The private sector delivers a substantial portion of healthcare services in Sub-Saharan Africa. In particular, drug shops comprise a sizable portion (nearly 40%) of the private healthcare sector in the region and provide between 15% and 83% of all child health services (Marriot, 2009).
In Nigeria, owner-operated drug retail outlets, or patent and proprietary medicine vendors (PPMVs), are a main source of medicine for acute conditions. PPMVs are a particularly important source of care in rural and lower income communities. PPMVs are defined as “a person without formal training in pharmacy who sells orthodox pharmaceutical products on a retail basis for profit”. They were established as a category of retailer by the Ministry of Health to provide a source of medicine in communities with limited access to essential health commodities (Barnes, Chandani & Feeley, 2008).
PPMV licensure does not require formal training in medicine or pharmacy. Rather, many PPMVs complete an apprenticeship with a more senior PPMV before opening their own shop, and by convention are expected to have completed primary school. Regulations permit PPMVs to sell a limited number of pre-packaged, over-the-counter medicines and medical products, but prohibit them from selling prescription medications (including antibiotics) or conducting invasive medical procedures (e.g. injections). In the area of family planning, PPMVs are permitted to sell condoms and oral contraceptive pills, but are not allowed to prescribe or sell oral contraceptives to first-time contraceptive users or users experiencing complications (Nigerian Federal Ministry of Health, 2015).
Egbon (2014) stated that Patent Medicine Vendors (PMVs) have both functional and legal dimensions to their practice. The functional part involves the process of selling a product, while the legal component designates which products the PMV can and should sell.
Patent medicine refers to proprietary drugs that are considered safe to sell to the general public in prepackaged form, and include common drugs like pain-relieving tablets and cough syrups. Such medicines are to be sold in their original packets as they come from the manufacturer. That package must not be altered, and drugs must not be extracted from the package and sold in lesser or greater number, as this constitutes dispensing (Twebaze, 2011).
The term ‘vending’ itself denotes that the work of PMVs is commercial and retail in nature. Therefore, even though the vending involves health care products, the primary function of the PMV is a business, not unlike selling stationery supplies, as is evidenced by the fact that the bulk of customer PMV interactions simply involve the selling of medications requested by the customer (Osamor, 2011). Like any other successful business person, the PMV tries to respond to customer demand. Hence, one often finds for sale in the PMV shop generic drugs like paracetamol and chloroquine in large tins and antibiotic and psychotropic drugs that are outside the scope of the PMV’s license (Nigerian Federal Ministry of Health, 2015). This is where the legal component of PMV practice becomes salient.
In short, selling medicine is a business with tentacles in all corners of Africa where people perceive a need to buy medicinal products. In this context, the PMV can be broadly, defined as a person without formal pharmacy training who sells orthodox pharmaceutical products on a retail basis for profit. While this definition does not clearly designate the PMV as a health care provider, the fact is, the PMV enterprise as broadly described above is the primary source of orthodox drugs for both urban and rural populations (Iweze, 2007).
References
Barnes, J., Chandani, T. & Feeley, R. (2008). Nigeria private sector health assessment. Bethesda, MD: Private Sector Partnerships-One project, Abt Associates Inc.
Egbon, A. A. (2014). Pharmacy laws and practice in Nigeria. Ikeja, Nigeria: Literamed Publications.
Iweze, E. A. (2007). The patent medicine store: hospital for the urban poor. In: Makinwa PK, Ozo OA [eds]. The urban poor in Nigeria. Ibadan, Nigeria: Evans Brothers Ltd.
Marriot, A. (2009). Blind optimism: Challenging the myths about private health care in poor countries. Oxfam Briefing Paper. Oxfam International.
Nigerian Federal Ministry of Health (2015). National Family Planning/Reproductive Health Policy Guidelines and Standards of Practice, Abuja: FMOH
Osamor, P. E. (2011). Knowledge and selling practice of Patent Medicine Vendors (PMV) regarding the treatment of malaria in Idikan Community, Ibadan, Oyo State. Dissertation, Department of Health Promotion and Education. College of Medicine, University of Ibadan, Nigeria.
Twebaze, D. (2011). A literature review of care-seeking practices for major childhood illnesses in Uganda. Basic Support for Institutionalizing Child Survival Project (BASICS II). Arlington, Virginia: United States Agency for International Development.
