A 2025 study published in Globalisation and Health reveals that limited access to effective antibiotics is like a double-edged sword with inherent risks and downsides.
On one hand, patients suffer and die from treatable infections while misuse of low-quality or inappropriate drugs drives resistance.
According to the study, equity in access to effective antibiotics must be central to Antimicrobial Resistance (AMR) containment strategies.
Similarly, a 2023 paper on the ResearchGate appraising Nigeria’s response to AMR highlighted persistent gaps in regulation, financing, and public awareness, despite the existence of a national action plan.
In 2024, Nigeria unveiled its second National Action Plan on Antimicrobial Resistance (NAP 2.0), an upgraded strategy meant to tackle the gaps identified in the first plan (2017–2022).
The new plan prioritises expanding surveillance of resistant infections; ensuring antibiotics remain effective through stewardship programmes.
It also promotes research and innovation including local production of quality medicines, and strengthening community-level access to effective drugs.
In Karshi, a rural community tucked away on the outskirts of the Federal Capital Territory (FCT), Mrs Ramatu Mairiga, a 28-year-old mother of two, sat quietly under the shade of a neem tree.
Her youngest child was coughing persistently, his frail body weakened by repeated bouts of infection.
“I went to this roadside chemist last week and bought drugs, but my child did not get better.
“The man there told me to come back for a stronger medicine, but it was too expensive,” Mairiga said softly.
She said that the “stronger medicine” turned out to be an antibiotic that cost nearly half of her husband’s weekly income from farming.
With no functioning primary health centre nearby, she turned again to the local patent medicine store–the only accessible option for many residents in the community.
Just a few kilometres away in Kwaku, another village in the FCT, Mr James Sunday, a motorbike rider (Okada), recounted his struggle with a stubborn ear infection.
“I bought antibiotics from three different chemists, but the infection kept coming back.
“At the hospital in Gwagwalada, the doctor told me those drugs were not working because the bacteria had become resistant.
“But the right drugs were unavailable there either,” Sunday narrated.
The experiences of Mairiga and Sunday highlight a growing crisis–the struggle of rural communities to access effective antibiotics, a challenge fuelling the dangerous rise of antimicrobial resistance (AMR) in the country.
According to the World Health Organisation (WHO), Antimicrobial resistance occurs when bacteria, viruses, fungi, and parasites evolve and no longer respond to the medicines designed to kill them.
The result is that infections become harder, sometimes impossible, to treat.
Globally, AMR is already responsible for nearly 5 million deaths annually, with Africa projected to carry a disproportionate share of the burden.
In Nigeria, experts warn that weak health systems, unregulated drug markets, and poverty are accelerating the crisis.
Yet, as Mairiga and Sunday’s experiences show, policy often fails to translate into practice at the community level.
In villages like Karshi and Kwaku, the promises of NAP 2.0 remain distant.
Health experts say access challenges cannot be separated from the broader realities of poverty and weak infrastructure.
Dr Sati Ndulukun, Director of Bacteriology, Parasitology & Virology at the National Veterinary Research Institute (NVRI), underscored the importance of cost.
“Most effective antibiotics are costly, and poor people simply cannot afford them.
“To make matters worse, these medicines are usually stocked in big pharmacies located in cities rather than in rural villages.’’
Ndulukun warned that the result was a dangerous reliance on sub-standard and fake antibiotics.
“The risks are severe, from the spread of resistant strains to avoidable deaths.”
According to him, three urgent steps are needed; first, health insurance coverage should be expanded so that poor households can afford effective antibiotics.
“Second, community pharmacies must be strengthened to bring quality medicines closer to rural residents.
“Third, poverty in rural communities must be reduced, as it often determines whether a patient receives life-saving treatment or not,” he said.
His warning aligns with the World Health Organisation (WHO), which has consistently emphasised that universal health coverage (UHC) must include access to effective antimicrobials as an essential health service.
In rural Nigeria, antibiotics are not only used in humans but also in livestock farming; farmers often purchase antibiotics over the counter to treat or even fatten their animals for sale.
While this practice is seen as a shortcut to productivity, it contributes to AMR as resistant bacteria in animals can be transferred to humans through food, water, or the environment.
“In villages like Kwaku, where many households rear poultry or goats, misuse of antibiotics in animals is common.
“If not properly addressed, it will worsen AMR in both people and livestock,” Malam Nura Shafwi, a public health researcher based in the FCT, said
This intersection of human health, animal health, and the environment, often referred to as the One Health approach, is at the centre of Nigeria’s NAP 2.0, but implementation remains uneven.
For families like Maigiri, the burden of repeated infections and ineffective treatment is not only health-related but also financial.
Each round of antibiotics, whether effective or not, drains an already limited household income.
“When a child falls sick, we sell maize or borrow from neighbours; but when the medicine does not work, the money is wasted, and the sickness continues,” she explained.
Such experiences reinforce what researchers describe as a cycle of poverty and ill-health–inability to afford effective antibiotics leads to prolonged sickness, which reduces productivity and income, further deepening poverty.
Dr Mary Alex-Wele, Consultant Clinical Microbiologist and Head of the Department of Medical Microbiology & Parasitology at the University of Port Harcourt Teaching Hospital, said that tackling AMR in Nigeria required equity-driven solutions.
Alex-Wele said that expanding the reach of the upgraded National Action Plan to rural areas was critical.
“Community pharmacies, if properly regulated and supported, could serve as lifelines for villages.
“Expanding the National Health Insurance Authority (NHIA) to cover antibiotics, coupled with community awareness campaigns, would reduce reliance on fake drugs,” she said.
Public health advocates say there is need for grassroots education as many villagers are unaware that the incomplete or inappropriate use of antibiotics fuels resistance.
People often stop taking antibiotics once they feel better, not realising this creates stronger bacteria that no longer respond to treatment,” Manji Bature, a pharmacist in Karshi, said.
Non-governmental organisations such as Ducit Blue Solutions and Dr Ameyo Stella Adadevoh Health Trust (DRASA), are also working to raise awareness on antimicrobial resistance, particularly in underserved communities.
As the world races against time to contain AMR, the voices of Maigiri in Karshi and Sunday in Kwaku serve as a stark reminder that access to effective antibiotics is not just a medical issue, it is a matter of justice, equity and survival.
For Nigeria to succeed in its fight against AMR, experts say no community, whether in the bustling city of Abuja or the quiet villages of the FCT, should be left behind. (NAN)
