FHS Nigeria Oladimeji Oladepo January 12, 2009

Research Question How can the poor have access to effective malaria treatment?

How can the poor have access to effective malaria treatment?

Study Background: Importance of Malaria in Nigeria Malaria a major cause of mortality and morbidity (About 25-35% of child deaths) and poverty Resistance to conventional drugs (CQ, SP); Many substandard drugs available New policy to provide ACTs as 1 st and 2 nd line drugs Little known about the main source of treatment: Patent Medical Vendors (PMVs)

Malaria a major cause of mortality and morbidity (About 25-35% of child deaths) and poverty

Resistance to conventional drugs (CQ, SP); Many substandard drugs available

New policy to provide ACTs as 1 st and 2 nd line drugs

Little known about the main source of treatment: Patent Medical Vendors (PMVs)

Study Background : Further justification Public and private stakeholders are not working together in the regulation (demand and supply) of anti-malarial drugs The poor are not empowered to demand for quality malaria services Difficult to achieve MDGs without addressing poor peoples’ access to quality anti-malarial drugs through evidence-based innovations.

Public and private stakeholders are not working together in the regulation (demand and supply) of anti-malarial drugs

The poor are not empowered to demand for quality malaria services

Difficult to achieve MDGs without addressing poor peoples’ access to quality anti-malarial drugs through evidence-based innovations.

FHS Nigeria:-Purpose and Objectives Goal To improve the provision of quality malaria services to poor people through innovative public and private sector engagement, citizen empowerment, surveillance and sustainable malaria drug regulation policies. Specific objectives Generate knowledge that would aid the understanding of issues and perceptions related to poverty and malaria vulnerability. Develop intervention proposals that will test or guide changes in the health systems that could have a major impact on the poor

Goal

To improve the provision of quality malaria services to poor people through innovative public and private sector engagement, citizen empowerment, surveillance and sustainable malaria drug regulation policies.

Specific objectives

Generate knowledge that would aid the understanding of issues and perceptions related to poverty and malaria vulnerability.

Develop intervention proposals that will test or guide changes in the health systems that could have a major impact on the poor

FHS Cornerstones-Nigeria Citizen empowerment, surveillance, and demand Protecting the poor from low quality anti-malarial drugs through public and private sector engagement Malaria and drug regulation policies

Citizen empowerment, surveillance, and demand

Protecting the poor from low quality anti-malarial drugs through public and private sector engagement

Malaria and drug regulation policies

FHS Nigeria :Project Phases Inception Phase Oct 2005-Mar2006. Engaging stakeholders to define research agenda NAP, PMVs, MOH, DFID) Phase I Apr 06-Dec 07 Formative research Intervention design Research into policy Phase II Jan08-Oct 10 Intervention design Research into policy FHS How can the poor get access to effective malaria treatment?

Inception Phase

Oct 2005-Mar2006.

Engaging stakeholders to define research agenda NAP, PMVs, MOH, DFID)

Phase I Apr 06-Dec 07

Formative research

Intervention design

Research into policy

Phase II Jan08-Oct 10

Intervention design

Research into policy

Scoping studies-Results First Source of Treatment for Most Recent Episode of Malaria

54 Different Types of Anti-malarial Drugs Found in Oyo, Enugu & Kaduna

Percent of Patent Medical Vendor Shops with Anti-Malarial Drugs

Mean Price of Malaria Brands

Other Study Findings Low quality drugs cited as major problem by households, PMVs and Associations, government officials Low confidence in government to regulate, but wide regional variation PMVs know little about malaria policy change Gov’t officials know nothing about PMV Associations

Low quality drugs cited as major problem by households, PMVs and Associations, government officials

Low confidence in government to regulate, but wide regional variation

PMVs know little about malaria policy change

Gov’t officials know nothing about PMV Associations

What are the Options? Business as usual Educate parents, PMVs Subsidize all ACTs Support low-cost diagnostics Support local institutions that work: civil society, PMV associations, gov’t regulators, industry, to monitor treatment/quality of drugs

Business as usual

Educate parents, PMVs

Subsidize all ACTs

Support low-cost diagnostics

Support local institutions that work: civil society, PMV associations, gov’t regulators, industry, to monitor treatment/quality of drugs

FHS Nigeria: Developing Interventions Goal: To reduce avoidable deaths from malaria and diminish the financial burden on households in the prevention and treatment of malaria through a more effective use of patent medicine vendors Outcomes: Availability of effective, appropriate and affordable drugs Competent identification of people requiring hospital care and effective referral Availability of bed nets

Goal:

To reduce avoidable deaths from malaria

and diminish the financial burden on households

in the prevention and treatment of malaria

through a more effective use of patent medicine

vendors

Outcomes:

Availability of effective, appropriate and affordable drugs

Competent identification of people requiring hospital care and effective referral

Availability of bed nets

FHS Nigeria: Developing Interventions New co-regulation with PMV Associations, citizens groups, government New regulatory arrangements that ensures quality assurance, standard setting and accountability Strengthening of supply chain to ensure drugs and ITNs sold by PMVs are of good quality and appropriately priced

New co-regulation with PMV Associations, citizens groups, government

New regulatory arrangements that ensures quality assurance, standard setting and accountability

Strengthening of supply chain to ensure drugs and ITNs sold by PMVs are of good quality and appropriately priced

FHS Nigeria: Developing Interventions Mini-Lab testing of drugs maintained by members of monitoring team-PMV Association, government, community Reps

Mini-Lab testing of drugs

maintained by members of monitoring team-PMV Association, government, community Reps

FHS Nigeria: Developing Interventions Cell phone information on drugs, policy, regulations and guidelines and referrals to PMVs PMV IT service:- Messaging and information sharing service between government health workers and PMV members maintained through the telephone company and other social entrepreneurs

Cell phone information on drugs, policy, regulations and guidelines and referrals to PMVs

PMV IT service:- Messaging and information sharing service between government health workers and PMV members maintained through the telephone company and other social entrepreneurs

FHS Nigeria: Developing Interventions Increasing the knowledge of PMVs through competency based Training that would lead to competent provision of care involving drugs, impregnated bed-nets, and advice

Increasing the knowledge of PMVs through competency based Training that would lead to competent provision of care involving drugs, impregnated bed-nets, and advice

FHS Nigeria: Developing Interventions Increasing consumer knowledge and expectations for consumer rights, including involvement in the creation of effective regulatory partnerships for ensuring quality (e.g. monitoring of efficacy of drugs, including the use of low cost testing kits,) and affordability of drug supplies.

Increasing consumer knowledge and expectations for consumer rights, including involvement in the creation of effective regulatory partnerships for ensuring quality (e.g. monitoring of efficacy of drugs, including the use of low cost testing kits,) and affordability of drug supplies.

FHS Nigeria: Stakeholders’ Consensus for Proposed Interventions Proposed interventions discussed with and consensus reached with moving them forward. PMV Associations - Nigerian Association of Patent and Proprietary Medicine Dealers (NAPPMED), Oyo State Policy makers at FMOH including National Health Research and Knowledge Enterprise Committee and MOH Pharmaceutical Inspection Committee (PIC) of the Pharmaceutical Council of Nigeria (PCN), Oyo state branch Nigeria Assembly Delegation MDG and PPP DFID Mid term review Team Other Anticipated Players-MTN, Zenith bank and other innovators and social entrepreneurs etc

Proposed interventions discussed with and consensus reached with moving them forward.

PMV Associations - Nigerian Association of Patent and Proprietary Medicine Dealers (NAPPMED), Oyo State

Policy makers at FMOH including National Health Research and Knowledge Enterprise Committee and MOH

Pharmaceutical Inspection Committee (PIC) of the Pharmaceutical Council of Nigeria (PCN), Oyo state branch

Nigeria Assembly Delegation MDG and PPP

DFID Mid term review Team

Other Anticipated Players-MTN, Zenith bank and other innovators and social entrepreneurs etc

FHS :The Abuja Meeting Innovators, potential collaborators, researchers to learn, gather resources and plan for implementation Expected outcome- tangible plan of action with Budget to be marketed for funding support

Innovators, potential collaborators, researchers to learn, gather resources and plan for implementation

Expected outcome- tangible plan of action with Budget to be marketed for funding support