Feasibility of patent and proprietary medicine vendor provision of injectable contraceptives: preliminary results from implementation science research in Oyo and Nasarawa, Nigeria

Dwyer, Sara Chace; Ishaku, Salisu Mohammed; Okunade, Faizah; Reichenbach, Laura; Jain, Aparna

doi:10.1016/j.contraception.2018.08.015

Cited by 8 publications

(16 citation statements)

References 5 publications

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“…Although the pharmacy laws prohibit PMVs from selling and administering injectable contraceptives [ 13 , 14 ] data from the latest (2019) Demographic Health Survey (DHS) [ 4 ] and other research [ 12 ] confirm that PMVs provide these services. Similar findings have been observed in other sub-Saharan Africa countries [ 15 – 18 ]. Thus, there is a growing recognition of the need to integrate this category of health workers into the formal health care system if the country is to meet its target of universal health coverage and increasing the contraceptive prevalence rate [ 19 ].…”

Section: Introductionsupporting

confidence: 91%

“…In 2015, the Population Council, an international non-governmental organisation, in collaboration with the Federal and State Ministries of Health, began a two-phase, pilot implementation research project to train 381 PMVs to deliver injectable contraceptive services in drug shops in six states; one each in the six geopolitical region of Nigeria [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Process evaluation of an intervention to improve access to injectable contraceptive services through patent medicine vendors in Nigeria: a mixed methods study

Oluwasanu

Adebayo

Okunade³

et al. 2021

J of Pharm Policy and Pract

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Background The low utilisation of modern contraceptives in many low- and middle-income countries remains a challenge. Patent medicine vendors (PMVs) that operate in the informal health sector, have the potential to address this challenge. Between 2015 and 2018, the Population Council, in collaboration with the Federal and State Ministries of Health and the Pharmacy Council of Nigeria, trained PMVs in six states to deliver injectable contraceptive services. Outcome evaluation demonstrated increased client uptake of injectable contraceptive services; however, there is limited information on how and why the intervention influenced outcomes. This study was conducted to elucidate the processes and mechanism through which the previous intervention influenced women’s utilisation of injectable contraceptive services. Methods The study utilised a mixed methods, convergent parallel design guided by the UK Medical Research Council framework. Quantitative data were obtained from 140 trained PMVs and 145 of their clients in three states and 27 in-depth interviews were conducted among relevant stakeholders. The quantitative data were analysed descriptively, while the qualitative data were analysed thematically. Results The results revealed that even after the completion of the PMV study which had a time-bound government waiver for injectable contraceptive service provision by PMVs, they continued to stock and provide injectables in response to the needs of their clients contrary to the current legislation which prohibits this. The causal mechanism that influenced women’s utilisation of injectable contraceptives were the initial training that the PMV received; the favourable regulatory environment as demonstrated in the approval provided by government for PMVs to provide injectable contraceptives for the duration of the study; and the satisfaction and the confidence the female clients had developed in the ability of the PMVs to serve them. However, there were gaps with regards to the consistent supply of quality injectable contraceptive commodities and in PMVs use of job aids. Referral and linkages to government or private-owned facilities were also sub-optimal. Conclusion PMVs continue to play important roles in family planning service provision; this underscores the need to formalize and scale-up this intervention to aid their integral roles coupled with multi-faceted initiatives to enhance the quality of their services.

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Section: Introductionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Process evaluation of an intervention to improve access to injectable contraceptive services through patent medicine vendors in Nigeria: a mixed methods study

Oluwasanu

Adebayo

Okunade³

et al. 2021

J of Pharm Policy and Pract

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“…There are no educational or training requirements for PPMV licensure [14] and the perception among some in Nigeria is that PPMVs have limited education because there is no educational requirement. Many studies have found, however, that the majority of PPMVs have attained a secondary education or higher [15–18].…”

Section: Introductionmentioning

confidence: 99%

“…Studies that have assessed drug shop owners’ knowledge and service provision after training, however, show more promising results. A study in six states in Nigeria found that PPMVs had higher knowledge of injectable contraceptives after receiving a training [15]. Drug shop owners in Uganda also demonstrated increased knowledge after receiving a training and clients reported receiving quality services [23].…”

Section: Introductionmentioning

confidence: 99%

The effect of job aids on knowledge retention among Patent and Proprietary Medicine Vendors trained to administer injectable contraceptives: longitudinal results from implementation science in Nigeria

et al. 2019

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BackgroundTo increase access to voluntary family planning (FP) services, Nigerian policymakers are debating how to task share injectable contraceptive services to drug shop owners known as Patent and Proprietary Medicine Vendors (PPMVs). Task sharing FP services to drug shops is a promising practice, but information is needed on how to ensure high quality FP services. This analysis assesses the effects of job aids on PPMVs’ knowledge of injectable contraceptives 9 months after receiving a standardized training.MethodsOne hundred ninety-four PPMVs were trained on FP counseling and administration of injectable contraceptives in Bauchi, Cross River, Ebonyi and Kaduna states. PPMVs were interviewed before, after, and 9 months after the training. Three variables were used to assess injectable contraceptive knowledge: 1) intramuscular depot-medroxyprogesterone acetate (DMPA-IM) knowledge: a combination of three questions related to device type, injection location, and reinjection frequency; 2) subcutaneous DMPA (DMPA-SC) knowledge: a combination of the same three questions but for DMPA-SC; and 3) knowledge of at least 4 of the 7 common injectable side effects. Three separate adjusted logistic regression models were conducted to determine the factors that influence PPMV knowledge of injectable contraceptives 9 months after the training.ResultsOver half of PPMVs (56%) reported using at least two job aids at 9 months. PPMVs’ knowledge of DMPA-IM, DMPA-SC and side effects were low before the training but increased immediately after. Nine months later, knowledge remained higher than pre-test levels but generally reduced compared to posttest levels. PPMVs who reported using at least two FP job aids were 2.6 (95% CI: 1.4–5.1) times more likely to have DMPA-IM knowledge 9 months after the training compared to those who used one or no job aids, while adjusting for PPMV characteristics. Similar results were observed for knowledge of DMPA-SC (AOR: 2.5; 95% CI: 1.2–4.6) and side effects (AOR: 2.5; 95% CI: 1.3–4.8).ConclusionPPMVs who used at least two FP job aids were more likely to correctly answer key injectable contraceptive questions 9 months after training. Incorporating proven job aids into routine trainings is a low-cost strategy that can reinforce knowledge and help PPMVs to retain information.

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“…Finally, since PPMVs do not typically charge consultation fees, their services are often cheaper [16,19]. For these reasons, several public health programmes in Nigeria have already began to engage PPMVs to expand access to family planning commodities [20] and quality services for malaria and diarrhea diseases treatment [21].…”

mentioning

confidence: 99%

Assessing readiness to implement routine immunization among patent and proprietary medicine vendors in Kano, Nigeria: a theory-informed cross-sectional study

Adamu

Gadanya

Jalo

et al. 2020

Expert Review of Vaccines

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Feasibility of patent and proprietary medicine vendor provision of injectable contraceptives: preliminary results from implementation science research in Oyo and Nasarawa, Nigeria

Abstract: PPMVs should be trained before providing injectable services. Additional research is needed on the benefits of job aids for screening and counseling.

Cited by 8 publications

References 5 publications

Process evaluation of an intervention to improve access to injectable contraceptive services through patent medicine vendors in Nigeria: a mixed methods study

Process evaluation of an intervention to improve access to injectable contraceptive services through patent medicine vendors in Nigeria: a mixed methods study

The effect of job aids on knowledge retention among Patent and Proprietary Medicine Vendors trained to administer injectable contraceptives: longitudinal results from implementation science in Nigeria

Assessing readiness to implement routine immunization among patent and proprietary medicine vendors in Kano, Nigeria: a theory-informed cross-sectional study

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