Why Nigeria Should Embrace Peritoneal Dialysis For Kidney Diseases -Adcem MD
Pharm. Adeyemi Adewole is the managing director and CEO of Adcem Pharmaceuticals Limited. Established 25 years ago, the company is a leading provider of renal care services in Nigeria; its subsidiary Adcem Healthcare Limited, was birthed a few years ago. In this interview with Pharmanews, Adewole who is currently using Adcem Pharmaceuticals Limited to target local production of important renal care pharmaceutical products, speaks on the challenges facing the provision of renal care services in Nigeria and why he went into provision of renal care solution at a time very few people were into the sector. He also speaks on why Nigeria should embrace peritoneal dialysis (PD) products as a means of expanding access to dialysis. Excerpts:
What were your specific objectives when you established Adcem Healthcare?
My decision immediately after graduation from pharmacy school was that I would not want to practise pharmacy the way it was being practiced generally. I did not like the fact that pharmacists had very little control of supply chains and things like that. So, I decided to play in an area where I could apply the professional skills I had to meet the needs of the industry because I was gravitating towards the industry.
This was what attracted me to Fresenius AG of Germany. Their products were very specialised. The parenterals and other consumables, which are things like amino acids and other products – some of whom were not available in Nigeria – were special. It was thus easy to go into that area because it was a specialised niche and we were quickly known for it as there was very little competition. Those looking for these kinds of products come to us because they know they will find them with us.
We later got into the area of kidney disease. At that time, there were only about five centres in the whole of Nigeria. That was in 1992 and that fulfilled my dream of being able to use my professional knowledge in a niche area that was not fully exploited.
What then really influenced your decision to take Adcem fully into the business of pharmaceuticals?
Adcem has always been into the business of pharmaceuticals. There has always been the issue of providing supplements for the treatment of kidney disease and there are a number of pharmaceuticals needed for renal care which we handled together. But, yes, we decided to focus more on it by establishing Adcem Pharmaceuticals to operate side-by-side with Adcem Healthcare.
The number of centres available to take care of patients with renal conditions in the country is inadequate. Having operated in the sector for 25 years, what should we be doing as a nation to expand access of this critical care to those who needs it?
Let me first state that everywhere in the world where they have a successful renal care programme, it is the government that pays for and provides it. This is the case in USA, Germany and other countries. This is because dialysis is the most expensive form of medical treatment.
To manage chronic kidney disease, the patient has to continually be on treatment. Therefore, this treatment can never be viable for insurance companies, as even private health insurance can only give few sessions of dialysis before the government takes over. So, what is done is a reimbursement programme in developed countries. In some of these countries, when private companies establish these centres, they know it will be viable because they know that government will partner with them.
In Nigeria, that is not the case. Here, people have to pay for treatment from their pockets and it is difficult because it is expensive. It is not affordable for anybody. They have to pay between 30,000 and 45,000 naira per session; and sometimes, the patient needs three sessions in one week. This is the main reason we don’t have these centres because their services are not affordable to Nigerians and thus there will be a challenge of patronage if and when established.
However, let me emphasise that infrastructure is also a main cause of not having these centres. Lack of needed infrastructure generally is a big problem in Nigeria. Most of the dialysis done here are haemodialysis, where you need advance water treatment to get ultra-pure water. You need dialysis machines, nephrologists, dialysis nurses and dialysis technicians. You need people who are trained and have the needed equipment to operate. Without infrastructure and the experts, it will be difficult to replicate and catch up with the requirement as it is in rest of the world.
In a resource-challenged environment like ours, therefore, I think what we should do is to embrace Peritoneal Dialysis (PD). This is done using a pharmaceutical product. It is a fluid that is released into the peritoneum of patients. The peritoneum then does the filtering.
How affordable is peritoneal dialysis?
It should be more affordable if it is manufactured in the country and if government embraces the idea and supports it because it is not just a case of affordability alone; it has to be used continuously every day and if there is a break, there is a problem. That means, the product must be available. Therefore, with local production and production in larger volumes, price will not be a big issue.
The main advantage of this is that patients don’t need to go to hospital to get this treatment as it can be administered at home or at the Primary Healthcare Centre level. So distributing the product and ensuring access to it will be a lot easier and will help bridge the gap in access, compared to haemodialysis that relies on infrastructure like power supply, a lot of special manpower and other things.
This is basically going to be just about logistics: training people on how to do it; the basic hygiene requirements to adhere to; and how to connect the health professionals from the tertiary level to the primary level to the provision of this care. We have to just look at it and embrace it from a public health perspective and not see it as one super specialty. That is what Adcem is trying to do.
Which countries in the world are currently using peritoneal dialysis?
Many countries are using it but let me say that in the world generally, peritoneal dialysis is about 20 per cent of all the dialysis done. That means haemodialysis is about 80 per cent and it is because most of the dialysis is done in the developed countries where they don’t have problem of infrastructure. It is thus a choice for the doctors.
But, to answer your question, Mexico, which can be regarded as a developing country like Nigeria, and which equally has infrastructure challenge like Nigeria, has embraced peritoneal dialysis. Most of the dialysis done there is peritoneal dialysis. 70 per cent of the dialysis in Mexico is peritoneal dialysis. This has enabled them to reach many more people who need it in rural and remote areas of the country. This has helped Mexico to expand access of this crucial health care needs to more people.
The product is part of what Adcem is trying to manufacture as part of our parenterals. We have been providing peritoneal dialysis solution and training for the past 18 years and it has only been used mainly for acute situations, especially in children, to great success because it is usually for a short period of two to three days. But what we are working on is the creation of a protocol to enable most people to know what to do in an acute situation to save children. This is because the expertise and the information that it is available is not out there. Lives that could be saved are being lost. Sometimes during delivery, there are instances of acute renal failure and we can save a lot of lives with PD.
How is this project shaping up and how are you surmounting the inherent challenges with setting up a manufacturing plant in this clime?
Yes, there are challenges. Financing is a big challenge. But, our decision is to move forward come what may and we are not going to allow anything to stop us.
We are acquiring the needed equipment and doing what we have to do. We are doing it in phases. We are not going to wait until everything is completely in place before starting our operation. We are starting with non-sterile products.
When will the first set of products from the plant come out?
The first set of products will be out by the end of this year 2017.
Adcem Pharmaceuticals has been in operation for about 25 years and now there is also Adcem Healthcare. Where do you hope to see these companies in the next 10 years?
Adcem Healthcare is 25 years and we recently celebrated our 25th anniversary which we themed “Social Enterprise in Healthcare”. This is because we want to be known as a company that focuses on social enterprise because we are a company established to help solve social problems.
We want to make services and products available to people especially those at the lower rung of the ladder who have limited resources to pay for such products or/and services. There are also people who are at a disadvantage in getting these services because of their location and we want to ensure they get the access.