OTC Drugs and the Quiet Cruelty of Prices in Nigeria

What should be a routine trip for basic medicines now tells a deeper story about how Nigeria’s economic structure is turning everyday health into a costly gamble, writes Festus Akanbi

On January 17, 2026, a former minister, Osita Chidoka, walked into a popular Abuja supermarket–pharmacy and did what millions of Nigerians do daily, often without reflection or ceremony. He bought four ordinary over-the-counter items: creatine, magnesium, a nasal spray, and a topical pain relief ointment. No prescription. No rare disease. Just routine health maintenance for an ageing body that still exercises and expects basic care. The bill came to N130,520, roughly $88 at prevailing exchange rates.

Chidoka’s account might have ended there, a personal lamentation, but it became a revealing economic peg. Out of curiosity, he priced the same basket elsewhere: about $54 in the United States, $77 in the United Kingdom, $45 in Egypt, and $37 in South Africa. Nigeria, paradoxically, was the most expensive, poorer than all four. Yet, as the former minister himself noted, the true story was not the dollar comparison but the burden relative to income. Adjusted for purchasing power, the same basket consumed roughly one per cent of average monthly income in the US, two per cent in the UK and South Africa, about five per cent in Egypt, and close to 15 per cent in Nigeria.

This disparity captures a structural problem quietly reshaping Nigeria’s health economy: the pricing of basic medicines has become detached from local earning power. In richer economies, over-the-counter drugs remain exactly that, low-friction purchases designed to keep minor ailments from becoming major ones. In Nigeria, they are increasingly discretionary expenses weighed against food, rent, and transport. For minimum-wage earners, Chidoka observed, the same basket could require the equivalent of two months’ income. In South Africa, it would take about 15 per cent of a month’s pay.

A Pharmacy That Mirrors the Macroeconomy

At first glance, Nigerian pharmacies still look reassuringly functional. Shelves are stocked, brand names are familiar, and the cold chain hums quietly in the background. But economists note that pharmacies now mirror the broader macroeconomic stress in the country. “Medicine prices have become one of the clearest transmission channels between foreign exchange volatility and household welfare,” says health economist Eric Ojo. “Few sectors pass through currency depreciation as directly and as quickly.”

Nigeria imports between 70 and 75 per cent of its medicines, either as finished products or as active pharmaceutical ingredients, excipients, and packaging materials. These inputs are priced almost entirely in foreign currency. Since the naira’s sharp depreciation over the past two years, every adjustment in the FX market has translated into new price tags at the pharmacy counter. Unlike consumer electronics or fashion, medicines offer little room for substitution or delayed purchase. Demand is inelastic; people either buy or they suffer.

Global factors have compounded the problem. Supply chains disrupted during the pandemic have not fully normalised. Freight costs remain elevated, partly due to security risks along key shipping routes. Insurance premiums are higher, and delivery times longer. Domestically, inflation above 30 per cent has pushed up energy, transport, and labour costs. Pharmaceutical inflation, analysts note, has outpaced even food inflation, compressing household budgets from multiple angles.

Policy Relief Without Price Relief

The government has not been entirely absent. Import duties on pharmaceutical inputs and certain machinery have been waived, and policy statements continue to emphasise local manufacturing. However, the impact on retail prices has been limited. Manufacturers still contend with congested ports, multiple levies, unreliable power supply and heavy reliance on diesel. Access to foreign exchange remains uneven, with letters of credit priced and repriced faster than production cycles can absorb.

“The idea that tariff waivers alone would lower prices ignored the structural costs of doing business,” says Muda Yusuf, Chief Executive Officer of the Centre for the Promotion of Private Enterprise. “When energy, logistics, and finance costs are all rising simultaneously, any isolated relief gets swallowed before it reaches the consumer.”

Market data illustrates this erosion. Anti-malarials that sold for about N1,400 two years ago now approach N8,000. Common injectable antibiotics have crossed N9,000 per vial. These are not luxury therapies but frontline treatments. Each price increase shifts more of the financial risk of illness onto households.

Insurance Under Strain, Informality on the Rise

Health insurance was designed to cushion precisely this kind of shock, but rising medical costs have strained its limits. Health Maintenance Organisations report sharp increases in provider charges, prompting higher premiums and tighter benefit caps. Corporate plans exhaust drug allowances earlier in the year, while individual subscribers discover that chronic conditions consume coverage faster than expected. With national health insurance penetration still below five per cent, most Nigerians remain exposed to out-of-pocket spending.

As affordability erodes, demand is migrating to informal drug markets. Regulators estimate that counterfeit and substandard medicines now account for a growing share of antibiotics in circulation. The economic cost is double-edged: households pay less upfront but often incur higher long-term costs through treatment failure, prolonged illness, and antimicrobial resistance. “Counterfeit drugs are not just a health problem; they are an economic inefficiency,” notes public health analyst Sola Akinwale. “They increase future costs while delivering no present value.”

Health as an Economic Variable

The implications extend beyond individual households. Health spending now absorbs a rising share of household consumption, crowding out education, nutrition, and productive investment. At the macro level, economists warn that rising out-of-pocket drug costs reduce aggregate demand and productivity. Workers lose hours to untreated illness; businesses absorb the costs of absenteeism; scarce foreign exchange is spent importing medicines that could, in part, be produced locally.

Chidoka’s framing, that high medicine prices “quietly punish people for trying to stay healthy”, resonates because it links personal experience to structural weakness. Import dependence without scale, FX pass-through without effective price buffers, fragmented distribution networks, and weak local nutraceutical manufacturing combine to produce outcomes that appear irrational on the surface but are economically consistent beneath the surface.

Paths to Stabilisation

Analysts agree that local manufacturing is the durable solution, but they also caution against treating it as a quick fix. Many domestic pharmaceutical plants operate far below capacity because key inputs remain imported. Addressing this requires targeted FX access for pharmaceutical inputs, predictable power tariffs, and credible, phased import-substitution policies.

In the interim, bulk public procurement offers a pragmatic lever. Federal and state governments, security agencies, and public institutions collectively spend billions of dollars on medicines annually. Coordinating this demand could deliver scale, bargaining power, and price stability, potentially reducing unit costs by 15 to 20 per cent. Similar pooled procurement models elsewhere on the continent have achieved measurable savings.

A Test of Economic Meaning

Ultimately, the test of policy success will not lie in strategy documents or production targets but in everyday transactions. When a minimum-wage earner can buy basic OTC medicines without sacrificing food or rent, the system will be working. Until then, the price of a nasal spray or pain ointment will remain more than a line item on a receipt; it will be a quiet indicator of how macroeconomic choices translate into lived reality.

Chidoka’s pharmacy visit was unremarkable in itself. Its significance lies in what it revealed: in Nigeria today, even staying healthy has become an economic decision.