The Pharmaceutical Society of Nigeria, a subgrantee of PACFaH@Scale project, conducted a research to review the new strategic direction and course correction of the IntegratE project with a view to determining success and challenges in the project. Findings from this research showed the project was highly successful as majority of the success criteria were achieved, thus, indicating a huge potential to advance the TAS. The research also found GPS mapping of all PPMVs in Lagos and Kaduna States as part of the success. However, some of the challenges found are lack of review of the TSTS policy and the APML to reflect the TAS which will strengthen implementation of the accreditation system.

The Nigerian Government through her commitment to the family planning goal of achieving a 27% modern contraceptive prevalence rate, aimed to expand access through the integration of the private sector and other community providers in FP service provision following the evidence from 2013 National Demographic Health Survey that 50% of family planning clients source their FP commodities from these providers. The commitment further received multisectoral support from diverse stakeholders towards the actualization of this goal. One of such support was received by the government is the LauchDSI project backing the Pharmacists Council of Nigeria in responding to the rapidly changing landscape of healthcare practitioners under its regulatory purview, specifically the practice of the Patent and Proprietary Medicine Vendors. The LaunchDSI project was implemented by the Management Sciences for Health, and supported the regulator to understudy, adapt and contextualize the success recorded in Tanzania, with similar situation. 

The LaunchDSI project led to the classification of Patent Medicine Vendors based on their qualification. This classification termed the Tiered Accreditation System of the Patent and Proprietary Medicine Vendors was based on the evidence that practising vendors possess diverse healthcare qualifications. This concept proposes to align their certifications with some aspects of Primary Health Care services that can be delivered by these providers in the actualization of Universal Health Coverage, especially in hard-to-reach communities where the pharmacy workforce is inadequate. After the development of the innovative accreditation system, it was pertinent for the regulator to test the accreditation system as a proof of concept that with the accreditation, training and adequate supervision of the vendors, they will provide quality primary health care services.

The Society for Family Health, along with other partners received funding from the Gates Foundation and MSD for mothers to support the Pharmacists Council of Nigeria in piloting the Tiered Accreditation System in Lagos and Kaduna States. The PACFaH @Scale project was also pivotal in the pilot project to provide enabled policy environment for the success of the pilot. 

Furthermore, a lot has been achieved from the pilot which is ongoing, with verifiable progress, even though there were challenges encountered that needs to be addressed quickly. Moreover, a full roll out will not be recommended as certain aspects of the guiding policies needs to be ratified. Also, the pilot location is not representative of the Nigeria context, rather a scale-up to ensure adequate geographical spread and application of experience from the implementation thus far. This work described here is a learning and course-correction review of the pilot project

The purpose of the desk review is document information on progress, experience during implementation, successes and challenges in rolling out the accreditation system; possible steps in mitigating challenges or bottlenecks identified; Highlight necessary legislative and/or regulatory changes needed for full roll-out of the accreditation system and strategies for accomplishment and recommend for scale-up, successful implementation and sustainability of the PPMVs tiered accreditation system.

The assessment was conducted using qualitative methods and sampling was purposive to adequately answer the key review questions based on the ToR. Data collection was carried out through in-depth interviews with key stakeholders directly involved in the implementation of the IntegratE project as well as other relevant staff of the Pharmacists Council of Nigeria involved in the PPMVs Tiered Accreditation System. A well-designed interview tool was developed and validated for use during the interviews.

Finding revealed that overall, the pilot project was highly successful as the majority of the success criteria were achieved, thus, indicating a huge potential to advance the TAS. Some of the major achievements made include the GPS mapping of all PPMVs in Lagos and Kaduna States, which indicates the actual number and location of these providers as well as the support to PCN for the development of an SOP for the operationalization of the TAS. Another achievement is the classification, recruitment and training of PPMVs for the pilot of the TAS. In Lagos state, the project set out to work with a hundred and five (105) health trained PPMVs and two hundred and eleven (211) non health trained PPMVs, bringing it to a total of 306 PPMVs. In Kaduna, two hundred (200) health trained PPMVs, and one hundred and thirty-one (131) non-health trained PPMVs were earmarked for the project. Comparatively, there are more health trained PPMVs (tier 2 & 3) in the north (Kaduna) compared to the south (Lagos) which has more non-health trained PPMVs (tier 1).

For the scale-up to be successful, however, the challenges and inadequacies identified during the first phase of the pilot must be holistically addressed. The following are recommended:

• There should be a review of the TSTS policy and the APML to reflect the TAS which will strengthen implementation of the accreditation system.
• There should be a comprehensive accreditation of interested vendors for the pilot project in its entirety.
• The Pharmacists Council of Nigeria should start in earnest to accredit more institutions for the training of recruited vendors early enough so there will be no disruption of capacity building activities.
• The Training of Trainers should be continuous to ensure availability of trainers when needed.
• Findings from the first phase of the project implemented in Lagos and Kaduna States should be disseminated to all key stakeholders. This is to ensure that progress made is adequately tracked and appreciated by the stakeholders while conferring trust in the intentions and role of the regulator. 
• The PCN as the regulator should ensure that its operational mechanisms are reviewed frequently and incorporate process improvement systems and approaches, anticipate potential bottlenecks and put in place adequate contingency plans to address unexpected challenges.
• The governing council of PCN should sustain its support for TAS and ensure that internal issues and other regulatory function do not impede the implementation of PCN’s role.
• The PCN should communicate to the Federal Ministry of Health and other government agencies through a memo that the TAS is a regulatory tool to improve the PPMVL practice.
• There should be a strengthened coordination of partners working on TAS, and where possible there should be a routine meeting to share progress and challenges for quick resolve on the project.
• All partners must ensure that roles do not overlap and should quickly seek for guidance from PCN.

For the resistance experienced, continuous stakeholder engagement must be implemented to sustain the interest of all stakeholders particularly the service providers.