Academic journal article Bulletin of the World Health Organization

The Role of Drug Vendors in Improving Basic Health-Care Services in Nigeria/Role Des Vendeurs De Medicaments Dans L'amelioration Des Services Medicaux De Base Au Nigeria/El Papel De Los Proveedores De Medicamentos En la Mejora De Los Servicios Sanitarios Basicos En Nigeria

Academic journal article Bulletin of the World Health Organization

The Role of Drug Vendors in Improving Basic Health-Care Services in Nigeria/Role Des Vendeurs De Medicaments Dans L'amelioration Des Services Medicaux De Base Au Nigeria/El Papel De Los Proveedores De Medicamentos En la Mejora De Los Servicios Sanitarios Basicos En Nigeria

Article excerpt

Introduction

Both specialized emergency care and basic health-care services depend on the presence of a well-staffed and well-trained, health-care workforce. Yet, despite the high burden of disease in sub-Saharan Africa, many countries have a shortage of health workers that is projected to persist well into the future. (1) New strategies for developing a robust health-care workforce are needed to help achieve universal health coverage and health equity.

Studies have shown that front-line health workers, including community health workers, can improve access to--and the equity of--health services. (2,3) Community access to trained health workers and essential health-care products are core elements of patient-centred health-care systems in places without access to formal health care. (4) In sub-Saharan Africa, people often seek care from drug vendors (i.e. patent and proprietary medicine vendors) for common but potentially deadly illnesses, such as malaria and diarrhoea. (3) Although vendors are not always recognized as front-line health workers, they provide the first and the main point of care in many communities. In some settings, training drug vendors to provide high-quality basic services, such as the treatment of common childhood illnesses and malaria, may offer a cost-effective way of delivering community-based health programmes. (6)

Nigeria, which faces many health-care challenges, is a prime example of a country where drug vendors could supplement the health-care workforce and improve access to basic primary care currently beyond the reach of many people. Drug vendors, who are not required to have formal pharmacy training but who sell prepackaged, over-the-counter pharmaceutical products on a retail, for-profit basis, (7) are the main access points for many health-care products and services. (8) They are also consulted for advice and diagnosis, particularly by poor, rural and marginalized people with limited access to formal health services. (9-12) Previous study has shown that some of the vendors investigated (53/250) had some medical training. (13)

There is no reliable estimate of the number of drug vendors in Nigeria or of their locations and the services they offer--basic information needed to understand how this sector could be better engaged. This is partly because vendors often fail to register with the Pharmacist Council of Nigeria, the official regulatory body for both pharmacies and patent and proprietary medicine vendors. (14) Rather, vendors prefer to register with their professional association, the National Association of Patent and Proprietary Medicine Dealers, which provides support such as monitoring the types of products sold, facilitating education and training and giving business and financial assistance. (15,16) However, this organization does not have a regulatory mandate.

Any national plan or policy to deliver quality-assured, health-care services and products through patent and proprietary medicine vendors' shops depends on knowledge of the characteristics, stocking practices and coverage of these shops. We conducted a census of shops in 16 states in Nigeria to: (i) document the size and coverage of the patent and proprietary medicine sector; (ii) describe the basic characteristics of the shops and their workers; and (iii) assess the range of products stocked, including those for common illnesses, such as malaria and diarrhoea, as well as for priority healthcare needs, such as family planning. We also examined the relationship between the products stocked and the shop's registration with official bodies and the medical training of the person in charge.

Methods

In 2013 and 2014, we conducted a census of all patent and proprietary medicine vendors' shops that could be identified in 16 of the 36 Nigerian states: Akwa-Ibom, Bauchi, Delta, Edo, Jigawa, Kano, Katsina, Kebbi, Kogi, Kwara, Lagos, Ogun, Oyo, Rivers, Sokoto and Zamfara. …

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