The IntegratE Project is a proof of concept that Community Pharmacists and Patent and Proprietary Medicine Vendors can provide a wider range of family planning services when trained in family planning counseling and service delivery.
In Nigeria, Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) are the first point of care for many individuals in their communities. A CP is a trained pharmacist with full license to sell and buy prescription and non-prescription drugs while a PPMV is defined as “a person without formal training in pharmacy who sells orthodox pharmaceutical products on a retail basis for profit.” CPs and PPMVs are not formally recognized as family planning (FP) service providers in Nigeria, yet 22% of modern contraceptive users received their last method from a PPMV and 12% from a private pharmacy. Although CPs and PPMVs are a popular source for FP, many have not received formal training to provide FP services and often do not have the necessary knowledge and skills to provide those services. As the Federal Ministry of Health (FMoH) explores including CPs and PPMVs in its task sharing FP policy, evidence is needed on an effective regulatory system to support CPs and PPMVs to provide high quality FP services.
The IntegratE Project is a 4-year initiative (2017-2021) co-funded by the Bill & Melinda Gates Foundation and MSD for Mothers; led by the Society for Family Health Nigeria; and implemented by a consortium of partners including MSI Reproductive Choices, Planned Parenthood Federation of Nigeria, the Population Council and PharmAccess. The project seeks to establish a regulatory system with the Pharmacists Council of Nigeria (PCN) to ensure that CPs and PPMVs in Lagos and Kaduna states provide high quality FP services, comply with FP regulations, and report service statistics to the National Health Information Management System (NHMIS). To achieve this, the IntegratE Project, in collaboration with PCN and the FMoH, is implementing three main activities:
- Piloting a 3-tiered accreditation system for PPMVs based on their healthcare qualifications;
- Piloting a hub-and-spoke supervisory model to ensure standard drug stocking practices; and
- Building the capacity of CPs and PPMVs to provide expanded FP services and report service statistics to the NHMIS.
Under the pilot accreditation system, PPMVs are trained in FP counseling and services based on their tier (see Box 1). Though CPs function outside of the accreditation system, they receive the same training and provide the same services as Tier 2 and Tier 3 PPMVs.
As the Research, Monitoring and Evaluation partner on the project, the Population Council is leading a mixed-method study on CPs and PPMVs’ capacity to provide high quality FP services. Specifically, the study seeks to assess:
- The effect of the 3-tiered accreditation system on PPMV and CP’s knowledge and technical skills when offering FP services;
- Client experiences of FP services received from PPMVs and CPs, including clients’ perceptions of the quality, accessibility, convenience, and costs of services;
- CPs and PPMVs’ perceptions of the accreditation system and the hub-and-spoke supervisory model;
- The effect of the hub-and-spoke model on improving drug stock practices; and
- Cost of implementing the 3-tiered accreditations system and supervisory model.
Evidence of a regulatory system that effectively supports CPs and PPMVs to provide high quality FP services is needed to scale CP and PPMV provision of FP nationally. Results from the IntegratE project will provide information to the Federal and State Ministries of Health, Pharmacist Council of Nigeria and professional associations about the success and lessons of a tiered accreditation approach.
Through a collaborative process between public, private, non-governmental and community-based organizations, and associations, the IntegratE project is piloting regulatory and supervisory models. This partnership strengthens the capacity of participating organizations to sustain and monitor the progress of these activities, and to disseminate evidence directly to policy makers and program implementers who will use the evidence to inform policy change and scale-up.