Nigeria Private Sector Health Assessment - SHOPS project

4. Assessment Methodology
The assessment team consisted of Taara Chandani (health networks and health finance), Rich Feeley
(health financing and policy and regulatory environment), and Jeff Barnes (social marketing and
products). In addition the team relied on in-country expertise from the Community Participation for
Action in the Social Sector Project (COMPASS) (Dr. Habib Sadauki) for provider services and quality
issues. SFH (Jennifer Anyanti, Sadiq Abdulsamad, and Wale Adedji) provided information about the
pharmaceutical sector. Particular attention was given to the NHIS given its planned expansion and
potential to increase consumers’ ability to access health services, ensure stable income for private
providers, and ensure provider quality. PSP-One already had begun supporting one of the HMOs
involved in expanding access to the scheme, Total Health Trust. The scope of work for the assessment
is Annex 1 of this report.
Prior to the in-country assessment, team members conducted a literature review of the health situation
in Nigeria, reviewed government and USAID country strategies, and studied many of the reports
addressing the status of reproductive health (such as DHS 2003 and the National HIV/AIDS and
Reproductive Health Survey) and related topics, including provider quality, contraceptive security, and
sources of health financing. While this assessment focuses on family planning rather than HIV/AIDS,
as many of the issues for the private sector in HIV/AIDS are the same (such as product supply, human
resources, and quality assurance) a number of HIV/AIDS reports and organizations were consulted as
well. A bibliography of reports and documents consulted is in Annex 2.
During the in-country assessment, the team interviewed informants from regulatory bodies and
professional associations. Unlike the public sector, which has well-defined structures and entry points,
the private health sector is often loosely organized. Therefore regulatory bodies and professional
associations are usually the best places to start when assessing issues affecting a broad range of private
providers. In Nigeria few private providers operate in group or corporate settings that allow for
sharing resources and economies of scale. The exceptions to this generalization are the HMOs and
the faith-based organizations that are a part of the Christian Health Association of Nigeria (CHAN).
CHAN has more than 350 member institutions, many of which share the benefits of procuring drugs
and supplies through Christian Health Association of Nigeria-Pharmacy Procurement (CHANPHARM).
HMO networks do not pool procurement or share facilities, but they are beginning to share training
resources. The providers interviewed were selected with a view to getting a wide range of scopes of
practice and, therefore, included specialists, general practitioners, nurses, midwives, traditional birth
attendants, pharmacists, and patent medicine vendors (PMVs). More attention was given to private
commercial providers than private non-governmental or faith-based providers.
Because of time constraints, the assessment team could not visit all of the sites or meet with all of
the people necessary to make a national assessment. Visits were limited to Abuja, Kano, and Lagos. In
Kano and Lagos, however, the team did visit providers in their clinics, hospitals, pharmacies, and PMV
stores to better understand the conditions in which providers work. To understand the pharmaceutical
distribution system, site visits were made to the wholesale markets in Kano and Lagos where selected
wholesalers were interviewed. The complete schedule of meetings is in Annex 3.
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