Improving Access to Health Care in Rural Communities by Re-Orienting and Integrating Patent Medicine Sellers into Primary Health Care Service Delivery in Nigeria

Download Article

Authors : Okumagba Mamodesan



Good health is fundamental to improved quality of life, and the goal of promoting the health of rural community dwellers in Nigeria is critical in improving the quality of life of a vast majority of Nigerians who reside in rural communities. The objectives of this study were to determine the purpose for patronage of patent medicine shops; determine the reason(s) for preference for patent medicine shops to local health care centres; review the major challenges of patent medicine sellers or patent and proprietary medicine vendors (PPMVs); ascertain the level of uptake of cases in patent medicine shops compared to health centres; and to proffer a functional policy framework involving the patent and proprietary medicine vendors and shops to improve the quality and access to primary health care especially in rural communities in Nigeria.


This cross sectional pilot study made use of questionnaires containing semi structured questions, through direct one-on-one interviews, and information was obtained from both PPMVs and individuals who patronize their shops. This study was done in four rural communities of Delta State, Nigeria. Two major primary data sets and a secondary data set were generated. The Statistical Package for Social Sciences (SPSS) version 21 for windows software was used for analysis and a descriptive presentation of the data was given.


From a total of 51 patent medicine shop users, 21 (41.2%) males and 30 (58.8%), females, with mean age of 30.2 years, 35 (70.5%) patronize PPMVs to buy medicine, while 14 (27.5%) went for consultation and just one person went to buy condom.

Twenty two (43.1%) respondents claimed proximity to place of residence as a major reason for preference for PPMVs, 6 (11.8%), mentioned familiarity with PMS owners, 5 (9.8%) said there was no delay in receiving treatment. All but one of the 14 patent and proprietary medicine vendors that were interviewed was male, with a mean age of 36.43 years. Four (28.6%) PPMVs claimed there was no major challenge in their business, 3 (21.4%) mentioned financial constraint. A comparative look at the total attendance records of both patent medicine shops and the health centres revealed poor level of utilization of health centres.


Patent medicine shops are unique and very important in health care delivery especially in rural communities of Nigeria. There is need for a paradigm shift towards reorienting and integrating PPMVs and other related drug outlets into the mainstream primary health care delivery system. This will serve as an opportunity to improve the coverage and quality of the health system in Nigeria.


Access to health; Rural communities; Patent medicine sellers; Primary health care.


1.      Abimbola S. How to improve the quality of primary health care in Nigeria. 2012. BMJ. Accessed 29/04/15

2.      Adetunji JA. Response of parents to five killer diseases among children in a Yoruba community, Nigeria. Soc Sci Med 1991; 32:1379-1387.

3.      Adikwu MU. Sales practices of patent medicine sellers in Nigeria. Health Policy Planning. 1996; 11(2):202–205.

4.      Africa Health Workforce Observatory [AHWO] (2008) Human Resources for Health Country Profile: Nigeria. Geneva: World Health Organization

5.      Amooti-Kaguna B, Nuwaha F. Factors influencing choice of delivery sites in Rakai district of Uganda. Soc Sci Med 2000; 50: 203-13.

6.      Awodele OI, Adeniran A, Awodele DF. Pharmacovigilance amongst patent medicine vendors (PMVs) in Ekiti state, Nigeria. Int J Risk Saf Med. 2012; 24 (2): 65-72. doi: 10.3233/JRS-2012-0562.

7.      Baker JB, Bazemore AW, Jacobson CJ. Rapid Assessment of Access to Primary Care in Remote Parts of the Developing World. Field Methods 2008; 20 (3): 296–309. DOI: 10.1177/1525822X08317114. Accessed 29/04/15

8.      Barnes J, Chandani T, Feeley R (2008) Nigeria Private Sector Health Assessment. Bethesda, MD: Private Sector Partnerships-One project, Abt Associates Inc.

9.      Beyeler N, Liu J, Sieverding M. A Systematic Review of the Role of Proprietary and Patent Medicine Vendors in Healthcare Provision in Nigeria. PLoS ONE 2015; 10(1): e0117165. doi:10.1371/journal.pone.0117165

10.  Brieger WR, Osamor PE, Salami KK, Oladepo O, Otusanya SA. Interactions between patent medicine vendors and customers in urban and rural Nigeria. Health Policy Plan 2004; 19:177-182.

11.  Brieger W, Unwin A, Greer G, Meek S. Interventions to improve the role of medicine sellers in malaria case management for children in Africa. London, UK and Arlington, Va., USA: the Malaria Consortium and BASICS for the United States Agency for International Development; prepared for Roll Back Malaria's Sub-group for Communication and Training and Malaria Case Management Working Group; 2005.

12.  Brugha R, Zwi A: Improving the quality of private sector delivering of public health services: challenges and strategies. Health Policy Plan 2002; 13: 103-120.

13.  Delta State, 2015. Accessed 1/5/15.

14.  Egboh A. Pharmacy laws and practice in Nigeria. Ikeja: Literamed Publications; 1984.

15.  Erhun OO, Babalola MO, Erhun WO. Drug regulation and control in Nigeria: The challenge of counterfeit drugs. Journal of Health & Population in Developing Countries 2001; 4: 23-34.

16.  Foster SD. Pricing, distribution, and use of antimalarial drugs. Bull World Health Organ 1991; 69: 349-363.

17.  Frankenberg E. The effects of access to health care on infant mortality in Indonesia. Health Transit Rev 1995; 5: 143-63.

18.  Grais RF, Dubray C, Gerstl S, Guthmann JP, Djibo A, Nargaye KD, et al. Unacceptably high mortality related to measles epidemics in Niger, Nigeria, and Chad. PLoS Med 2007; 4: e16.

19.  Iweze EA. The patent medicine store: hospital for the urban poor. In The urban poor in Nigeria. Edited by Makinwa PK, Ozo OA. Ibadan, Nigeria: Evans Brother Ltd; 1987:317-322.

20.  Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS, Bellagio Child Survival Study Group. How many child deaths can we prevent this year? Lancet 2003; 362: 65-71.

21.  Kadobera D, Sartorius B, Masanja H, Mathew A, Waiswa P. The effect of distance to formal health facility on childhood mortality in rural Tanzania, 2005-2007. Glob Health Action (Global Health Action) 2012; 5: 1-9.

22.  National Population Commission, National Malaria Control Programme, ICF International (2012) Nigeria Malaria Indicator Survey 2010 Abuja, Nigeria: NPC, NMCP and ICF International; doi: 10.1016/j.asjsur.2012.06.01025554668

23.  National Primary Health Care Development Agency (2011) Draft Essential Childhood Medicines Scale-Up Plan Abuja, Nigeria: Federal Ministry of Health; doi: 10.1080/17437199.2011.58796125473706

24.  Nwangwu PU. Health care delivery in Nigeria: contributions of Nigerians in diaspora. Address to the convention of Nigerian professionals in diaspora, at Paris, France. Accessed 15/04/2015.

25.  Okonkwo AD, Okonkwo UP. Patent medicine vendors, community pharmacists and STI management in Abuja, Nigeria. (African Health Sciences) Afr Health Sci. 2010; 10(3): 253–265.

26.  Onwujekwe O, Onoka C, Uzochukwu B, Hanson K. Constraints to universal coverage: inequities in health service use and expenditures for different health conditions and providers. Int J Equity Health 2011;10: 50 doi: 10.1186/1475-9276-10-5022078263

27.  Peterson K, Obileye O. Access to drugs for HIV/AIDS and related opportunistic infections in Nigeria. Policy Project/Nigeria. 2002:1–45.

28.  Ross-Degnan D, Goel P, Berman P, Soumeari S. Retail pharmacies in developing countries: A behaviour and intervention framework. Social Science & Medicine. 1996;42(8): 1155–1161.

29.  Say L, Raine R. A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bull World Health Organ 2007; 85: 812-19.

30.  Starfield B, Shi L, Macinko J. 2005. Contribution of primary care to health system and health. Milbank Quarterly 83 (3): 457–502.

31.  Sule SS, Ijadunola KT, Onayade AA, Fatusi AO, Soetan RO, Connell FA. Utilization of primary health care facilities: Lessons from a rural community in southwest Nigeria. Nigerian Journal of Medicine 2008; 17 (1): 98-106.

32.  Sunday A. Adedini, Clifford Odimegwu, Olusina Bamiwuye, Opeyemi Fadeyibi and Nicole De Wet. Barriers to accessing health care in Nigeria: implications for child survival. Glob Health Action 2014; 7: 23499 -

33.  Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med 1994; 38: 1091-110.

34.  World Bank. 2008. Nigeria—Improving Primary Health Care Delivery: Evidence from Four States. Washington, DC. © World Bank. License: CC BY 3.0 Unported.”

35.  World Health Organization, 1986. Ottawa Charter for Health Promotion. Geneva: World Health Organization, 1986 (WHO/HPR/HEP/95.1)

36.  World Health Organization, 1990. The role of the pharmacist in the health care system. Report of WHO. Action Programme on Essential Drugs and Unit of Pharmaceuticals consultative group, New Delhi, 13–16 December 1988. Geneva: WHO; 1990.

37.  World Health Organization, 1997a. Public-private roles in the pharmaceutical sector: Implications for equitable access and rational drug use. Geneva World Health Organization 1997a. WHO/DAP/97.12

38.  World Health Organization, 1997b. Public education in rational drug use. Geneva: WHO; 1997b. WHO/DAP/97.5.

39.  World Health Organization 2009. Milestones in Health Promotion: Statements from Global Conferences. Geneva: World Health Organization, 2009. WHO/NMH/CHP/09.01

40.  World Health Organization, 2015. Global Health Workforce Alliance. Accessed 29/04/15

41.  World Health Organization/United Nations Children's Fund, 1978. Primary Health Care, Alma Ata 1978. ‘Health for All’ series no. 1. Geneva: World Health Organization, 1978