drugs than for genuine ones because the general public has fewer experiences (and thus, fewer cognitive associations) with specific cases of fake drug problems. Thus people’s perceptions are more malleable and open to alteration. As such, this study implies that people are more likely to depend on peripheral information to form impressions of fake drugs.
Health care providers appeared to be highly knowledgeable on the negative effects of fake drugs. However, a good number of them have limited information on the observed effects. This could be because of poor or no reporting of such cases. Also, without formal documentation or report of cases of fake drugs to the appropriate government agencies by health care providers and consumers, the situation would be played down to the detriment of the health care users.
Furthermore, the inability of government to publicize incidences of fake drugs and counterfeiters could impinge on the attitude of people towards fake drugs.
Limitations: though positive relationships were established in the study, items in the questionnaire might not have tapped the true dispositions of the participants. Confounding variables might have influenced the observed relationships. Such third variables include tight work schedules for some of the participants, and doubt that the confidentiality they were assured of was true.
RECOMMENDATIONS
It has been observed in the study that with increase in the use of fake drugs in HCDS there is also a positive increase in the problems associated with them.
Therefore, the following recommendations will reduce the problems of fake drugs in HCDS:
- Governments (at local, state and federal levels) should on periodic basis make known to public health care facilities, institutions, organizations and individuals that use, supply and or produce counterfeit
- Information on incidences of adverse effects of counterfeit drugs should be disclosed to the public as they
- A further study on the adverse effects of counterfeit drugs is necessary togenerate research information on specific
Conclusion: In a broader sense, more experimental quantitative research should be conducted to empirically verify what this descriptive qualitative study has found. In the meantime, this study provides an empirical perspective to the belief that fake drugs are health risks, poisonous and threats to life.
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