Future Health Systems (FHS) Research Programme consortium

This 4-page policy brief discusses the role of the patent medicine vendor (PMV) in dispensing anti-malarial drugs (AMDs) in Nigeria. Reportedly, there are both fake medicines and those to which the malaria parasite has become highly resistant. A recent government recommendation is that people use artemisinin-combined therapy (ACT), though this study shows that it is the least commonly stocked by PMVs of the anti-malarial medicine and that PMVs are generally not aware of the recommendation.

An Ibadan University scoping study showed that:

• PMVs are the largest source of malaria treatment in all areas
• PMVs have little knowledge of the new treatment guidelines, and most government officials know little about PMVs
• The PMVs provide many different drugs for malaria, but the most common and cheapest are the least effective
• The recommended treatment, ACT, is not readily available, and is the most expensive
• PMVs, other health providers, government officials, and community members share concerns about the quality of drugs
• The organisation of the supply chain for pharmaceuticals differs between states, meaning that local knowledge and locally adapted solutions are needed

The document concludes that the following policy actions are needed now:
1. "Training PMVs and their drug suppliers about appropriate malaria treatment and about the potential role of insecticide-treated nets in malaria prevention.
2. Reducing the opportunities for PMVs to supply sub-standard drugs through a combination of more effective government regulation, PMV association self-regulation, and community involvement involving:
  a. Educating communities on appropriate malaria treatment.
  b. Increasing the roles of community organisations in monitoring drug quality. Tasks can include looking for NAFDAC registration and expiry dates and the use of simple technologies for testing drug quality or scanning product identification.
  c. Using information and communication technology, such as mobile phones, to provide real-time support to PMVs and regulators. PMV associations could use new drug testing technologies.
  d. Exploring new approaches for broadening participation in the formulation and dissemination of drug policies and guidelines.
3. Negotiating ways in which PMVs shops that meet certain quality standards can form a franchise to provide anti-malarial drugs for children at subsidised prices.
4. Encouraging governments in Nigeria and elsewhere to finance subsidies for ACTs to reduce their prices below undesirable alternatives in the market. This will also require careful monitoring of how such subsidies affect local markets and consumer behaviour."

Recommendations for further studies include gathering  information on:
1. "Institutional arrangements within which patent medicines vendors obtain their supplies and the kinds of arrangements between wholesalers and retailers, the role of middlemen and drug retailers, and the activities of wholesaling companies.
2. The incentives and disincentives for PMVs and their suppliers that would reduce the risk of sub-standard drugs reaching PMV shops.
3. Organisation and performance of patent medicine vendors associations and the type of relationship between them and government health officials and drug regulatory agencies."

Improving provider performance id21 insights website, Issue 76, March 2009, on accessed on March 12 2009.