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OlaOlorun FM, Jain A, Olalere E, Daniel-Ebune E, Afolabi K, Okafor E, Dwyer SC, Ubuane O, Akomolafe TO, Baruwa S. Nigerian stakeholders’ perceptions of a pilot tier accreditation system for Patent and Proprietary Medicine Vendors to expand access to family planning services. BMC Health Serv Res 2022; 22:1119. [PMID: 36057584 PMCID: PMC9440463 DOI: 10.1186/s12913-022-08503-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) are often the first point of care for many Nigerians, and when sufficiently trained, they contribute to the expansion of family planning services. Nigeria’s task shifting policy and existing regulatory and licensing bodies provide the enabling environment for PPMVs to be stratified and trained. This study explored the perceptions of stakeholders toward the pilot three-tier accreditation system instituted by the Pharmacists Council of Nigeria with support from the IntegratE project. Methods Two rounds of qualitative phone interviews were conducted among stakeholders in Kaduna and Lagos states in 2020 and 2021. In addition, there were two rounds of phone interviews with CPs and PPMVs (program recipients) from Lagos and Kaduna states. All participants were purposively selected, based on their involvement in the IntegratE project activities. Interviews were recorded, transcribed, and coded using Atlas.ti software. Thematic analysis was conducted. Results Fifteen stakeholders and 28 program recipients and 12 stakeholders and 30 program recipients were interviewed during the first and second rounds of data collection respectively. The data are presented around three main themes: 1) the pilot three-tier accreditation system; 2) enabling environment; and 3) implementation challenges. The accreditation system that allows for the stratification and training of PPMVs to provide family planning services was perceived in a positive light by majority of participants. The integrated supportive supervision team that included representation from the licensing and regulatory body was seen as a strength. However, it was noted that the licensing process needs to be more effective. Implementation challenges that need to be addressed prior to scale up include bottlenecks in licensing procedures and the deep-rooted mistrust between CPs and PPMVs. Conclusion Scale up of the three-tier accreditation system has the potential to expand access to family planning services in Nigeria. In other resource-poor settings where human resources for health are in short supply and where drug shops are ubiquitous, identifying drug shop owners, training them to offer a range of family planning services, and providing the enabling environment for them to function may help to improve access to family planning services. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08503-3.
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Onwujekwe O, Mbachu C, Onyebueke V, Ogbozor P, Arize I, Okeke C, Ezenwaka U, Ensor T. Stakeholders' perspectives and willingness to institutionalize linkages between the formal health system and informal healthcare providers in urban slums in southeast, Nigeria. BMC Health Serv Res 2022; 22:583. [PMID: 35501741 PMCID: PMC9059679 DOI: 10.1186/s12913-022-08005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The widely available informal healthcare providers (IHPs) present opportunities to improve access to appropriate essential health services in underserved urban areas in many low- and middle-income countries (LMICs). However, they are not formally linked to the formal health system. This study was conducted to explore the perspectives of key stakeholders about institutionalizing linkages between the formal health systems and IHPs, as a strategy for improving access to appropriate healthcare services in Nigeria. METHODS Data was collected from key stakeholders in the formal and informal health systems, whose functions cover the major slums in Enugu and Onitsha cities in southeast Nigeria. Key informant interviews (n = 43) were conducted using semi-structured interview guides among representatives from the formal and informal health sectors. Interview transcripts were read severally, and using thematic content analysis, recurrent themes were identified and used for a narrative synthesis. RESULTS Although the dominant view among respondents is that formalization of linkages between IHPs and the formal health system will likely create synergy and quality improvement in health service delivery, anxieties and defensive pessimism were equally expressed. On the one hand, formal sector respondents are pessimistic about limited skills, poor quality of care, questionable recognition, and the enormous challenges of managing a pluralistic health system. Conversely, the informal sector pessimists expressed uncertainty about the outcomes of a government-led supervision and the potential negative impact on their practice. Some of the proposed strategies for institutionalizing linkages between the two health sub-systems include: sensitizing relevant policymakers and gatekeepers to the necessity of pluralistic healthcare; mapping and documenting of informal providers and respective service their areas for registration and accreditation, among others. Perceived threats to institutionalizing these linkages include: weak supervision and monitoring of informal providers by the State Ministry of Health due to lack of funds for logistics; poor data reporting and late referrals from informal providers; lack of referral feedback from formal to informal providers, among others. CONCLUSIONS Opportunities and constraints to institutionalize linkages between the formal health system and IHPs exist in Nigeria. However, there is a need to design an inclusive system that ensures tolerance, dignity, and mutual learning for all stakeholders in the country and in other LMICs.
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Affiliation(s)
- Obinna Onwujekwe
- Department of Pharmacology and Therapeutics, Health Policy Research Group, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria, Enugu-Campus, Enugu, Nigeria
| | - Chinyere Mbachu
- Department of Pharmacology and Therapeutics, Health Policy Research Group, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Nigeria.
- Department of Community Medicine, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Nigeria.
| | - Victor Onyebueke
- Department of Pharmacology and Therapeutics, Health Policy Research Group, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Nigeria
- Department of Urban and Regional Planning, University of Nigeria, Enugu-Campus, Enugu, Nigeria
| | - Pamela Ogbozor
- Department of Pharmacology and Therapeutics, Health Policy Research Group, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Nigeria
- Department of Psychology, Enugu State University of Science and Technology, Enugu, Nigeria
| | - Ifeyinwa Arize
- Department of Pharmacology and Therapeutics, Health Policy Research Group, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria, Enugu-Campus, Enugu, Nigeria
| | - Chinyere Okeke
- Department of Pharmacology and Therapeutics, Health Policy Research Group, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Nigeria
- Department of Community Medicine, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Nigeria
| | - Uche Ezenwaka
- Department of Pharmacology and Therapeutics, Health Policy Research Group, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria, Enugu-Campus, Enugu, Nigeria
| | - Tim Ensor
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
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Agha S, Ruiz-Gaona LA, Friedman J, Cheikh N, Gorgens M. Factors associated with the adoption of a digital health service by patent proprietary medicine vendors (PPMVs) in Lagos, Nigeria. Digit Health 2022; 8:20552076221142666. [DOI: 10.1177/20552076221142666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 11/15/2022] [Indexed: 12/02/2022] Open
Abstract
Background Patent proprietary medicine vendors (PPMVs) are the first point of care for low-income Nigerian households. They are likely to have an important role in a digital care pathway established for low-income Nigerian women and children. Yet, little is known about what drives the adoption of digital platforms by PPMVs. Methods This study explores factors associated with the adoption of a digital service, NaijaCare, created to enable PPMVs to increase the range and quality of products and services they offer. A structured, quantitative, face-to-face survey was conducted among 248 PPMVs in Lagos in February and March 2020. Multivariate analysis was conducted to identify factors associated with the adoption of NaijaCare. Results Women comprise the majority (67%) of medicine vendors in Lagos. Most medicine vendors (64%) had gotten health training on the job. About a quarter (27%) of medicine vendors reported seeking business advice on the internet. Medicine vendors who had obtained on-the-job training had a 12.31 times higher odds ratio ( p < 0.01) of adopting the digital service. Medicine vendors who sought business advice on the internet had a 6.48 times higher odds ratio ( p < 0.001) of adopting NaijaCare. Conclusion The study findings suggest that PPMVs’ use of the digital service was driven by their desire to increase business profits. Digital care pathways targeting low-income households should be aligned with the business interests of informal providers.
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Affiliation(s)
- Sohail Agha
- Behavior Design Lab, Stanford University, Stanford, CA, USA
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Chiu C, Hunter LA, McCoy SI, Mfaume R, Njau P, Liu JX. Sales and pricing decisions for HIV self-test kits among local drug shops in Tanzania: a prospective cohort study. BMC Health Serv Res 2021; 21:434. [PMID: 33957903 PMCID: PMC8101213 DOI: 10.1186/s12913-021-06432-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/22/2021] [Indexed: 11/14/2022] Open
Abstract
Background Public health initiatives must look for ways to cost-effectively scale critical interventions to achieve high coverage. Private sector distribution channels, can potentially distribute preventive healthcare products to hard-to-reach populations, decongest public healthcare systems, and increase the sustainability of programs by getting customers to share costs. However, little is known about how sellers set prices for new products. By introducing a new product, HIV self-test kits, to local drug shops, we observed whether shops experimented with pricing, charged different buyers different prices, and whether prices converged within the local market over our study period. Methods From August to December 2019, we provided free HIV self-test kits, a new product, to 26 drug shops in Shinyanga, Tanzania to sell to the local community. We measured sales volume, price, customer age and sex using shop records. Using a multiple linear regression model, we conducted F-tests to determine whether shop, age, sex, and time (week) respectively were associated with price. We measured willingness-to-pay to restock test kits at the end of the study. Results 514 test kits were sold over 18 weeks; 69% of buyers were male, 40% were aged 25–34 and 32% aged 35–44. Purchase prices ranged from 1000 to 6000 Tsh (median 3000 Tsh; ~$1.30 USD). Within shops, prices were 11.3% higher for 25–34 and 12.7% higher for 45+ year olds relative to 15–19-year olds (p = 0.029) and 13.5% lower for men (p = 0.023) on average. Although prices varied between shops, prices varied little within shops over time, and did not converge over the study period or cluster geospatially. Mean maximum willingness-to-pay to restock was 2000 Tsh per kit. Conclusions Shopkeepers charged buyers different prices depending on buyers’ age and sex. There was limited variation in prices within shops over time and low demand among shopkeepers to restock at the end of the study. Given the subsidized global wholesale price ($2 USD or ~ 4600 Tsh), further demand creation and/or cost-reduction is required before HIV self-test kits can become commercially viable in drug shops in this setting. Careful consideration is needed to align the motivations of retailers with public health priorities while meeting their private for-profit needs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06432-1.
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Affiliation(s)
- Calvin Chiu
- School of Public Health, University of California, 2121 Berkeley Way, Berkeley, 94704, CA, USA.
| | - Lauren A Hunter
- School of Public Health, University of California, 2121 Berkeley Way, Berkeley, 94704, CA, USA
| | - Sandra I McCoy
- School of Public Health, University of California, 2121 Berkeley Way, Berkeley, 94704, CA, USA
| | - Rashid Mfaume
- Shinyanga Regional Medical Office, Shinyanga, Tanzania
| | - Prosper Njau
- Health for a Prosperous Nation, Dar es Salaam, Tanzania.,National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, Tanzania
| | - Jenny X Liu
- Institute for Health and Aging; Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
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Daini BO, Okafor E, Baruwa S, Adeyanju O, Diallo R, Anyanti J. Characterization and distribution of medicine vendors in 2 states in Nigeria: implications for scaling health workforce and family planning services. HUMAN RESOURCES FOR HEALTH 2021; 19:60. [PMID: 33933081 PMCID: PMC8088718 DOI: 10.1186/s12960-021-00602-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 04/16/2021] [Indexed: 06/12/2023]
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 medical training on the provision and stocking of FP services and commodities by vendors. METHODS We conducted a census of all Patent Medicines stores (PMS) 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 (CI) for the test of significance in the study. RESULTS A total of 8318 medicine shops were enumerated (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 professional association. Also, 28.2% of vendors reported formal medical training, with 56.3% of these medically trained vendors relatively new in the business, opening within the last 5 years. Vendors utilized open drug markets as the major source of supply for FP products. Medical training significantly increased the stocking of FP products and inhibited utilization of open drug markets. CONCLUSION Patent and Proprietary Medicines Vendor (PPMVs) have continued to grow progressively in the last 5 years, becoming the most proximal health facility for potential clients for different health services (especially FP services) across both Northern and Southern Nigeria, now comprising a considerable mass of medically trained personnel, able to deliver high-quality health services and complement existing healthcare infrastructure, if trained. However, restrictions on services within the PPMV premise and lack of access to quality drugs and commodities 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.
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Oyeyemi AS, Oladepo O, Adeyemi AO, Titiloye MA, Burnett SM, Apera I. The potential role of patent and proprietary medicine vendors' associations in improving the quality of services in Nigeria's drug shops. BMC Health Serv Res 2020; 20:567. [PMID: 32571381 PMCID: PMC7310190 DOI: 10.1186/s12913-020-05379-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 05/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patent and Proprietary Medicine Vendors (PPMVs) play a major role in Nigeria's health care delivery but regulation and monitoring of their practice needs appreciable improvement to ensure they deliver quality services. Most PPMVs belong to associations which may be useful in improving their regulation. However, little is known about how the PPMV associations function and how they can partner with relevant regulatory agencies to ensure members' compliance and observance of good practice. This study sought to describe the PPMV associations' structure and operations and the regulatory environment in which PPMVs function. With this information we explore ways in which the associations could help improve the coverage of Nigeria's population with basic quality health care services. METHODS A mixed methods study was conducted across four rural local government areas (LGAs) (districts) in two Nigerian states of Bayelsa and Oyo. The study comprises a quantitative data collection of 160 randomly selected PPMVs and their shops, eight PPMV focus group discussions, in-depth interviews with 26 PPMV association executives and eight regulatory agency representatives overseeing PPMVs' practice. RESULTS The majority of the PPMVs in the four LGAs belonged to the local chapters of National Association of Patent and Proprietary Medicine Dealers (NAPPMED). The associations were led by executive members and had regular monthly meetings. NAPPMED monitored members' activities, provided professional and social support, and offered protection from regulatory agencies. More than 80% of PPMVs received at least one monitoring visit in the previous 6 months and local NAPPMED was the organization that monitored PPMVs the most, having visited 68.8% of respondents. The three major regulators, who reached 30.0-36.3% of PPMVs reported lack of human and financial resources as the main challenge they faced in regulation. CONCLUSIONS Quality services at drug shops would benefit from stronger monitoring and regulation. The PPMV associations already play a role in monitoring their members. Regulatory agencies and other organizations could partner with the PPMV associations to strengthen the regulatory environment and expand access to basic quality health services at PPMV shops in Nigeria.
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Affiliation(s)
- Abisoye S Oyeyemi
- Department of Community Medicine, Niger Delta University, Wilberforce Island, Bayelsa State, Nigeria.
| | - Oladimeji Oladepo
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adedayo O Adeyemi
- Centre for Infectious Diseases Research and Evaluation, Abuja, Nigeria
| | - Musibau A Titiloye
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Sarah M Burnett
- Accordia Global Health Foundation, now Africare, Washington, DC, USA
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Cremers AL, Alege A, Nelissen HE, Okwor TJ, Osibogun A, Gerrets R, Van’t Hoog AH. Patients' and healthcare providers' perceptions and practices regarding hypertension, pharmacy-based care, and mHealth in Lagos, Nigeria: a mixed methods study. J Hypertens 2019; 37:389-397. [PMID: 30645210 PMCID: PMC6365248 DOI: 10.1097/hjh.0000000000001877] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/08/2018] [Accepted: 07/02/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND In sub-Saharan Africa, cardiovascular disease is becoming a leading cause of death, with high blood pressure as number one risk factor. In Nigeria, access and adherence to hypertension care are poor. A pharmacy-based hypertension care model with remote monitoring by cardiologists through mHealth was piloted in Lagos to increase accessibility to quality care for hypertensive patients. OBJECTIVES To describe patients' and healthcare providers' perceptions and practices regarding hypertension, pharmacy-based care, and mHealth and explore how this information may improve innovative hypertension service delivery. METHODS This study consisted of observations of patient-pharmacy staff interactions and hypertension care provided, four focus group discussions and in-depth interviews with 30 hypertensive patients, nine community pharmacists, and six cardiologists, and structured interviews with 328 patients. RESULTS Most patients were knowledgeable about biomedical causes and treatment of hypertension, but often ignorant about the silent character of hypertension. Reasons mentioned for not adhering to treatment were side effects, financial constraints, lack of health insurance, and cultural or religious reasons. Pharmacists additionally mentioned competition with informal, cheaper healthcare providers. Patients highly favored pharmacy-based care, because of the pharmacist-patient relationship, accessibility, small-scale, and a pharmacy's registration at an association. The majority of respondents were positive towards mHealth. CONCLUSION Facilitating factors for innovative pharmacy-based hypertension care were: patients' biomedical perceptions, pharmacies' strong position in the community, and respondents' positive attitude towards mHealth. We recommend health education and strengthening pharmacists' role to address barriers, such as misperceptions that hypertension always is symptomatic, treatment nonadherence, and unfamiliarity with mHealth. Future collaboration with insurance providers or other financing mechanisms may help diminish patients' financial barriers to appropriate hypertension treatment.
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Affiliation(s)
- Anne L. Cremers
- Amsterdam Institute for Global Health and Development
- Center of Tropical Medicine and Travel Medicine, Division of Internal Medicine, Department of Infectious Diseases, Academic Medical Center
- Department of Anthropology
| | - Abiola Alege
- Centre for Epidemiology and Health Development, Lagos
| | - Heleen E. Nelissen
- Amsterdam Institute for Global Health and Development
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Tochi J. Okwor
- Centre for Epidemiology and Health Development, Lagos
- Department of Community Health, University of Nigeria Teaching Hospital Enugu, Enugu
| | - Akin Osibogun
- Centre for Epidemiology and Health Development, Lagos
- Department of Community Health Lagos University Teaching Hospital, Lagos, Nigeria
| | - René Gerrets
- Amsterdam Institute for Global Health and Development
- Department of Anthropology
| | - Anja H. Van’t Hoog
- Amsterdam Institute for Global Health and Development
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Onah MN, Horton S. Male-female differences in households' resource allocation and decision to seek healthcare in south-eastern Nigeria: Results from a mixed methods study. Soc Sci Med 2018; 204:84-91. [PMID: 29602090 DOI: 10.1016/j.socscimed.2018.03.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
Abstract
Ability to influence household decision-making has been shown to increase with improved social capital and power and is linked to better access to household financial resources and other services outside the household including healthcare. To examine the male-female differences in household custody of financial resources, decision-making, and type of healthcare utilised, we used a mixed methods approach of cross-sectional household surveys and focus-group discussions (FGDs). Data was collected between 10 January-28 February 2011. We analyzed a sample of 411 households and a sub-sample of 223 households with a currently married head. We conducted six single-sex FGDs in 3 communities (1 urban, 2 rural) among a random sub-sample of participants in the survey. We performed univariate, bivariate, and logistic regression analyses with a 95% confidence interval. For the qualitative data, we performed thematic analysis where broad themes relevant to the research objective were abstracted. In all households and in those with a married head, sick male members were less likely to forgo healthcare (aORall0.87, 95% CI 0.80-0.90; aORmarried0.52, 95% CI 0.18-0.83) and more likely to utilise formal healthcare relative to female sick members (aORall3.36, 95% CI 3.20-3.87; aORmarried19.50, 95% CI 9.62-39.52). Formal healthcare providers are medically trained while informal providers are untrained vendors that dispense medications for profit. There were more reports of sole custody of household resources among men within households with married heads. Joint decision-making on healthcare expenditure improved women's access to healthcare but is not reflective of unhindered access to household financial resources. Qualitatively, women spoke of seeking permission from male household head before expenditure was incurred, while male heads spoke of concealing household financial resources from their spouse. Gender constructs and male-female differences have important effects on household resource allocation and healthcare utilisation.
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Affiliation(s)
- Michael Nnachebe Onah
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Canada.
| | - Susan Horton
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Canada
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Izugbara CO, Wekesah F. What does quality maternity care mean in a context of medical pluralism? Perspectives of women in Nigeria. Health Policy Plan 2018; 33:1-8. [PMID: 29036530 PMCID: PMC5886285 DOI: 10.1093/heapol/czx131] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/20/2022] Open
Abstract
User priorities regarding quality care in contexts of medical pluralism are poorly documented. Drawing on group and individual interviews with women, we interrogate ideas of quality maternity care in the context of Nigeria's medical pluralism. We found complex utilization patterns for conventional, complementary and alternative maternity care services as well as ideas of quality maternity care that stress effective coordination and integration of different typologies of maternity health services; socially sensitive and truthful providers; and socioeconomic, physical and parochial forms of safety. Informal providers were the commonly reported source of maternal health services in the study. Maternal health services in the country were also generally viewed as poor quality, characterized by pervasive abuse, quackery and lack of commitment to the needs and sensitivities of women. Convenience, availability and affordability of maternal health services, as well as sociocultural factors were major influences on women's use of services. Results demonstrate the embeddedness of women's quality of care notions in the vast socioeconomic inequities that typify Nigeria's particular form of poorly regulated medical pluralism, raising need for strategies to strengthen the delivery, coordination and supervision of maternal health services in the country.
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Affiliation(s)
- Chimaraoke O Izugbara
- African Population and Health Research Center, 2nd Floor, APHRC Campus, P.O. Box 10787- 00100, Nairobi, Kenya
| | - Frederick Wekesah
- African Population and Health Research Center, 2nd Floor, APHRC Campus, P.O. Box 10787- 00100, Nairobi, Kenya
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Abimbola S, Ogunsina K, Charles-Okoli AN, Negin J, Martiniuk AL, Jan S. Information, regulation and coordination: realist analysis of the efforts of community health committees to limit informal health care providers in Nigeria. HEALTH ECONOMICS REVIEW 2016; 6:51. [PMID: 27844451 PMCID: PMC5108730 DOI: 10.1186/s13561-016-0131-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/26/2016] [Indexed: 05/06/2023]
Abstract
One of the consequences of ineffective governments is that they leave space for unlicensed and unregulated informal providers without formal training to deliver a large proportion of health services. Without institutions that facilitate appropriate health care transactions, patients tend to navigate health care markets from one inappropriate provider to another, receiving sub-optimal care, before they find appropriate providers; all the while incurring personal transaction costs. But the top-down interventions to address this barrier to accessing care are hampered by weak governments, as informal providers are entrenched in communities. To explore the role that communities could play in limiting informal providers, we applied the transaction costs theory of the firm which predicts that economic agents tend to organise production within firms when the costs of coordinating exchange through the market are greater than within a firm. In a realist analysis of qualitative data from Nigeria, we found that community health committees sometimes seek to limit informal providers in a manner that is consistent with the transaction costs theory of the firm. The committees deal not through legal sanction but by subtle influence and persuasion in a slow and faltering process of institutional change, leveraging the authority and resources available within their community, and from governments and NGOs. First, they provide information to reduce the market share controlled by informal providers, and then regulation to keep informal providers at bay while making the formal provider more competitive. When these efforts are ineffective or insufficient, committees are faced with a "make-or-buy" decision. The "make" decision involves coordination to co-produce formal health services and facilitate referrals from informal to formal providers. What sometimes results is a quasi-firm-informal and formal providers are networked in a single but loose production unit. These findings suggest that efforts to limit informal providers should seek to, among other things, augment existing community responses.
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Affiliation(s)
- Seye Abimbola
- School of Public Health, Sydney Medical School, University of Sydney, Rm 128C, Edward Ford Building A27, Sydney, NSW, 2006, Australia.
- National Primary Health Care Development Agency, Abuja, FCT, Nigeria.
- The George Institute for Global Health, Sydney, NSW, Australia.
| | - Kemi Ogunsina
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Augustina N Charles-Okoli
- School of Public Health, Sydney Medical School, University of Sydney, Rm 128C, Edward Ford Building A27, Sydney, NSW, 2006, Australia
- Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Joel Negin
- School of Public Health, Sydney Medical School, University of Sydney, Rm 128C, Edward Ford Building A27, Sydney, NSW, 2006, Australia
| | - Alexandra L Martiniuk
- School of Public Health, Sydney Medical School, University of Sydney, Rm 128C, Edward Ford Building A27, Sydney, NSW, 2006, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Stephen Jan
- School of Public Health, Sydney Medical School, University of Sydney, Rm 128C, Edward Ford Building A27, Sydney, NSW, 2006, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
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Sieverding M, Beyeler N. Integrating informal providers into a people-centered health systems approach: qualitative evidence from local health systems in rural Nigeria. BMC Health Serv Res 2016; 16:526. [PMID: 27687854 PMCID: PMC5041446 DOI: 10.1186/s12913-016-1780-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 09/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The presence of a large informal healthcare sector in many low- and middle-income countries poses both challenges and opportunities for achieving a people-centered health system. However, few studies have considered how informal providers may fit into a people-centered health systems approach. We examine the self-described roles and motivations of informal medicine vendors and public healthcare workers in rural Nigeria, as well as interactions between them, with the aim of identifying how local health systems may be reoriented for improved service delivery through a people-centered approach. METHODS We analyzed data from in-depth interviews with 70 medicine vendors and 21 staff of public health facilities in 30 villages across Kogi, Kwara and Enugu states in Nigeria. Interview guides covered the respondent's or her facility's role in providing health services to the local community, motivation to work in her respective profession, and relationships and interactions with other frontline healthcare providers. Data were analyzed in Atlas.ti using an open coding approach. RESULTS Both medicine vendors and staff of public health facilities viewed themselves as fulfilling an essential primary healthcare function in their villages, and described their main motivation as the desire to help their communities. Medicine vendors were acknowledged by both groups to play an important role in providing care close to underserved rural communities, but within a limited scope of practice. Vendors described referring cases beyond their self-defined capacity to the local public facility. Health facility staff also sent clients to vendors to purchase drugs that were out of stock. However, referrals were informal and unspecific in nature, and the degree to which relationships between vendors and health facility staff were collaborative was highly context-dependent despite their recognized interdependencies in health services provision. CONCLUSIONS Policies aimed at fostering people-centered health systems should consider the role of informal providers in the delivery of integrated care. In the context of our rural study sites in Nigeria, supporting stronger and more consistent linkages between medicine vendors and public health facilities is a key step towards improving health service delivery.
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Affiliation(s)
- Maia Sieverding
- Global Health Sciences, University of California San Francisco, 550 16th Street, 3rd floor, Box 1224, San Francisco, CA, 94158, USA.
| | - Naomi Beyeler
- Global Health Sciences, University of California San Francisco, 550 16th Street, 3rd floor, Box 1224, San Francisco, CA, 94158, USA
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Ibeneme GC, Nwaneri AC, Ibeneme SC, Ezenduka P, Strüver V, Fortwengel G, Okoye IJ. Mothers' perception of recovery and satisfaction with patent medicine dealers' treatment of childhood febrile conditions in rural communities. Malar J 2016; 15:336. [PMID: 27352902 PMCID: PMC4924311 DOI: 10.1186/s12936-016-1384-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infant mortality in rural areas of Nigeria can be minimized if childhood febrile conditions are treated by trained health personnel, deployed to primary healthcare centres (PHCs) rather than the observed preference of mothers for patent medicine dealers (PMDs). However, health service utilization/patronage is driven by consumer satisfaction and perception of services/product value. The objective of this study was to determine 'mothers' perception of recovery' and 'mothers' satisfaction' after PMD treatment of childhood febrile conditions, as likely drivers of mothers' health-seeking behaviour, which must be targeted to reverse the trend. METHODS Ugwuogo-Nike, in Enugu, Nigeria, has many PMDs/PHCs, and was selected based on high prevalence of childhood febrile conditions. In total, 385 consenting mothers (aged 15-45 years) were consecutively recruited at PMD shops, after purchasing drugs for childhood febrile conditions, in a cross-sectional observational study using a pre-tested instrument; 33 of them (aged 21-47 years) participated in focus group discussions (FGDs). Qualitative data were thematically analysed while a quantitative study was analysed with Z score and Chi square statistics, at p < 0.05. RESULTS Most participants in FGDs perceived that their child had delayed recovery, but were satisfied with PMDs' treatment of childhood febrile conditions, for reasons that included politeness, caring attitude, drug availability, easy accessibility, flexibility in pricing, shorter waiting time, their God-fearing nature, and disposition as good listeners. Mothers' satisfaction with PMDs' treatment is significantly (p < 0.05) associated with mothers' perception of recovery of their child (χ(2) = 192.94, df = 4; p < 0.0001; Cramer's V = 0.7079). However, predicting mothers' satisfaction with PMDs' treatment from a knowledge of mothers' perception of recovery shows a high accord (lambda[A from B] = 0.8727), unlike when predicting mothers' perception of recovery based on knowledge of mothers' satisfaction with PMDs' treatment (lambda[A from B] = 0.4727). CONCLUSIONS Mothers' satisfaction could be the key 'driver' of mothers' health-seeking behaviour and is less likely to be influenced by mothers' perception of recovery of their child. Therefore, mothers' negative perception of their child's recovery may not induce proportionate decline in mothers' health-seeking behaviour (patronage of PMDs), which might be influenced mainly by mothers' satisfaction with the positive attributes of PMDs' personality/practice and sets an important agenda for PHC reforms.
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Affiliation(s)
- Georgian Chiaka Ibeneme
- Department of Nursing Sciences, Faculty of Health Sciences and Technology, College of Medicine, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Ada Caroline Nwaneri
- Department of Nursing Sciences, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Abakaliki, Ebonyi State, Nigeria
| | - Sam Chidi Ibeneme
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Abakaliki, Ebonyi State, Nigeria. .,German UNESCO Unit on Bioethics, Fakultät III-Medien, Information und Design, Hochschule Hannover-University of Applied Sciences and Arts, Hannover, Germany.
| | - Pauline Ezenduka
- Department of Nursing Sciences, Faculty of Health Sciences and Technology, College of Medicine, Nnamdi Azikiwe University, Nnewi, Anamabra State, Nigeria
| | - Vanessa Strüver
- German UNESCO Unit on Bioethics, Fakultät III-Medien, Information und Design, Hochschule Hannover-University of Applied Sciences and Arts, Hannover, Germany
| | - Gehard Fortwengel
- German UNESCO Unit on Bioethics, Fakultät III-Medien, Information und Design, Hochschule Hannover-University of Applied Sciences and Arts, Hannover, Germany
| | - Ifeoma Joy Okoye
- Department of Radiation Medicine, Faculty of Medical sciences, College of Medicine, University of Nigeria, Enugu Campus, Abakaliki, Ebonyi State, Nigeria
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13
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Liu J, Prach LM, Treleaven E, Hansen M, Anyanti J, Jagha T, Seaman V, Ajumobi O, Isiguzo C. The role of drug vendors in improving basic health-care services in Nigeria. Bull World Health Organ 2016; 94:267-75. [PMID: 27034520 PMCID: PMC4794299 DOI: 10.2471/blt.15.154666] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 10/15/2015] [Accepted: 11/16/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To characterize patent and proprietary medicine vendors and shops in Nigeria and to assess their ability to help improve access to high-quality, primary health-care services. METHODS In 2013 and 2014, a census of patent and proprietary medicine shops in 16 states of Nigeria was carried out to determine: (i) the size and coverage of the sector; (ii) the basic characteristics of shops and their staff; and (iii) the range of products stocked for priority health services, particularly for malaria, diarrhoea and family planning. The influence of the medical training of people in charge of the shops on the health-care products stocked and registration with official bodies was assessed by regression analysis. FINDINGS The number of shops per 100,000 population was higher in southern than in northern states, but the average percentage of people in charge with medical training across local government areas was higher in northern states: 52.6% versus 29.7% in southern states. Shops headed by a person with medical training were significantly more likely to stock artemisinin-based combination therapy, oral rehydration salts, zinc, injectable contraceptives and intrauterine contraceptive devices. However, these shops were less likely to be registered with the National Association of Patent and Proprietary Medicine Dealers and more likely to be registered with the regulatory body, the Pharmacist Council of Nigeria. CONCLUSION Many patent and proprietary medicine vendors in Nigeria were medically trained. With additional training and oversight, they could help improve access to basic health-care services. Specifically, vendors with medical training could participate in task-shifting interventions.
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Affiliation(s)
- Jenny Liu
- Institute for Health and Aging, Social and Behavioral Sciences, University of California - San Francisco, 3333 California Street (Suite 340), San Francisco, California, CA 94118, United States of America (USA)
| | - Lisa M Prach
- Institute for Health and Aging, Social and Behavioral Sciences, University of California - San Francisco, 3333 California Street (Suite 340), San Francisco, California, CA 94118, United States of America (USA)
| | - Emily Treleaven
- Institute for Health and Aging, Social and Behavioral Sciences, University of California - San Francisco, 3333 California Street (Suite 340), San Francisco, California, CA 94118, United States of America (USA)
| | - Mara Hansen
- Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | | | - Temple Jagha
- Partners for Human Research Empowerment and Development, Abuja, Nigeria
| | - Vince Seaman
- Bill & Melinda Gates Foundation, Seattle, Washington, USA
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