Characterization and distribution of medicine vendors in 2 states in Nigeria: implications for scaling health workforce and family planning services

Changes in clients' perceptions of family planning quality of care in Kaduna and Lagos States, Nigeria: A mixed methods study

Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) are crucial to improving access to family planning (FP) services in Nigeria. Although the private sector is preferred for convenience, availability of commodity, privacy, and timeliness, less well known is the quality of care received by clients who obtain FP services from CPs and PPMVs. This paper seeks to explore the use of validated quality of care measures for programming in Kaduna and Lagos States and to assess how these measures worked in capturing changes in quality of care using client exit interviews implemented at two time points. Using validated measures of quality of care, 598 and 236 exit interviews in rounds 1 and 2 were conducted with FP clients aged 18–49 years old. The quality of care domains were assessed using 22 questions. A weighted additive quality score was created, and scores were grouped into three: low, medium, and high quality. Changes in quality of care received were examined using χ2 test. A subset of 53 clients were selected for in-depth interviews. Deductive and inductive approaches were used for coding, and data analysis was thematic. In Lagos, we observed increases in 16 out of 22 items while in Kaduna increases were only observed in 8 items. For instance, increases were observed in the proportion of women who experienced visual privacy between rounds 1 and 2 in Lagos (74%–89%) and Kaduna (66%–82%). The quality of care received by clients changed over time. Women who reported high quality care in Lagos increased from 42% to 63%, whereas women who reported high quality care in Kaduna decreased from 35% to 21%. In both states, in-depth interviews revealed that women felt they were treated respectfully, that their sessions with providers were visually private, that they could ask questions, and that they were asked about their preferred method. This study demonstrates that clients received high quality of care services from providers (CPs and PPMVs) especially in Lagos, and such services can be improved over time. Continuous support may be required to maintain and prevent reduction in quality of FP counseling and services, particularly in Kaduna.

Factors associated with the adoption of a digital health service by patent proprietary medicine vendors (PPMVs) in Lagos, Nigeria

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.