Opportunities for improving the quality of pediatric care provided by informal medicine vendors in Nigeria

Informal medicine vendors (PPMVs) play an important role in healthcare delivery in Nigeria; they are frequently the first source of healthcare for child illness, particularly in rural areas and among lower SES populations. However, the services provided by PPMVs are of very low quality. In this paper, we discuss potential opportunities for improving the quality of child health services provided at Nigerian medicine shops.

Data are drawn from a mixed-methods study conducted in Kogi and Kwara states.  We combine three sources of data to make recommendations: a census of PPMVs in the two states, a retail survey of 250 shops, including exit interviews with 5500 customers, and qualitative fieldwork with PPMVs, caregivers of children under 5, and government health staff in rural areas.

PPMVs’ interactions with their customers focus primarily on discussions about drug cost and usage. Drug choice is largely driven by customer demand, and PPMVs infrequently stock recommended essential medicines. There is little discussion of symptoms or illness history, and PPMVs lack the knowledge and tools to properly diagnose illness. Presumptive treatment and improper dispensing are common. PPMVs and government health staff report strong inter-personal connections; however referrals from medicine stores to health facilities are informal and often delayed. 

To improve pediatric care at PPMVs, we recommend an integrated approach including improved drug supply, expanded training for PPMVs, behavior change communication for caregivers, and formalized referral networks. In the long-term, changing the regulations governing PPMV practice and strengthening monitoring and enforcement will be necessary for sustainable quality improvements.