FHS Nigeria


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This presentation was Oladimeji Oladepo of the University of Ibadan at a Future Health Systems conference in Abuja, Nigeria, in January 2009. www.futurehealthsystems.org.

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FHS Nigeria

  1. 1. FHS Nigeria Oladimeji Oladepo January 12, 2009
  2. 2. Research Question <ul><li>How can the poor have access to effective malaria treatment? </li></ul>
  3. 3. Study Background: Importance of Malaria in Nigeria <ul><li>Malaria a major cause of mortality and morbidity (About 25-35% of child deaths) and poverty </li></ul><ul><li>Resistance to conventional drugs (CQ, SP); Many substandard drugs available </li></ul><ul><li>New policy to provide ACTs as 1 st and 2 nd line drugs </li></ul><ul><li>Little known about the main source of treatment: Patent Medical Vendors (PMVs) </li></ul>
  4. 4. Study Background : Further justification <ul><li>Public and private stakeholders are not working together in the regulation (demand and supply) of anti-malarial drugs </li></ul><ul><li>The poor are not empowered to demand for quality malaria services </li></ul><ul><li>Difficult to achieve MDGs without addressing poor peoples’ access to quality anti-malarial drugs through evidence-based innovations. </li></ul>
  5. 5. FHS Nigeria:-Purpose and Objectives <ul><li>Goal </li></ul><ul><ul><li>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. </li></ul></ul><ul><li>Specific objectives </li></ul><ul><ul><li>Generate knowledge that would aid the understanding of issues and perceptions related to poverty and malaria vulnerability. </li></ul></ul><ul><ul><li>Develop intervention proposals that will test or guide changes in the health systems that could have a major impact on the poor </li></ul></ul>
  6. 6. FHS Cornerstones-Nigeria <ul><li>Citizen empowerment, surveillance, and demand </li></ul><ul><li>Protecting the poor from low quality anti-malarial drugs through public and private sector engagement </li></ul><ul><li>Malaria and drug regulation policies </li></ul>
  7. 7.
  8. 8. FHS Nigeria :Project Phases <ul><li>Inception Phase </li></ul><ul><li>Oct 2005-Mar2006. </li></ul><ul><li>Engaging stakeholders to define research agenda NAP, PMVs, MOH, DFID) </li></ul><ul><li>Phase I Apr 06-Dec 07 </li></ul><ul><li>Formative research </li></ul><ul><li>Intervention design </li></ul><ul><li>Research into policy </li></ul><ul><li>Phase II Jan08-Oct 10 </li></ul><ul><li>Intervention design </li></ul><ul><li>Research into policy </li></ul>FHS How can the poor get access to effective malaria treatment?
  9. 9. Scoping studies-Results First Source of Treatment for Most Recent Episode of Malaria
  10. 10. 54 Different Types of Anti-malarial Drugs Found in Oyo, Enugu & Kaduna
  11. 11. Percent of Patent Medical Vendor Shops with Anti-Malarial Drugs
  12. 12. Mean Price of Malaria Brands
  13. 13. Other Study Findings <ul><li>Low quality drugs cited as major problem by households, PMVs and Associations, government officials </li></ul><ul><li>Low confidence in government to regulate, but wide regional variation </li></ul><ul><li>PMVs know little about malaria policy change </li></ul><ul><li>Gov’t officials know nothing about PMV Associations </li></ul>
  14. 14. What are the Options? <ul><li>Business as usual </li></ul><ul><li>Educate parents, PMVs </li></ul><ul><li>Subsidize all ACTs </li></ul><ul><li>Support low-cost diagnostics </li></ul><ul><li>Support local institutions that work: civil society, PMV associations, gov’t regulators, industry, to monitor treatment/quality of drugs </li></ul>
  15. 15. FHS Nigeria: Developing Interventions <ul><ul><li>Goal: </li></ul></ul><ul><ul><li>To reduce avoidable deaths from malaria </li></ul></ul><ul><ul><li>and diminish the financial burden on households </li></ul></ul><ul><ul><li>in the prevention and treatment of malaria </li></ul></ul><ul><ul><li>through a more effective use of patent medicine </li></ul></ul><ul><ul><li>vendors </li></ul></ul><ul><ul><li>Outcomes: </li></ul></ul><ul><ul><li>Availability of effective, appropriate and affordable drugs </li></ul></ul><ul><ul><li>Competent identification of people requiring hospital care and effective referral </li></ul></ul><ul><ul><li>Availability of bed nets </li></ul></ul>
  16. 16. FHS Nigeria: Developing Interventions <ul><li>New co-regulation with PMV Associations, citizens groups, government </li></ul><ul><li>New regulatory arrangements that ensures quality assurance, standard setting and accountability </li></ul><ul><ul><li>Strengthening of supply chain to ensure drugs and ITNs sold by PMVs are of good quality and appropriately priced </li></ul></ul>
  17. 17. FHS Nigeria: Developing Interventions <ul><li>Mini-Lab testing of drugs </li></ul><ul><ul><li>maintained by members of monitoring team-PMV Association, government, community Reps </li></ul></ul>
  18. 18. FHS Nigeria: Developing Interventions <ul><li>Cell phone information on drugs, policy, regulations and guidelines and referrals to PMVs </li></ul><ul><ul><ul><ul><li>PMV IT service:- Messaging and information sharing service between government health workers and PMV members maintained through the telephone company and other social entrepreneurs </li></ul></ul></ul></ul>
  19. 19. FHS Nigeria: Developing Interventions <ul><li>Increasing the knowledge of PMVs through competency based Training that would lead to competent provision of care involving drugs, impregnated bed-nets, and advice </li></ul>
  20. 20. FHS Nigeria: Developing Interventions <ul><li>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. </li></ul>
  21. 21. FHS Nigeria: Stakeholders’ Consensus for Proposed Interventions <ul><ul><ul><li>Proposed interventions discussed with and consensus reached with moving them forward. </li></ul></ul></ul><ul><ul><ul><ul><li>PMV Associations - Nigerian Association of Patent and Proprietary Medicine Dealers (NAPPMED), Oyo State </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Policy makers at FMOH including National Health Research and Knowledge Enterprise Committee and MOH </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Pharmaceutical Inspection Committee (PIC) of the Pharmaceutical Council of Nigeria (PCN), Oyo state branch </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Nigeria Assembly Delegation MDG and PPP </li></ul></ul></ul></ul><ul><ul><ul><ul><li>DFID Mid term review Team </li></ul></ul></ul></ul><ul><ul><li>Other Anticipated Players-MTN, Zenith bank and other innovators and social entrepreneurs etc </li></ul></ul>
  22. 22. FHS :The Abuja Meeting <ul><li>Innovators, potential collaborators, researchers to learn, gather resources and plan for implementation </li></ul><ul><li>Expected outcome- tangible plan of action with Budget to be marketed for funding support </li></ul>