Interactions between patent medicine vendors and customers in urban and rural Nigeria
WILLIAM R BRIEGER
2
4
PAULINE E OSAMOR
1
4
KABIRU K SALAMI
0
4
OLADIMEJI OLADEPO
3
4
SAKIRU A OTUSANYA
3
4
0
Department of Sociology
1
Institute of Child Health, College of Medicine
2
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University
,
Baltimore, USA
3
African Regional Health Education Centre, Department of Health Promotion and Education, College of Medicine, University of Ibadan
,
Nigeria
4
Health, Bloomberg School of Public Health, Johns Hopkins University
, 621 N. Washington Street,
Baltimore, MD 21205, USA
Patent medicine vendors (PMVs) supply a large portion of the drugs used by the public in African countries to treat their illnesses. Little has been reported about what actually transpires between PMVs and their customers, but nevertheless, concerns have been raised about the potential for abuse of their position. This study conducted 720 observations of PMV-customer interaction in 444 medicine shops in both the metropolis of Ibadan and the rural town of Igbo-Ora in Oyo State, Nigeria. Each interaction lasted 2 minutes on average. A quarter of the customers shared their illness problems with the shop attendant, 9% presented a prescription and the majority simply requested items for purchase. Most customers (73%) were buying drugs for themselves, while the remainder had been sent to purchase for another person. The former were more likely to be adults, while the latter were more often children and adolescents. The most common PMV behaviours are: selling the requested medicine (69%), giving their own suggestions to the customer (30%), asking questions about the illness (19%) and providing instructions on how to take the medicine (21%). Only three referrals were observed. The large number of specific drug requests was evidence of a public that was actively involved in self-care, and thus the major role of the PMV appeared to be one of salesperson meeting that need. A second role became evident when the customer actually complained about his/her illness, a practice associated with the more active PMVs who asked questions, gave suggestions and provided information. These PMV roles can be enhanced through consumer education, PMV training and policy changes to standardize and legitimize PMV contributions to primary health care.
Introduction
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 (Egboh 1984; Snow et al. 1992;
Mwenesi et al. 1995). 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 2001). Ironically, selling a
chloroquine base product such as Nivaquine in its packet is
patent medicine vending, while counting generic chloroquine
tablets from a tin is considered dispensing (Egboh 1984).
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
customerPMV interactions simply involve the selling of medications
requested by the customer (Oshiname and Brieger 1992;
Osamor 2001). 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 PMVs
license (Nigeria Federal Ministry of Health 1946; Egboh
1984; Fassin 1986; Monsoro et al. 1987; Adikwu 1996; Ongore
and Nyabola 1996; Indalo 1997). This is where the legal
component of PMV practice becomes salient.
In addition to specifying that the PMV should sell only
prepackaged patent medicines, Pharmacy Law in Nigeria
requires that the licencee be at least 21 years of age and
submit the names of two referees (Egboh 1984). Educational
level is not specified, but by convention in Nigeria, the
minimum educational attainment of PMVs has been primary
schooling (Akinde et al. 1982; Abiola et al. 1983; Ojuawo and
Oyaniyi 1993; Osamor 2001). Studies have shown that this
minimal level of education does not confer on the PMV or
her clerk or apprentice correct knowledge about the
medications in her store or the common illnesses experienced by
her customers (van der Geest 1991; Wolf-Gould et al. 1991;
Oshiname and Brieger 1992; Masele et al. 1993; Osamor
2001). Concerning malaria, it has been found that shop clerks
and owner (...truncated)