Nigeria Private Sector Health Assessment - SHOPS project

for associations of small-scale providers, such as the community pharmacists, as well as for the Guild of
Medical Directors, which is the association of clinic and secondary facility managers.
5.3 Service Regulation
In general the scopes of practice for service providers are well thought out and do not constitute
a constraint to private-sector development. The Ministry of Health has a thorough designation of
reproductive health responsibilities printed in the booklet National Family Planning Reproductive Health;
Guidelines and Standards of Practice. For family planning, the guidelines specify the following scope of
practice.
• Patent medicine vendors (PMVs) and traditional birth attendants (TBAs) can sell condoms and oral
contraceptives (OCs) for refills (they must refer first-time OC users to qualified providers for
consultation).
• Licensed pharmacies can sell emergency contraception and OCs without prescription.
• Nurses can counsel patients about family planning, initiate and resupply oral contraceptives, and
administer injectables.
• Midwives can perform all of the aforementioned functions plus insert intrauterine devices (IUDs)
and implants (if they have been trained how to perform this procedure).
• Physicians can perform all of these functions.
The Pharmacy Council of Nigeria (PCN) regulates pharmacies and PMVs. The impetus for creating the
PMV practice was to expand access to basic medicines in rural and underserved areas. The Ministry of
Health drove this undertaking, and initially it was responsible for issuing PMV licenses. But this function
proved controversial, especially as PMVs in urban areas proliferated because of ineffective enforcement
of licensing guidelines. The PCN is making a more concerted effort to ensure adherence to the laws
defining PMVs’ scope of practice. PMVs have no minimum training requirement, although several of
the ones the assessment team interviewed have Community Health Extension Worker (CHEW)
qualifications or nurse or midwife training. Responsibility for licensing PMVs was transferred back to
the PCN in 2003, which has slowed down issuing of licenses in an effort to exercise more control over
the localization of PMVs. A number of PMVs have not had their licenses issued despite having submitted
their fees and applications more than a year ago.
Pharmacy Council published a list of drugs that PMVs can dispense. It includes basic painkillers,
antimalarials, antihelmitics and over-the-counter antiseptics, cold and cough remedies, and vitamins. It
does not include antibiotics or drugs requiring prescriptions. The approved PMV drug list shows only
condoms and foams as allowed family planning supplies. All parties understand that OC resupply is
permitted for PMVs under Ministry of Health policy, but the absence of OCs on the published list could
be abused by inspectors, as they are authorized to seize any drugs in a drug shop that are not on the
list. Most of the PMVs the assessment team visited sold antibiotics and other drugs not on the list of
approved medicines.
The National Nurse and Midwife Council licenses both groups. Midwifery has been a higher qualification
for nurses who already had been registered. In a change of policy, the government is just beginning
to train some combined nurse midwives at first degree with the expectation they will serve in the
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