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This study examined the dynamics of access to medicines within the narrow prism of patent law. The changing world of health care finance has led to a paradigm shift with health care being viewed more as a commodity. The central theme of neoliberal policies is that, instead of the state providing health care, consumers are expected to purchase it in the open market based on the interplay of market forces and market-driven trajectories. In spite of detailed analysis on negative implications of market based reforms by scholars in availability, accessibility, and affordability of health care services delivery system, World Bank has ensured that a majority of sub-Saharan African countries have adopted the reforms. There is growing universal concern regarding counterfeit medications. In particular, counterfeit antimicrobial drugs are a threat to public health with many devastating consequences for patients; increased mortality and morbidity and emergence of drug resistance. Quantitative method was employed to generate primary data from questionnaire administered on the target population. Also, qualitative method of data collection was gleaned from observation, unstructured interview, focus group discussions and secondary sources to gain insight to detail information, clarify, and complement issues raised in the responses from the questionnaire. The theoretical framework was anchored on economic nationalism. In analyzing data
generated, we applied frequency tables, mean, simple percentages, diagrams and charts. The study therefore recommended Amendments of IPRs agreement to accommodate commercial and public health care interests for cheaper drugs and development of local pharmaceutical industry. It also advocated that policies on health care should be tailored on peculiarities of the nation rather than global imposed policies. 


1.1 Background of the Study

For the past three decades, both economic policy and public thought based on neo-liberalism has been the dominant development paradigm. Neoliberalism is necessary end of globalization of capitalism. Economic globalization has become a vehicle through which the advanced capitalist countries are pushing their neoliberal agenda throughout the world. Contemporary globalization is basically a phase where capitalism has attained the level of worldwide expansion, deteritorization of industrial production; a result of which has made the choice over where to produce, shop,
invest and save no longer confined within national border. Obianyo (2009:144) defined globalization as internationalization of capital and integration of autonomous economics into a global system. Global capitalism has evolved through the stages of mercantilism or economic nationalism, classical liberalism, Keynesianism and neoliberalism. Gilpin (1987) noted that parallel existence and mutual interaction of “state” and “market” in the modern world create “political economy”, without both state and market there could be no political economy. He noted further that neither state nor market is primary; the causal relationships are interactive and indeed cyclical.


Similarly, Gilpin (1987:12) asserted that: Debate has raged for several centuries over the nature and consequences of the clash of the fundamentally opposed logic of the market and that of the state. From early modern writers such as David Hume, Adam Smith and Alexander
Hamilton to the nineteenth century luminaries such as David Ricardo, John Stuart Mill, and Karl Marx to contemporary scholars, opinion has been deeply divided over the interaction of economics and politics.

The conflicting interpretations represent three fundamentally different ideologies of political economy. In the last three decades, ideologies of economic nationalism, liberalism and Marxism have divided the world views on public healthcare delivery. This conflict among these three moral and intellectual positions has revolved around the role and significance of the market, state and capital in health care delivery. These views are charaterised by ideological spectrum of left-wing versus right wing health debates usually consisting a more versus less state intervention dichotomy in health care delivery. However these debates are attenuated by moderating views of few centre-point apologists. Meanwhile, Bambara (1999) noted that it is profoundly paradoxical that, in a period when the importance of public policy as a determinant of health is routinely acknowledged, there remains a continuing absence of mainstream debate about the ways in which the politics, power and ideology, which underpin it influence people’s health. 

According to Gilpin (1987:31) “the central idea of mercantilism is that economic activities are, and should be subordinate to the goal of state building and the interest of the state”. By this postulation, he virtually underscores the primacy of state over the economy. Thus economic nationalism should be viewed as a general commitment to state building.
The interest of state comes first and rights of the citizens are placed before the right of capital. Public policies lead to fair distribution of nation’s wealth. Although the precise objectives pursued and policies advocated have differed at different times and different places which has been labeled statism, protectionism, the German Historical School and recently, New Protectionism.
Economic liberalism was basically a counterpoise to mercantilism. Adam Smith attacked the mercantilist doctrine and asserted that rather than increasing the wealth of a nation, it actually depressed the economy. Thus, liberalism was born as an expression of freedom from absolute state and a defense of emerging markets against ‘unnatural’ mercantilist regulation. Gilpin (1987) asserted that from Adam Smith to the contemporary
proponents, liberal thinkers are committed to the market forces. Key element of liassezfaire philosophy identified by Smith is the self- regulating role of the market forces of demand and supply.

However, according to Kevin and Wildes (1999), historically, government has had to intervene, not only to redress the gross inequality of market determined income and wealth, but to rescue the market from itself when it periodically goes haywire. It is no secret that markets cannot properly value a host of essential societal needs such as education, health, public infrastructure, water etc The global economic crisis of capitalism brought Keynes into the scene.

Balaam and Veseth (1996:61) asserted that “during this period, the term liberal on political discourse came to mean something different from what it means historically in international political economy. Liberal came to be associated with the stronger state role that the Keynesians and eventually the socialists advocated”. Lister (2007) remarked that a breakdown in the predominant post war welferism under Washington Consensus has led to re-emergency of neo-liberalism.

Again he noted that these changes came not directly from the powerful forces of the global economy but they came through the ideology and policy prescriptions- the “hidden politics agenda of the Washington consensus. Neoliberalism is a theory of political economic practices which advocated for the uninhibited reign of market forces as the main agent of development. Neoliberalists blamed the state for the failure of previous development projects and argued that it should play as small a role as possible, with the laws of supply and demand now being the deciding factors for economic policy developed and implemented by the International Finance Institutions (IFIs), including the World Bank and the International Monetary Fund (IMF). 
Harrison (2010: 21) asserted that “a major concern with the neoliberal agenda is the perceived or claimed of equal treatment of developed and developing nations by the market”. That, critics argued that neoliberalism “virtually abolishes the idea of development as a specific concern, in favour of a universal set of prescriptions applied to developed and developing counties alike”.

Similarly, Thorne (2010) noted that neoliberalism argument is driven by a set of interrelated agendas, “to homogenize socio-cultural diversity, to project Western power throughout the world, to construct a global market order, and to reconfigure class relations in favour of property” which clearly benefit one part of the world over the other. That, neoliberal policies treat nations as if the market is a level playing field, however, it clearly is not. By doing so, the neoliberal policies favour the developed countries. In this sense, neoliberalism may be viewed as neocolonialism or neoimperialism. Many scholars have submitted that the policy is the consolidation of imperialism, which had been described by the late Comrade V.I Lenin, as the highest stage of international capitalism.
Social policy is a means by which a society protects and enhances human life and dignity. Health care is often considered one of the three pillars of social policy, along with education and social welfare/income security, traditionally funded through taxation, designed to enhance the physical well-being of all members of the population. However, Lister (2005) noted that the neoliberal agenda of health care reform includes cost cutting for efficiency, decentralizing to the local or regional levels rather than the national levels and setting health care up as a private good for sale rather than a public good paid for with tax dollars.
According to Kervin and Wildes (1999) underlying the breakdown of the health care system is a far deeper phenomenon associated with the marketization of all human transactions. The overall impact is to denature fundamental human values and dismantle the ties that nurture communal life. They equally noted that underlying this use of market forces is the assumption that health care can be treated as a commodity. A free, open market creates demand among those who can pay for health care services. Leys (2001) argued that market forces can regulate the costs of houses and cars, things we choose to buy. But nobody chooses to be sick.

The patient has little choice but to buy and therefore lacks bargaining power. Today, health policies have been consumed by ideological debates between neoliberalism on one side and economic nationalism and Marxism on the other side. Boenlinger (2005) noted that a dividing line between those who support and those who oppose health care as a right is the question of whether health care is a human necessity. If health care is just another commodity, it can be supplied by market. If a necessity the market is not adequate. Thus, Andre and Velasquez (n.d) remarked that the ethic implication of growing commercialization of health care has become a matter of heated controversy. Marketisation and commdification of health care has come under serious attack of economic nationalists and Marxist.
Healthcare is becoming a massive new field of capital accumulation with dire implications for public health. Hence Albo (2009) observed that the British Labour Party, which 60 years ago set an example of universal and comprehensive health care that was followed all over the world –including Canada, is now busy dismantling the integrated National Service and recreating a healthcare market relying heavily on US advisers and US multinational to make it happen.

The paradigm shift could be traced to militant campaign that is now been waged by capital, the health insurance industry, the multinational pharmaceutical firms, biotechnology industry and big health providers to break up statefunded healthcare and provide healthcare system in every country that has them and turn them into field of accumulation. The power of corporations moving into public health service is huge and growing. In Canada, USA, UK and other advanced capitalist countries they are major actors in the restructuring of states on neo-liberal lines that has been pushed through to a greater or lesser extent in all countries over the past 30 years.

The more neoliberal a government is the less policy is concerned with equality. On the other hand, Andre and Velasquez (n.d.) stated that marketization and commodification of healthcare have come under serious attack of the Marxist. The Marxists believe that access to healthcare is fundamental human right. Against this backdrop Barihanlt and Cloyd (n.d.) questioned, should healthcare be treated like any other good or service and be competitively bought and sold or should it be treated as public goods guaranteed and regulated by the government? They also noted that Sweden a strong welfare state considered health care as a ‘moral right’ and has one of the most highly developed health care system in the world. Ramakumar (2012) outlined the two major features of marketization of healthcare as follows:
i. a decline in proportion of public health care expenditure; and
ii. a growth of private insurance.
Moreover he noted that neo-liberalists argue that private healthcare market emerges for those who can afford to pay it. Citizens are consumers who should have the choice to buy the best health products they can afford. Instead of the state providing health care, consumers are expected to purchase it in the market place. He also asserted that there is potential conflict between profit motive inherent in capitalism and fundamental rights of all people to health care.
Against this backdrop Andre and Velasquez (n.d.) warned that mixing business with medicine will inevitably lead to abuse that violates patient dignity. A patient is in a
vulnerable position necessarily trusting that the doctor’s decisions about his or her medical care will be guided solely by the patient’s best interests. But in a system of for profit health care, doctor will become subject to the control of lay managers accountable to shareholders whose primary aim is making a profit. He noted that such hospitals will encourage doctors to produce profit –generating drugs, surgeries, tests and treatments. In a system of for profit health care, the opportunities for patient manipulation and exploitation are endless.
Where profits rule, unprofitable research and services to health care will be neglected. Furthermore, as profit come to dominate the health care sector, society will suffer a severe shortage of unprofitable but crucial service, such as emergency rooms.
Bairagiel el al (2011) noted that prior to 1999, cultural practices, topography, socioeconomic factors, high poverty rate and illiteracy especially in the rural areas have created significant barrier to health care delivery in Katsina State. From 1987 when Katsina State was created up to 1999, the State had been under the rule of military administrators except for brief period of the aborted third republic (1993-1994). Abdullai (2009) noted that
Katsina State is a rural State and its transformation was rather too slow under the military rule. Similarly, he asserted that the few health care infrastructures that existed prior tocivilian administration in 1999 were in deplorable condition, poorly equipped with inadequate manpower and most of health workers preferred to work in urban areas.
According to National Bureau of Statistics, there were 720 primary health care centers in Katsina State by 2000 with population ratio of 6,997 to a primary health centre. Again, Abdullai (2009) pointed out that at the inception of civilian administration in 1999 Governor Umaru Yardua made health care development as a priority of his administration which the present Governor Ibrahim Shema is building on. This study would examine the extent the leadership of Governor Umaru Yardua (1999-2007) and Governor Ibrahim Shema (2007-till date) have contributed in improving health care in Katsina State.
Global health care reforms have led to a paradigm shift in health care delivery with health care being viewed more and more as a commodity. Against this backdrop, this study explored the influence of neo-liberal policies on health care services delivery and how Katsina State government and indeed Nigeria are responding to these policies between 1999 and 2012.


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