The Pharmaceutical Society of Nigeria, PSN, a sub grantee of the partnership for Advocacy in Child and Family Health At Scale, PACFaH@Scale, in collaboration with Society for Family Health’s IntergratE project, have acquired a waiver from the Federal Ministry of Health as well as relevant states Ministries of Health to pilot the training of Community Pharmacists, CPs and Patent Proprietors Medicine Vendors, PPMVs to provide expanded services and other Primary Healthcare services in Nigeria.

The FP project is being piloted to serve as a proof of concept that the CPs and PPMVs can provide expanded FP services and other PHC services. The project involves PSN-PAS as the advocacy arm, while SFH/IntegrateE as the pilot organization on the service delivery component.

Initially, the policy did not allow CPs and PPMVs to provide expanded FP services in Nigeria. But because of the need to expand FP services to numerous populace that have not been able to access services due to shortage of human resource for health in many communities, the PSN-PAS project worked hard to secure the permission through the Pharmaceutical Council of Nigeria, PCN, an agency set up by the Nigerian government to regulate pharmaceutical services and training in the country. The PSN-PAS project also approached the Food and Drugs, F&DS department of the FMoH to obtain a waiver for pilot.

Justification of the waiver to train CPs and PPMVs

In May 2019, the National Population Commission in collaboration with the Federal Ministry of Health in Nigeria released their 2018 Demographic Health Survey findings. The findings show marginal progress on key family planning and reproductive health indicators. Results indicate the country’s total fertility rate (TFR), which measures the number of children a woman is likely to have during her childbearing years, decreased from 5.5 births per woman in the 2013 Nigeria Demographic Health Survey (NDHS) to 5.3 births per woman in the 2018 NDHS. Meanwhile, the total contraceptive prevalence rate (CPR) for married women using both traditional and modern methods has increased by 2 percentage points over the last five years, from 15% to 17%.

Although this reports shows a marginally increase on some FP indicators, the need for more opportunity for CPs and PPMVs to be empowered to administer some FP services become necessary hence the decision to, therefore,  generate the evidence to see if CPs & PPMVs can provide the expanded role.

Accordingly, the PCN provided a guideline that will monitor the pilot scheme to ensure both the CPs and the PPMVs have distinct but effective training to be able to provide these services. Under the guidelines, CPs will provide both injectable contraceptives and Implants, while the PPMVs in Tier 1 role are restricted to refill oral pills, counsel and refer patients. Those PPMVs in Tier 2 and 3 will be trained on DMPA-SC to refill already initiated and refer.

Before now, the PCN was never consulted for permission to provide a waiver to train the CPs and PPMVs in Nigeria.  However, the PSN-PAS working with the NDF/EDL review committee engaged in a rigorous process of scientific research to provide evidence that PPMVs can provide Amoxicillin Dispersible Tablets.  The evidence included the high child mortality rate due to pneumonia, access and operational researches to prove that PPMVs can actually provide these services.

The pilot trainings for the CPs and PPMVs were conducted in Taraba, Enugu and Anambra states.

The Consultative Meeting

It was as a result of these efforts that a consultative engagement on the PCN Tiered Accreditation System Pilot of the PPMVs was called on Wednesday 14th August, 2019 to present, harmonize, and better understand the tiered accreditation system, which serves as the basis for the pilot training for the PPMVs and to secure the buy-in of the relevant stakeholders on the tiered accreditation system.

The Stakeholders

The stakeholders present included the PSN-PAS as the host, The Registrar of PCN, the President of PSN, the Chairman PSN Foundation BoT, representative and officers of the Director of Food and Drugs Services Department of the Federal Ministry of Health, the Chairman of ACPN, the National Chairman Association of Hospital and Administrative Pharmacist of Nigeria, the Chairman Nigeria Association of Pharmacists in Academia, NAFDAC etc.

The Way Forward

A report on the review of recent publications on PPMVs” which highlighted the 2016 findings on PPMVs in 16 States was presented. Another presentation on the Overview of the Tiered Accreditation System Pilot Study” which also highlighted the Hub and Spoke Model of supervision of the Pharmacists Council of Nigeria was made.

In the final resolution, the meeting emphatically clarified that all stakeholders in the pharmaceutical business had no opposition to the tiered classification and that the concept is well appreciated.  The stakeholders also expressed support for the APML and the lists of drugs contained. They all promised to work as a collective to promote FP services in Nigeria.