The World Health Organization (WHO) has estimated that nearly two billion people lack access to essential, life-saving medicines (1) – a basic human right. Save the Children healthcare facilities like the stabilisation centre in Maiduguri, Nigeria, are key to accessing these medicines for the children and families that use them.
However, the availability of these medicines is only one small part of the puzzle in the provision of life saving treatment. Medicines availability is conditional to effective planning, sourcing, use and management of medicines. These aspects are intertwined and need to be achieved simultaneously to ensure access to quality medicines.
Like access to medicines, food insecurity is a growing problem worldwide and affects many of the children that access Save the Children health care facilities. According to the WHO, undernutrition is responsible for almost half the deaths of children under 5 worldwide (2).
Of the estimated 2 million children in Nigeria suffering from Severe Acute Malnutrition (SAM), only 20% receive treatment (3). Habibah* was one of the lucky ones.
Habibah's story
Habibah’s mother grew concerned when parts of her child’s small body began to swell up, her belly, face and her feet. Protein insufficiency, which forces fluid from the blood vessels to accumulate in the tissues and areas under the skin, causes the oedema or swelling.
Habibah was just 3 years old when she was brought to the stabilisation centre in Borno, Maiduguri, North-eastern Nigeria. However, she weighed only 10.3kg, the weight expected of a child less than half her age. Her mid-–upper arm circumference, a measure used to determine the severity of her malnutrition was 109mm, indicating severe wasting and increased risk of death. (4) She was so weak that she could not sit up, let alone stand without support and had difficulty breathing, a fever and a cough.
Struggles due to displacement
Habibah’s family had been displaced by the ongoing conflict in the region, which has affected over 2 million people (5) and were struggling to make ends meet. When she arrived at the stabilisation centre, the medical team assessed Habibah’s condition and established a treatment plan for her. They began treatment for severe acute malnutrition in addition to prescribing intravenous antibiotics to treat her temperature, cough and difficulty breathing.
A medicines formulary – a list of medicines approved for use for various conditions and based on national prescribing guidelines – is available to all medical staff working at the stabilisation centre. In Nigeria, this formulary is reviewed and updated regularly. This supports the supply chain teams in predicting what medication is most likely to be required and ordered on a regular basis. In addition, this formulary ensures Save the Children medical teams are always using the most effective medicines available to treat children. The medication prescribed for Habibah was evidence based and provided her with the best chance at recovering from her illness.
More specifically the antibiotic dose prescribed for Habibah was calculated based on her weight. Weight based dose calculation is vital in prescribing medicines for children as weights are so variable in this population. This is even more important for Habibah as her weight is not that of an average three year old. Accurate weight based prescribing and dose calculation is key to ensuring that children receive safe and effective medicines at the correct doses.
A second diagnosis
However, while Habibah’s malnutrition improved, her temperatures and cough did not, prompting the medical team to investigate further. This revealed that Habibah had tuberculosis (TB). She was prescribed medication to treat TB while she completed her treatment for SAM.
When medicines arrive at the pharmacy storeroom, their quality is maintained through appropriate storage. At the stabilisation centre, the secure medical store has been designed to keep its contents at the appropriate temperature. If medicines are exposed to high temperatures, they can degrade, become ineffective or dangerous and could harm the children who take them. The medicines are organised in appropriate sections on the shelves to minimise the risk of stock picking errors and according to expiry dates. The stock levels are carefully monitored to prevent stock outs.
Counterfeit and expired medicine risks
To ensure that medicines are safe and effective, they have to be of high quality. However the WHO has estimated that one medicine in every ten is counterfeit, leading them to be ineffectual at best, and dangerous, at worst.
Antibiotics like the ones Habibah was given to treat her TB are a group of medicines that are most commonly found to be counterfeit. This issue affects health programmes and services on a global scale, but is exacerbated in countries without national monitoring processes to prevent these medicines from entering the market.
To minimise this risk within Save the Children health programmes, medicines are only procured from trusted sources, such as the WHO in the case of the stabilization centre in Maiduguri. In addition, on receipt, medicines are checked thoroughly for any indicators of poor quality, such as visual abnormalities, broken packaging and short expiry dates. This additional step ensures that any poor quality medicines are identified and disposed of before they can harm patients. Any medicines with short expiry dates can be returned to the supplier and used elsewhere so they are not wasted.
Habibah's recovery
For Habibah, this story ends well. Today she is a thriving little girl who loves to play and is known as ‘princess’ by those closest to her. Habibah’s story was one success but others are not as lucky and there is still a long way to go to reach these children and ensure that access to medicines is not a barrier to preventing them from growing up healthy.
At Save the Children, we work exceptionally hard to ensure that the children accessing our healthcare facilities receive effective high quality medicines that will help them to get better. This is a multifactorial but crucial challenge and one that we are continually trying to improve with our incredible pharmacy, supply chain and medical teams to ensure that we provide quality lifesaving medicines to the children and families that need them.
1. World Health Organization. Access to medicines: Making Market forces serve the poor
2. Fact sheets - Malnutrition (who.int)
5. Northeast Nigeria: Displacement Report 36 (May 2021) - Nigeria | ReliefWeb
*name changed to protect child’s identity
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