1 FHS Nigeria Oladimeji Oladepo January 12, 2009
Sep 06, 2014
1
FHS Nigeria
Oladimeji Oladepo
January 12, 2009
2
Research Question
How can the poor have access to effective malaria treatment?
3
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)
4
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.
5
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
6
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
7
8
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?
9
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
10
54 Different Types of Anti-malarial Drugs Found in Oyo, Enugu & Kaduna
11
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
12
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
13
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
14
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
15
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
16
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
17
FHS Nigeria: Developing Interventions
Mini-Lab testing of drugsmaintained by members of
monitoring team-PMV Association, government, community Reps
18
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
19
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
20
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.
21
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
22