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

Abstract

Background In 2014, Nigeria issued the task-shifting/sharing policy for essential health services, which aimed to fill the human resource gap and improve the delivery of health services across the country. This study focuses on the characteristics, spread, and Family planning (FP) stocking practices of medicine vendors in Lagos and Kaduna, assessing the influence of health training on the provision and stocking of FP services and commodities by vendors. Methods We conducted a census of all patent and proprietary medicine vendor (PPMV) shops and followed up with a facility assessment among 10% of the mapped shops; utilizing an interviewer-administered questionnaire. Bivariate analysis was conducted using the chi-square test, and multiple logistic regression was used to estimate the adjusted odds ratio (OR) and confidence intervals (C.I) for the test of significance in the study. Results 8,318 medicine shops were censused (76.2% Urban). There were 39 shops per 100,000 population in both states on average. About half (50.9%) were manned by a medicine vendor without assistance, 25.7% claimed to provide FP services to > 2 clients per week, and 11.4% were not registered with the regulatory body or any trade association. Also, 28.2% of vendors reported formal health training; with 56.3% of these health trained vendors relatively new in the business, opening within the last five years. Vendors utilized open drug markets as the major source of supply for FP products. Health training significantly increased the stocking of FP products and inhibited the utilization of open drug markets. Conclusion PPMVs have continued to grow progressively in the last five years, becoming the most proximal health facility for potential clients for different health services (especially FP services) across both Northern and Southern Nigeria. Now comprised of a considerable mass of health trained personnel, able to deliver high-quality health services and complement existing healthcare infrastructure, if trained. However, restrictions on services within the PPMV shop and lack of access to quality health commodities and consumables have resulted in poor practices among PPMVs. There is therefore a need to identify, train, and provide innovative means of improving access to quality-assured products for this group of health workers.

An Assessment of Healthcare Relationship Trust between Patent Medicine Vendors and Residents of Hard-to-Reach Settlements in Northern Nigeria

“…As Nigeria continues to pursue the Universal Health Coverage (UHC) goals and make healthcare more accessible, existing data has shown that the role of PPMVs has become more important [19,20], although not always recognized as front-line health workers in Nigeria and other sub-Saharan countries. Medicine shops often serve as an alternative source of healthcare in settings where there are healthcare system gaps (including human resource shortage) and are usually the closes care options in most communities [19][20][21][22][23].…”

“…As Nigeria continues to pursue the Universal Health Coverage (UHC) goals and make healthcare more accessible, existing data has shown that the role of PPMVs has become more important [19,20], although not always recognized as front-line health workers in Nigeria and other sub-Saharan countries. Medicine shops often serve as an alternative source of healthcare in settings where there are healthcare system gaps (including human resource shortage) and are usually the closes care options in most communities [19][20][21][22][23]. Findings from a recent study by Daini and colleagues showed that the distribution of PPMV shops in the southern and northern parts of Nigeria is far above twice that of the most populous health facilities; ranking 32 and 46 per 100,000, respectively, in Lagos (from Southern Nigeria) and Kaduna (from Northern Nigeria), and have continued to grow progressively in recent years compared to other traditional health facilities, thereby becoming the most accessible health facility for potential clients for different healthcare services [20].…”

“…Medicine shops often serve as an alternative source of healthcare in settings where there are healthcare system gaps (including human resource shortage) and are usually the closes care options in most communities [19][20][21][22][23]. Findings from a recent study by Daini and colleagues showed that the distribution of PPMV shops in the southern and northern parts of Nigeria is far above twice that of the most populous health facilities; ranking 32 and 46 per 100,000, respectively, in Lagos (from Southern Nigeria) and Kaduna (from Northern Nigeria), and have continued to grow progressively in recent years compared to other traditional health facilities, thereby becoming the most accessible health facility for potential clients for different healthcare services [20]. Physical access is one of the domains of UHC, and it's dependent on the proximity of health facilities to potential clients [24].…”

“…Studies have also shown the increase in the spread of PPMVs has major implications, especially in Rural areas [23][24][25][26]. With some recent studies in Nigeria revealing the emergence of PPMVs who report having undergone formal medical training [19,20,22,27], there is a shift from the previous consensus about the general definition of medicine vendors, who were only characterized as being able to read and write [23], having completed mainly primary education and not having formal training in medicine and pharmacy [28].…”