CHAPTER ONE

INTRODUCTION

1.1 Background Of Study

The importance of a good health-care delivery system for any population is self-evident and can not be overstated. A healthy person is a significant asset not just to himself, his family, and society as a whole. The World Health Organization (WHO) defined health in 1948 as a condition of whole physical, mental, and social well-being, rather than simply the absence of sickness or infirmity. The World Health Organization (WHO) said in the Ottawa Charter for Health Promotion in 1986 that "health is a human right.""Not the goal of existence, but a resource for everyday life. Health is a positive term that emphasizes social and personal resources in addition to physical abilities. " Physical, mental, emotional, and social well-being are all important components of overall health. To attain total health, we require health care delivery systems (HCDS) that can provide high-quality medical treatment while also being responsive to the health needs and expectations of the populations they serve. Health care delivery, on the other hand, is the prevention, treatment, and management of illness as well as the maintenance of mental and physical well-being through the services provided by the medical, nursing, pharmaceutical, dental, clinical laboratory sciences, and allied health professions (Wikipedia, 2009).

Health care delivery, according to WHO, encompasses all commodities and services aimed at promoting health, including "preventive, curative, and palliative interventions, whether directed at people or communities." A health care delivery system is a system that organizes the provision of such services. When fraudulent pharmaceuticals are utilized in health care delivery, the basic goal of the system, which is to achieve general health, is not met. By examining the levels of health care delivery systems, the relationship between fake drugs in the healthcare delivery system and how people view health care delivery systems will be better understood. 9 Lunde (1990) identified four key levels of care in all health-care systems:

1.Prioritize self-care.

2. Professional primary care.

3.Secondary care, or general specialized care.

4. Super-specialty care, i.e., tertiary care, is the fifth level of care.

5. quaternary care, which is the fifth level of care.

Self-care is defined by the World Health Organization as "actions that individuals, families, and communities engage in with the goal of improving health, avoiding disease, reducing illness, and restoring health." These activities are based on a combination of professional and non-professional knowledge and abilities. They are carried out by laypeople on their own behalf, either alone or in collaborative partnership with professionals. " The ability to take appropriate action (s) to achieve overall health will be manifested by an individual's self-care skills and knowledge. Knowing when to seek professional treatment, gathering information on what type of care to seek, and knowing where to acquire desired medical services are examples of such behaviors. Media reports (print and electronic) and lay information on fake drug incidents and consequences can affect a person's decision on how to obtain health treatment. As a result, it's crucial to figure out the link between false drug use in HCDS and how it influences people's perceptions of the disease.

Primary health care (PHC), as defined in the Alma-Ata Declaration (1978), is essential health care based on practical, scientifically sound, and socially acceptable methods and technology that is universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the community. Promotive, preventive, and rehabilitative health care are all aspects of primary health care. Immunization against the primary infectious diseases: measles, whooping cough, diphtheria, polio, tetanus, and TB, as well as other components of the National Health Policy, are included in PHC-based health services. 10 When false vaccinations are used and no immunity is imparted on the immunized, those who are inoculated are more likely to develop the disease.

 Secondary health care refers to services offered by medical specialists who do not often see patients first, such as cardiologists, urologists, and dermatologists. A physician may choose to confine his or her practice to secondary care by denying patients who have not seen a primary care provider first, or a physician may be forced to limit his or her practice in this fashion, usually via various payment agreements (Wikipedia, 2009).

 Tertiary health care is specialized consulting care provided by specialists working in a center with staff and facilities for particular investigation, diagnosis, and treatment, usually on recommendation from primary or secondary health care personnel (Wikipedia, 2008).

 Quaternary health care refers to the highest level of medicine, which is highly specialized and not frequently used (Intota, 2009). It includes providing medical care to patients in areas such as cardiac care, orthopedics, neurosciences, cancer, and renal care, among others. Given the current state of affairs in Nigeria, the environment is extremely stressful, and nearly everyone's health is jeopardized in some way. In times like these, our health-care system should bring relief to Nigerians, who are constantly on edge (Adelusi-Adeluyi, 1995). Unfortunately, the use of phony medications in our health-care delivery has exacerbated this painful scenario. It's worth noting that decisions about the authenticity of the drugs one takes, as well as the suitability and competency of health-care facilities and employees, demand a lot of thought. Because of Nigeria's unstable drug distribution, the risk of being a victim of counterfeit drugs is very high. After all, securing a property with over a thousand doors is more difficult than securing one or two doors. In Nigeria, there are a lot of handlers (intermediaries) involved in drug distribution. Each intermediary represents a possible entrance route for counterfeit medications. "A counterfeit medicine is one that is purposefully and fraudulently mislabeled with respect to identification and/or source," according to WHO (2006). Counterfeit products might include products with the exact ingredients or the incorrect components, products without active ingredients, products with insufficient active ingredients, or products with phony packaging. "A fake drug is defined in Nigeria's Counterfeit and Fake Drugs and Unwholesome Processed Foods (Miscellaneous Provisions) Decree 1993, as modified.

a. Any drug or drug product that isn't what it claims to be; or b.Any drug or drug product that isn't what it claims to be.

b. Any drug or drug product that is so colored, coated, powdered, or polished that the damage is hidden, or that is made to appear better or of greater therapeutic value than it really is, that is not labeled in the prescribed manner, or that has any statement, design, or device on the label, container, or anything else that comes with the drug that makes a false claim about the drug or that is false or misleading.

c. Any drug or drug product whose container is constructed, manufactured, or packed in such a way that it is deceptive; or

d. Any drug product with insufficient instructions for use and adequate warnings against using it in pathological circumstances or by children where it may be harmful to their health, or against using it in unsafe dosages, methods, or durations; or

e. Any drug product that has not been registered by the National Agency for Food and Drug Administration and Control (NAFDAC) in line with the Food, Drugs and Related Products Act (FDRA) (Registration, etc.).

The most serious error that can occur in HCDS is the use of counterfeit medications. It's a mistake because neither the health care professional nor the patient is aware that they're taking the wrong medication. Fake pharmaceuticals are destroying the essence of the health-care delivery system (HCDS) as well as people's trust in it. Counterfeiters are involved in every aspect of the pharmaceutical sector, from life-saving pharmaceuticals like HIV/AIDS, antituberculosis, anticancer, antidiabetic, and antihypertensive drugs, to recreational drugs. Many pharmaceutical producers who spend a lot of money on research, development, and distribution of legitimate pharmaceuticals are being pushed out of business by fraudulent drug makers, threatening the viability and functionality of our HCDS. 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 and Health care providers’ perspective

1.2 Statement of problem

Counterfeit drugs are suspected of being poisonous, toxic, life-threatening, posing health risks, lacking therapeutic utility, and providing insufficient therapeutic benefits, and can result in treatment failures, death, disease complications, worsening disease conditions, drug resistance, delayed recovery, and human organ damage. Because of these consequences, both health care professionals and consumers have lost faith in our health-care delivery system. Previously, the Nigerian government, through regulatory organizations such as NAFDAC, has made significant attempts to address this issue. The regulatory agencies have raised public awareness about fake drugs, ensured that drugs in use in Nigeria are approved and registered, banned known fake drug manufacturers from marketing their products in Nigeria, re-inspected manufacturing facilities to ensure that they still meet appropriate standards, and imposed harsh penalties on those caught with fake drugs. In addition, the agencies have worked with some foreign governments to ensure that pharmaceutical firms in those nations only ship genuine pharmaceuticals to Nigeria.

1.3 Objective Of Study

The following are objectives of this study:

1. To examine if poor health care delivery system contributes to the prevalence of fake drugs in Nigeria.

2. To assess the major factors affecting adequate health care delivery system in Nigeria?

3. To assess the implication of the prevalence of fake drugs in Nigeria.

1.4 Research Question

The following research questions guides this study:

1. Does poor health care delivery system contributes to the prevalence of fake drugs in Nigeria?

2. What are the major factors affecting adequate health care delivery system in Nigeria?

3.  What are the implication of fake drugs the prevalence in Nigeria?

1.5 Significance of study

This study will be useful to both the government and the general public. People's dedication to their health care needs should be increased. Motivate people to guarantee that the quality of pharmaceuticals, health-care services, and the qualifications of their health-care practitioners meet government standards. Encourage people to get the self-care information and skills they need to take a more active role in promoting their own health and altering the conditions that affect it.

This study will contribute to the current literature in this field and will also serve as a resource for academics, researchers, and students who may want to do future research on this or a comparable topic.

1.6 Scope of study

This study focuses on evaluating the perception of citizens on healthcare delivery system and fake drugs. Furthermore, the study will also examine if poor health care delivery system contributes to the prevalence of fake drugs in Nigeria, assess the major factors affecting adequate health care delivery system in Nigeria, and the implication of the prevalence of fake drugs in Nigeria. The enrolled participants for this study will be obtained from family women resident in Oshimili North Local Government Area of Delta State.

1.7 Limitation of study

Finance,inadequate materials and time constraint were the challenges the researchers encountered during the course of the study.

1.8 Definition of terms

Health Care Delivery System: A health care delivery system is an organization of people, institutions, and resources to deliver health care services to meet the health needs of a target population.

Fake Drugs: Fake drugs include those with less or none of the stated active ingredients, with added, sometimes hazardous, adulterants, substituted ingredients, completely misrepresented, or sold with a false brand name.

CHAPTER TWO

REVIEW OF LITERATURE

INTRODUCTION

Our focus in this chapter is to critically examine relevant literature that would assist in explaining the research problem and furthermore recognize the efforts of scholars who had previously contributed immensely to similar research. The chapter intends to deepen the understanding of the study and close the perceived gaps.

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