The Potential of the m-Health Platform to Safeguard Public Health

The Nigerian Example

Allen Nnanwuba Adum, Uche Patricia Ekwugha and Ngozi Marion Emmanuel

Department of Mass Communication, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria

Keywords: Mobile Authentication Service, Public Health Informatics, Fake Drugs, m-Health.

Abstract: Nigeria has a problem with fake drugs. This issue got to an intolerable height in 1989 when over 150

children died as a result of ingesting paracetamol syrup containing diethylene glycol. The National Agency

for Food and Drug Administration and Control (NAFDAC) was formed in 1993, as an agency under the

Nigerian federal ministry of health, to check the tide of fake drugs and adulterated products. To achieve this

mission, NAFDAC, in 2010, launched the Mobile Authentication Service (MAS) – a mobile-phone m-

Health platform, which empowers medication drug users to instantaneously verify the authenticity or

otherwise of a medication drug before purchase. This study sought to ascertain the workability of MAS

among medication drug users; and factors negating this platform. The study was designed as a survey. Data

was collected from 400 medication drug users in Lagos state, Nigeria, through a structured survey. Results

show that 91 percent of the respondents were aware of MAS and 53 percent among these utilized it prior to

purchasing medication drugs, while 9 percent were neither aware of MAS nor utilize it. The notable barriers

to the use of MAS found in this study were lack of awareness and the unreliable nature of the MAS.

1 INTRODUCTION

Mobile telephony, popularly known as GSM, was

introduced in Nigeria in the year 2001. Prior to this

development, Nigerians relied on telephone

landlines provided by state-owned telecom service,

NITEL (Nigerian Telecommunications). Today,

with the advent of mobile telephony, 118,850,928

Nigerians have been connected to GSM lines. Out of

this number, 553,425 actively use their mobile

phones (WWW.ncc.gov.ng). This was not obtainable

in the era of landline phone services in Nigeria.

Mobile telephony has engendered many

possibilities. Nigerians have been empowered to

make and receive calls from any part of the country,

once there is network coverage by any of the

operational telecom services. Also, SMS could be

sent and received in a matter of minutes or even

seconds. Nigerians no longer need to go and stand in

queues at NITEL call centres or phone booths to

make calls; neither do they need to write letters

which might take days, weeks or even months to get

to their various destinations. The Internet can now

be accessed on the go by owners of mobile phones.

This situation brings to mind the reality of Marshall

McLuhan’s idea of a Global Village.

In recent times, the use of mobile telephony has

gone beyond the conventional calls and SMS.

Today, mobile phones are being used as m-Health

tools. Mobile Health, also known as mHealth or m-

Health implies the use of mobile communication

devices such as mobile phones for health services

(Cipresso et al, 2012). One good example of m-

Health is the Mobile Authentication Service (MAS)

introduced by Nigeria’s National Agency for Food

and Drug Administration and Control (NAFDAC) in

the year 2010. According to Osuolale (2011:3) “this

is a world-first, showing the pro-active [stance] of

Nigeria in the global fight to rid the world of fake

medication.”

Nigeria is the largest medication drugs market in

Africa. The issue of fake pharmaceuticals has been a

problem in. Nigeria. Nigeria imports 70 percent of

its drugs from India and China, two main sources of

fake and adulterated pharmaceutical products. Also,

The World Health Organization reports that, 70

percent of drugs in circulation in Nigeria are

counterfeit (WHO Report 2014). Again, Osibo

(1998) observes that there may be more fake drugs

than authentic drugs in circulation in Nigeria.

Akuyili (2005) notes that drug counterfeiting started

383

Adum A., Ekwugha U. and Emmanuel N..

The Potential of the m-Health Platform to Safeguard Public Health - The Nigerian Example.

DOI: 10.5220/0005215203830389

In Proceedings of the International Conference on Health Informatics (HEALTHINF-2015), pages 383-389

ISBN: 978-989-758-068-0

 2015 SCITEPRESS (Science and Technology Publications, Lda.)

in Nigeria way back in the 60s; meaning, Nigerians

have been dying from fake drugs for decades. “

According to Davison (2011) and Bansal, Malla,

Gudala and, Tiwari (2013), a counterfeit medication

or a counterfeit drug is regarded as a medication or

pharmaceutical product which is produced and sold

with the intent to deceptively represent its origin,

authenticity or effectiveness.

In 1988, the World Health Assembly passed a

resolution requesting every member-nation to help

combat the menace of counterfeit drugs. Barely a

year after this resolution, the issue of deaths from

fake drugs in Nigeria became unbearable with the

deaths of 150 children as a result of ingesting

paracetamol syrup which contained diethylene

glycol.

The World Customs Organization estimates that

the fake drug market is a $200 Billion a year

industry; with a strong base in developing

economies. Also, the World Health Organization

estimates that 30 percent of drugs in developing

economies are faked and may be very harmful to

consumers.

In order to check fake and adulterated drugs in

Nigeria, the government established the NAFDAC

in 1993; and in 1994 it became a full agency under

the federal ministry of health.

In pursuit of its mandate, NAFDAC, on the 2nd

of February 2010, launched the first Mobile

Authentication Service (MAS) on anti- malaria drug,

Lonart-DS, marketed by Greenlife Pharmaceuticals,

Nigeria. MAS is a technology-based anti-drug

counterfeiting mobile telephony initiative, developed

by Sproxil Incorporated. Sproxil is a privately-

owned company founded in 2008 (and incorporated

in 2009) by Ghanaian-born Ashifi Gogo, a

Holekamp Family Ph.D. Innovation Fellow at

Dartmouth College. Sproxil provides a consumer

SMS and App. product verification service which

help consumers avoid purchasing counterfeit

products. Sproxil has operations in Ghana (serving

West Africa), Nigeria, Kenya (serving East Africa),

and India (Sproxil Solutions, 2014).

NAFDAC’s Mobile Authentication Service,

drug consumers to confirm the authenticity or

otherwise of a particular drug at the point of

purchase. The technical components of MAS include

a scratch panel pre-printed by Sproxil that can be

affixed on packs of medication or printed codes

embossed directly by manufacturers on medication

packs; mobile phone and GSM network service host

the Sproxil authentication portal. All the consumer

needs to do is to scratch the panel on the drug pack

and text a 12-digit number on it to 38353 without

paying any charges. A confirmatory message as to

the authenticity of the drug should come in a matter

of seconds.

Figure 1: How MAS works.

But the question is: is this as seamless as it sounds?

The lead author of this paper got a Lonart anti-

malarial drug on the 21

of January 2014, and sent

the pin (182032090421) to 38353 by 07:22 pm. Up

until now he’s yet to get the confirmatory message

from 38353. How many Nigerians face this kind of

situation? Does it make them unwillingly to utilize

MAS or perceive the service as unworkable? How

many are indeed aware of the existence of MAS?

Scratch-off

panel on pack for

12 digit PIN

Text 38353 using

mobile phone

Purchase

Confirmatory

message

Network Service

hosting Sproxil

ortal

Authentication by

Sproxil portal

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These questions are pertinent because, negligible

utilization of m-Health tool such as MAS, as a result

of certain barriers would amount to a big waste of

public informatics which would have otherwise

enhanced public health.

2 AIMS OF STUDY

The main aim of the study was to investigate the

utilization of NAFDAC’s Mobile Authentication

Service (MAS) among Nigerian medication drug

users and barriers to utilizing this innovation. The

study sought answers to the following questions:

1. Who among Nigerian medication drug users are

aware of NAFDAC’s Mobile Authentication

Service?

2. How many of these medication drug users indeed

utilize NAFDAC’s Mobile Authentication

Service?

3. What are the barriers to the utilization of the

Mobile Authentication Service?

3 METHOD

This study was designed as a survey. Focus was on

Lagos State, Nigeria. Lagos is a cosmopolitan city.

This city is also a major seaport and with a

population (according to Nigeria’s 2006 population

census) of 17.5 million (a population that is larger

than the population of Rwanda, 11.46 million

according to CIA World Fact book), it is the most

populous city in Nigeria This strategic position of

Lagos makes it a good starting point for almost

every innovation in Nigeria. This had informed

situating this study in Lagos State, Nigeria.

A sample of 400 medication drug users was used

for the study. This sample was arrived at using Taro

Yamane’s formula for determining sample size n=

N/1+ N (e)

. By a simple random sample we

selected 10 Local Government Areas from the

available 21 LGAs, using table of random digits,

The Local Government Areas are: Ojo; Amuwo-

odofin; Badagry; Alimosho; Ifako-ijaiye; Ikeja;

Surulere; Mushin; Ikorodu and Apapa. A validated

questionnaire was used as research instrument. Four

hundred copies of the questionnaire were distributed

at the rate of 40 copies per local government area;

389 completed surveys were returned, representing a

response rate of 97 percent.

A series of questions were asked on awareness of

NAFDAC’s Mobile Authentication Service;

utilization of Mobile Authentication Service and

barriers to the utilization of Mobile Authentication

Service.

4 THEORETICAL BASIS

This study was anchored on The Health belief

Model (HBM). The HBM is a psychological model

first developed in the 1950s by social psychologists

Hochbaum, Rosenstock and Kegels. HBM is used to

explain and predict health behaviors. In the light of

this, the core assumptions of this study, in line with

the HBM framework, are that a medication drug user

will take a health-related action (i.e., use Mobile

Authentication Service) if they:

1. feel that a negative health condition (ailments as

a result of ingesting fake drugs) can be avoided,

2. have positive expectations that by taking

recommended action, he/she will avoid

negative health condition (i.e., using Mobile

Authentication Service will be effective in

helping them not to purchase fake drugs), and

3. believe that they can successfully take a

recommended health action (i.e., they can use

Mobile Authentication Service withou

difficulties) (Rosenstock, 1974).

5 RESULTS

The distribution in the sample was 37 percent male

and 63 percent female. One third of the medication

drug users are civil servants, one quarter

professionals, one sixth business people, one eighth

university students, one twentieth artisans and self-

employed persons, one fortieth farmers and one

sixtieth unemployed persons. The majority of these

medication drug users were within the 18-30 age

bracket. Data also show that 52 percent of the

respondents were single, 47 percent married. The

remaining one percent were either separated or

divorced.

In terms of educational qualification, about two

thirds of the respondents indicated that they have

had secondary education; about 17 percent had first

degrees or above while the remaining one fifth did

not indicate any chosen option for the question.

We can therefore say that our respondents are

young persons who fall mainly within the middle

and lower classes of the Nigerian society.

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5.1 Purchase of Medication Drugs

over the Counter

Here we attempted to establish who among the

respondents engaged in over the counter drug

purchase. Survey question five in the questionnaire

was used for this purpose.

Figure 2: Respondents who purchased drugs over the

counter.

The study found that over two thirds of the

respondents purchased medication drugs over the

counter, while 12 percent were affirmative that they

did not purchase medication drugs over the counter.

It appears logical to say that our data suggest that a

majority among the respondents at one point in time

have purchased medication drugs over the counter.

5.2 Sources of Drug Supply

Figure 3: Respondents’ main source of drug supply.

Our data suggest that more of the respondents had

Chemist shops as their main source of drug supply;

‘Chemist’ as they are popularly known in Nigeria

are drug stores closer and more accessible to the

ordinary citizenry. Figure 3 shows that 51 percent of

the respondents purchased medication drugs from

Chemist shops; a little above two fourths got drugs

from pharmacy stores while 12 percent got drugs at

hospital dispensaries. One percent of the respondents

said they got drugs from hawkers. The ‘Chemist’ or

‘Patent medicine store’, by virtue of being run by

people who might not be regarded as well trained

medical personnel – even though most are

government-registered – could become fertile

grounds for the sale of fake drugs to unsuspecting

members of the Nigerian public. That large number

of people patronise the ‘Chemist’, as data in this

study show, points to the need to utilize the MAS at

the grassroots.

5.3 Ownership and Use of Mobile

Phones

Table 1: Ownership and use of mobile phones.

Own

mobile

phones

(N=389)

(%)

Own

mobile

phones

with text

message

features

(N=389)

(%)

Respondents

who wrote text

messages

(N=389)

(%)

Yes

100

Total 100 100

100

Our data show that 97 percent of the respondents

own mobile phones; virtually all these mobile

phones have features for text messaging. This is

against three percent that do not own mobile phones

and seven percent that own mobile phones but

cannot write text messages. Ninety-three percent of

the respondents claimed they could write text

messages.

Technology is something that appears to take

time before people get accustomed to it. Having the

right literacy means the ability to use ICT devices

like the text messaging feature on mobile phones.

Not having the necessary literacy apparently

accounts for the inability of seven percent among the

respondents to use mobile telephony text messaging

feature.

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5.4 Awareness of the Existence of

NAFDAC’s Mobile Authentication

Service

Figure 4: Respondents who have heard about NAFDAC’S

MAS.

The data in Figure 4 show that as at the time of this

study, majority of medication drug users studied in

the Lagos area were aware of the existence of

NAFDAC’s Mobile Authentication Service. Only 9

percent of the respondents affirmed not knowing

about the existence of MAS. This data would

suggest that NAFDAC’s public enlightenment

campaigns have been largely successful in

sensitizing the public on the need to safeguard their

health through the utilization of MAS; but more still

needs to be done by way of enlightenment to

consolidate the gains already made.

5.5 Sources of Information about

NAFDAC’s MAS

Figure 5: Respondents’ sources of information about

NAFDAC’s MAS.

On the question of sources of information on

NAFDAC’s MAS, the study found that 67 percent of

the respondents indicated that they got to know

about the NAFDAC’s MAS through enlightenment

campaigns on television (Figure 5); Seventeen

percent of the respondents said they got to know

about MAS through associates, while 16 percent of

the respondents said they got to know about MAS

via the Radio. None of the respondents chose the

Magazine, Newspapers, Billboards or Posters as the

medium through which they got to know about

MAS; therefore they were not reflected in our

presentation.

5.6 Utilization of NAFDAC’s MAS

Figure 6: Respondents who have used MAS to confirm the

authenticity of Medication drugs before purchase.

With regard to the respondents’ utilization of

NAFDAC’s MAS to authenticate medication drugs

before purchase, we found that a little above two

fourths of the respondents who said they were aware

of MAS also said they have used it to confirm the

authenticity of medication drugs before purchase;

while over two fifths among these respondents were

not affirmative as to having used MAS to

authenticate medication drugs before purchase.

5.7 Barriers to Utilizing NAFDAC’s

MAS

Data in Figure 7 show that close to 40 per cent of the

respondents who used NAFDAC’s MAS had some

difficulties; notably, delayed or non-arrival of

confirmatory SMS messages indicating whether a

drug about to be purchased is genuine or not; while

61 percent said they had no problems using the

mobile service. Network coverage is one issue that

negates the operations of the authentication portal in

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Figure 7: Respondents who have difficulties using MAS to

confirm the authenticity of Medication drugs before

purchase.

relaying confirmatory message to medication drug

users. Overall, the picture here is that MAS, going

by the number of people who could use it without

difficulties, as suggested by the findings of this

study, has the potential to be a workable m-Health

platform to safeguard the medication drug users

from purchasing and ingesting fake drugs.

5.8 Workability of NAFDAC’s MAS

Figure 8: Respondents’ perception of the workability of

NAFDAC’s MAS.

Part of this study examined how the respondents

perceived the workability of NAFDAC’s MAS. The

data in Figure 8 reveals that 33.percent of the

respondents believe that NAFDAC’s MAS is

workable in Nigeria, while 67 percent believe

otherwise. The fact that the service is balky might be

the basis for the position of those who do not believe

in the workability of this m-Health platform.

6 SUMMARY AND CONCLUSION

Our data show that our respondents are mainly

young persons who come from the middle and lower

classes of the Nigerian society.

The study found that more of the respondents are

aware of NAFDAC’s Mobile Authentication Service

and a greater percentage among them use the mobile

service before making purchase decisions. The data

suggest that nearly all medication drug users studied,

whose phones have text messaging features, can

actually compose text messages. Our data also

indicate that not all medication drug users who own

mobile phones, and were aware of MAS, utilized the

Mobile Authentication Service to verify the

genuineness or otherwise of pharmaceutical

products.

On the workability of the MAS m-Health

platform, a sizeable number of the respondents who

used the MAS, encountered difficulties ranging from

delayed confirmatory messages to non-arrival of

confirmatory messages. However, a significant

number of MAS users expressed high hopes of its

workability in Nigeria.

Overall, the findings of the study suggest that the

potential to safeguard public health through the

NAFDAC’s MAS m-Health platform is feasible and

with little effort at technical reappraisal and

improvement, the MAS innovation could be a

critical element that could assist Nigeria in the fight

against fake drugs which are harmful to medication

drug users.

7 RECOMMENDATIONS

Based on the findings of this study, it becomes

imperative to make recommendations that could

help NAFDAC, as well as relevant stakeholders who

may find the contents of this research helpful. These

recommendations are as follows:

 NAFDAC should as a matter of necessity,

intensify efforts on massive integrated awareness

creation on its Mobile Authentication. Service.

This is because, the relative success or failure of

an initiative, irrespective of how noble, is

measured by the level of awareness and

acceptability by its targets. Statistics gotten in the

course of this study suggest high level of

awareness, but more needs to be done to further

consolidate this gain.

 NAFDAC should also bear in mind that not

everyone who owns mobile phones that are text

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messaging-enabled, can write text messages.

This is another pitfall to the Mobile

Authentication Service, because even when

medication drugs users are willing to utilize

MAS, they may be deterred by the inability to

compose text messages. Special considerations

should be given to this category of persons in the

event of any future modification of MAS.

 Issues of delayed or non arrival of confirmatory

messages from the Mobile Authentication

Service portal should be addressed. This appears

to be the greatest stumbling block to the

utilization of the service. First time users of

MAS who fail to get confirmatory text messages

from the portal, could be discouraged from using

it further, and may also discourage others with

their experiences. Positive testaments from the

users of MAS could go a long way in influencing

and convincing other medication drugs users,

who are yet to utilize MAS.

 Seminars and workshops should be organised

periodically at different locations, to sensitize

and create adequate awareness about MAS.

Community and village heads as well as popular

celebrities should also be integrated in

campaigns pertaining to MAS. The goodwill and

positive images of these individuals could be

transferred to MAS, thus making it acceptable to

medication drugs users.

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