Panel Session (Abstract-Driven): Harnessing informal providers for health systems improvement: Lessons from Bangladesh, India and Nigeria
Date & Time: Fri 2 Nov 7:45 a.m. - 9:15 a.m.
Topic: State-of-the-Art Health Systems Research findings
Presenter: Oladimeji Oladepo (University of Ibadan. Department of Health Promotion and Education)
Abstract (299 words)
This study explored the dynamics of the Patent Medicine Vendor (PMV) informal health market in Nigeria, to guide policy and identify options for effective intervention.
Studies were undertaken in sampled wards/communities in 5 urban and 5 rural LGAs in Nasarawa and Oyo states, which represent different geographic and linguistic-ethnic regions of the country. They included a survey of 422 PMVs, inventories of anti-malarial products in 410 shops, and exit interviews with 126 fever/malaria clients. Focus Group Discussions, Key Informant and In-Depth Interviews were conducted with a wide variety of stakeholders.
The majority of PMVs in each stratum identified government recommended ACTs as the best treatment for Malaria. However, Chloroquine (CQ) and Sulfadoxine-pyrimethamine were the highest stocked antimalarials, averaging 66.9 and 11.8 packs per facility, compared with the 7.7 for ACTs. Many PMVs identified analgesics, antibiotics and antihistamines as antimalarials. A course of ACTs cost US$1.68 on average, compared with US$0.81 for CQ. Preventive antimalarial products were few, with insecticide being the most commonly stocked and only two Rapid Diagnostic Test kits (RDTs) were found. Exit interviews suggest that 75% of PMVs took illness histories, 48% prescribed government recommended ACTs. Inappropriate practices included prescribing multiple antimalarials to individual clients, selling antibiotics and taking blood samples without training (15%). Client referrals were rare. PMV Associations are central to all market operation, though NGOs and Government influence regulation and training. Over 75% of PMVs in each state report training on malaria, mainly from a PMV Association. Effective regulation is limited. Reported registrations with the PMV Association (96%) and government (76%) conflict with the official data (50% and 30%). Only 27% of PMVs displayed required signpost and the number of supervisory visits varied widely.
Policy and program interventions for improving governance, increasing capital base and building the capacity of PMV association are recommended.
Oladimeji Oladepo is a health promotion specialist with extensive experience in evaluating public health interventions in Nigeria. He has a special interest in social, behavioural and educational research in the control of tropical diseases, reproductive health, planning and evaluation of primary healthcare services, and policy development. He is head of the Department of Health Promotion and Education at the University of Ibadan, and the country coordinator of the Future Health Systems: Innovations for Equity research programme consortium in Nigeria.
Key Terms: patent medical vendors, healthcare, Nigeria, malaria
Authors (9): Oladimeji Oladepo (University of Ibadan. Department of Health Promotion and Education) , Ademola J. Ajuwon (University of Ibadan. Department of Health Promotion and Education) , Musibau Ayoade Titiloye (University of Ibadan. Department of Health Promotion and Education) , Benjamin O. Olley (University of Ibadan. Department of Health Promotion and Education) , Oluwafemi Dipeolu (University of Ibadan. Department of Health Promotion and Education) , Pauline E. Osamor (University of Ibadan) , Adeniyi F. Fagbamigbe (University of Ibadan) , Gerald Bloom (Institute of Development Studies) and Henry Lucas (Institute of Development Studies)
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