Interactions between patent medicine vendors and customers in urban and rural Nigeria

Health Policy and Planning, May 2004

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.

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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)


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William R Brieger, Pauline E Osamor, Kabiru K Salami, Oladimeji Oladepo, Sakiru A Otusanya. Interactions between patent medicine vendors and customers in urban and rural Nigeria, Health Policy and Planning, 2004, pp. 177-182, 19/3, DOI: 10.1093/heapol/czh021