Medical Sciences Project Topics

Relationship Between Fake Drugs and People’s Perception Healthcare Delivery System in Onitsha Urban

Relationship Between Fake Drugs and People’s Perception Healthcare Delivery System in Onitsha Urban

Relationship Between Fake Drugs and People’s Perception Healthcare Delivery System in Onitsha Urban

Chapter One


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.



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.




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.



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.




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.


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:

  1. 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
  2. Information on incidences of adverse effects of counterfeit drugs should be disclosed to the public as they
  3. 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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