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FHS Nigeria

Oladimeji Oladepo

January 12, 2009

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Research Question

How can the poor have access to effective malaria treatment?

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Study Background: Importance of Malaria in Nigeria Malaria a major cause of mortality and

morbidity (About 25-35% of child deaths) and poverty

Resistance to conventional drugs (CQ, SP); Many substandard drugs available

New policy to provide ACTs as 1st and 2nd line drugs

Little known about the main source of treatment: Patent Medical Vendors (PMVs)

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Study Background : Further justification

Public and private stakeholders are not working together in the regulation (demand and supply) of anti-malarial drugs

The poor are not empowered to demand for quality malaria services

Difficult to achieve MDGs without addressing poor peoples’ access to quality anti-malarial drugs through evidence-based innovations.

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FHS Nigeria:-Purpose and Objectives

Goal To improve the provision of quality malaria

services to poor people through innovative public and private sector engagement, citizen empowerment, surveillance and sustainable malaria drug regulation policies.

Specific objectives Generate knowledge that would aid the

understanding of issues and perceptions related to poverty and malaria vulnerability.

Develop intervention proposals that will test or guide changes in the health systems that could have a major impact on the poor

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FHS Cornerstones-Nigeria

Citizen empowerment, surveillance, and demand

Protecting the poor from low quality anti-malarial drugs through public and private sector engagement

Malaria and drug regulation policies

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FHS Nigeria :Project Phases

Inception Phase Oct 2005-Mar2006.

Engaging stakeholders to define research agenda NAP, PMVs, MOH, DFID)

Phase I Apr 06-Dec 07

Formative research Intervention designResearch into policy

Phase II Jan08-Oct 10

Intervention design Research into policy

FHS

How can the poor get access to effective malaria treatment?

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Scoping studies-ResultsFirst Source of Treatment for Most Recent Episode of Malaria

0%

20%

40%

60%

80%

100%

Oyo Kaduna Enugu

Per

cen

t o

f C

ases

Government health facility

Private health facility

Self-treatment traditionalmedicineSelf-treatment with modernmedicinePatent Medicine Vendor

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54 Different Types of Anti-malarial Drugs Found in Oyo, Enugu & Kaduna

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Percent of Patent Medical Vendor Shops with Anti-Malarial Drugs

0

10

20

30

40

50

60

70

80

90

100

ACTs Monotherapyartusenates

Chloroquine Sulfadoxine-pyrimethamine

Other

Per

cen

t o

f S

ho

ps

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Mean Price of Malaria Brands

504

393

83 91

272

0

100

200

300

400

500

600

ACT AS-Mono CQ SP Other

Nai

ra

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Other Study Findings

Low quality drugs cited as major problem by households, PMVs and Associations, government officials

Low confidence in government to regulate, but wide regional variation

PMVs know little about malaria policy change

Gov’t officials know nothing about PMV Associations

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What are the Options?

Business as usual Educate parents, PMVs Subsidize all ACTs Support low-cost diagnostics Support local institutions that work:

civil society, PMV associations, gov’t regulators, industry, to monitor treatment/quality of drugs

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FHS Nigeria: Developing Interventions

Goal:To reduce avoidable deaths from malariaand diminish the financial burden on householdsin the prevention and treatment of malariathrough a more effective use of patent medicinevendors

Outcomes: Availability of effective, appropriate and

affordable drugs Competent identification of people requiring

hospital care and effective referral Availability of bed nets

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FHS Nigeria: Developing Interventions

New co-regulation with PMV Associations, citizens groups, government

New regulatory arrangements that ensures quality assurance, standard setting and accountability

Strengthening of supply chain to ensure drugs and ITNs sold by PMVs are of good quality and appropriately priced

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FHS Nigeria: Developing Interventions

Mini-Lab testing of drugsmaintained by members of

monitoring team-PMV Association, government, community Reps

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FHS Nigeria: Developing Interventions

Cell phone information on drugs, policy, regulations and guidelines and referrals to PMVs PMV IT service:- Messaging and

information sharing service between government health workers and PMV members maintained through the telephone company and other social entrepreneurs

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FHS Nigeria: Developing Interventions

Increasing the knowledge of PMVs through competency based Training that would lead to competent provision of care involving drugs, impregnated bed-nets, and advice

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FHS Nigeria: Developing Interventions

Increasing consumer knowledge and expectations for consumer rights, including involvement in the creation of effective regulatory partnerships for ensuring quality (e.g. monitoring of efficacy of drugs, including the use of low cost testing kits,) and affordability of drug supplies.

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FHS Nigeria: Stakeholders’ Consensus for Proposed Interventions

Proposed interventions discussed with and consensus reached with moving them forward.

PMV Associations -Nigerian Association of Patent and Proprietary Medicine Dealers (NAPPMED), Oyo State

Policy makers at FMOH including National Health Research and Knowledge Enterprise Committee and MOH

Pharmaceutical Inspection Committee (PIC) of the Pharmaceutical Council of Nigeria (PCN), Oyo state branch

Nigeria Assembly Delegation MDG and PPP DFID Mid term review Team

Other Anticipated Players-MTN, Zenith bank and other innovators and social entrepreneurs etc

FHS :The Abuja Meeting

Innovators, potential collaborators, researchers to learn, gather resources and plan for implementation

Expected outcome- tangible plan of action with Budget to be marketed for funding support

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