Nigeria Private Sector Health Assessment - SHOPS project

Table 3: Percentage of retail outlets that perceived difficulties
stocking SFH products, by product
Condom
Oral
contraceptive
Emergency
contraception
Noristerat Depo Provera IUD
6.9% 7.1% 8.9% 10.8% 7.3% 8.2%
Table 4: Percentage of outlets able to refill orders from
wholesaler in less than a month, by product
Condom
Oral
contraceptive
Emergency
contraception
Noristerat Depo Provera IUD
80.2% 66.5% 73.1% 55.1% 59.1% 51.3%
Although far from perfect, these indicators contrast favorably with the public sector’s system. While
efficient, the private sector’s distribution channels are difficult to regulate for quality (see section 5.6).
Unlike most sub-Saharan countries where pharmaceutical products are distributed in channels distinct
from fast-moving consumer goods, in Nigeria these products are distributed in the same channels and
are handled and stored by traders in conditions inappropriate for pharmaceutical products.
Like pharmacists, PMVs resupply from pharmaceutical wholesalers and are subject to the same
transportation and restocking costs, although the range and quantity of their products is generally a
small fraction of a pharmacy’s. SFH estimates that 200,000 PMVs operate in Nigeria, although it is hard
to identify a reliable source of data for this figure. As with other facilities, licenses are issued at the state
level and there is no authority aggregating data at the national level. Moreover data at the state level is
likely to be unreliable. Issuing of PMV licenses has passed from the Ministry of Health to the PCN, which
has been reluctant to issue licenses. According to the PMV association, a large number of PMVs operate
with their license applications pending for longer than a year. This delay has lead to a number of PMVs
operating without licenses.
According to the regulations, PMV proprietors only need to read, write, and pass an interview. In fact a
significant number of PMV proprietors have medical training well beyond what it required—community
health agents, midwives, and nurses all operate PMVs. The assessment team met a retired nurse and a
midwife who operate PMVs. Both of them said that they opened a PMV facility because it was the easiest
facility to obtain a license for and establish in terms of the regulatory requirements and the required
capital. It is hard to know how prevalent this situation is, but it points to one reason so many PMVs
exceed the scope of practice for their facility and to the difficulties of small health entrepreneurs. Both
the nurse and the midwife admitted to selling antibiotics, giving injections, and providing other drugs
not on the approved list of medicines for PMVs. When asked about it, they maintained that the scope
of practice for their profession allowed them to supply these products and services, even though they
were operating in a facility that is not legally able to do so.
According to many informants, the intent of creating the PMV facility was to increase access to basic
palliative care in rural areas. A large number of PMVs, however, are established and operating in urban
and peri-urban areas, some in close proximity to pharmacies. The location of PMVs in urban areas is the
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