An assessment of the quality of advice provided by patent medicine vendors to users of oral contraceptive pills in urban Nigeria

Abstract

IntroductionIn Nigeria about 50% of oral contraceptive pill users obtain their products from proprietary patent medicine vendors (PPMVs). This group of service providers are poorly trained and have very limited knowledge about contraception. This paper investigated the nature of the advice offered to simulated current and potential users of oral contraceptive pills. The main objective was to assess the nature and quality of advice provided by PPMVs to pill users.MethodThis study is based on findings from a ‘mystery client’ approach in which three scenarios related to contraceptive pill use were simulated. Each of the 12 mystery clients simulated one of the following three scenarios: new pill users (new to family planning or switching from condom to pills); user seeking a resupply of pills; and dissatisfied pill users intending to discontinue use. Simple random sampling was used to select 410 PPMVs from a total of 1,826 in four states in Nigeria. Qualitative study using in-depth interviews was also conducted.ResultsA majority of the PPMVs had pills in stock on the day of the survey and resupplied pills to the clients. PPMVs also understood the reason and importance of referring clients who were new adopters of oral contraceptive methods to a health facility; 30% of the PPMVs referred new adopters to a health facility. However, demand from clients who do not want to go to health care facilities (for various reasons) necessitated the provision of oral contraceptive pills to 41% of the first time users. Some PPMVs prescribed treatment to mystery clients who presented with perceived complications arising from the use of pills, while 49% were referred to a health facility.ConclusionThe advice given by PPMVs often falls short of safety guidelines related to the use of oral contraceptive pills. There is a need to continuously update knowledge among the PPMVs to ensure that they provide quality oral contraceptive services as PPMVs bridge the gap between medical experts and users in rural communities.

A Systematic Review of the Role of Proprietary and Patent Medicine Vendors in Healthcare Provision in Nigeria

“…Studies on family planning services at PPMVs found similarly limited counseling for customers. Mystery client visits indicated that less than 15% of customers purchasing birth control pills were informed about side effects [ 40 , 78 ]. Some PPMVs expressed the need to maintain good communications, discretion, and confidentiality when dispensing family planning products to young customers [ 63 ], however others indicated that they may exclude youth and unmarried customers from receiving family planning services [ 79 ].…”

“…For family planning, 51% of PPMVs self-reported referring clients to health facilities for related services [ 61 ]. Yet two mystery client studies found that only 30% to 45% of PPMVs referred first-time users, and about 50% referred current users experiencing contraceptive-related complications [ 40 , 78 ]. Low rates of referral were also documented for customers with TB.…”

“…Interviews with PPMVs show that reasons for referral included the inability to treat an illness, lack of improvement following initial treatment, severe illness, and the need for diagnostic tests [ 52 ]. Reasons for not referring included the inaccessibility or understaffing of health centers [ 70 ] and the fear of potentially losing customers [ 78 ].…”

“…Studies on family planning also found that many PPMVs do not comply with current regulatory guidelines; between 9% and 17% of PPMVs sold oral contraceptives to mystery clients posing as first time pill users, and there were low rates of referral for family planning-related complications [ 40 , 78 ]. PPMVs also provided a number of family planning and reproductive health services beyond their legal scope of practice.…”

Characterization and Distribution of Medicine Vendors in Nigeria: A study of Lagos and Kaduna States.

“…As reported by the National demographic health survey, nearly half (41%) of contraceptives users in Nigeria obtain their contraceptives from the private sector, with more than half of all mothers/guardians seeking care from this sector for childhood illness such as Diarrhea (54.1%) and Fever (57.7%) [19]. Major reasons noted for this occurrence in several studies include the absence of formalities, reduced waiting time at the Medicine shop, the proximity of the outlets to clients, and the perception of clients that they will pay more at a health facility [20][21]. Patent and Proprietary Medicine Vendors (PPMVs) are increasingly being recognized as important providers of health commodities, as interest continues to grow among policymakers and Program implementers regarding their engagement in Primary Health Care delivery in Nigeria [16].…”