As we said before, we're looking at

two different methods of getting medicines to the community.

Of the medicine sellers or medicine vendors,

and the community health workers or community health volunteers.

So first, we're going to look a bit at the medicine vendors.

One of the big questions that comes up,

is are they health care providers?

Or are they business people?

And this is an important issue because,

what is it that motivates their behavior.

Are they able and willing to provide and sell what people really need?

Or are they willing to provide cheap and effective medicines?

Or do they want to sell more expensive.

Are they working on a business model? Or a health model?

Actually, studies we've done show that they have one foot in

each side because they do value their role,

as helping people in the community,

and they do want to learn,

at the same time they want to be able to make a profit,

and help their families.

So the question arises when we talk about patent medicine sellers, medicine shops etc.

What do we mean by patent medicines?

And in a number of countries the licensing does specify what this is.

There are different levels of stores shops,

pharmacies that can sell medicines,

and they are distinguished by the type of things they can sell.

So for example, in Nigeria a patent medicine license means

that you can only sell medicines that come in their original package.

This may be a bottle of cough syrup,

this may be a blister pack of ten tablets,

but the medicine seller does not take

medicines out of a large container and put them into small envelopes,

that is known as dispensing.

They're not allowed to dispense,

they can only sell things in their original container.

And of course patent medicines have been with us forever.

There are some old pictures of aspirin packets,

of bottles of quinine sulphate you know

quinine of course being malaria medicine since the old days.

So these medicines have been around for a long time,

but they're clearly manufactured in a specific packet or

bottle and they're sold exactly like that If their patent medicines.

And if you have a patent medicine license,

that doesn't mean that things don't happen the other way,

but we'll get into that in a minute.

The patent medicine vendors people call them medicines sellers,

their variety of names but people who have small shops that sell primarily medicines,

although you can find things like Cornflakes and milk powder.

We see that they are considered private health providers to some extent.

They have a variety of types of shops,

as we said they may have a general store,

they may have a kiosk,

they may have a market stall,

but they do ideally have a license.

In countries that do not recognize them.

They don't have a license and they operate on the side.

They definitely don't start off with any formal pharmacy training.

Many of them have learned on the job.

You are an apprentice or a clerk for the owner of the shop,

and in the process you learn how to do the work.

But more and more effort is being put into having

some formal training for them that goes along with their license.

And this is very much the case in Ghana.

That doesn't mean that this covers every eventuality,

but the concern is that at least,

they need to know what are the correct medicines

by national policy for the common diseases.

But in addition, training should look at things like storage,

like noting expiry dates.

This type of thing. Counseling people to take the drugs correctly.

So again, as we want to stress that the types of

medicine are these over-the-counter pre-packaged patented to drugs.

So the concern about primary health care is that,

these people are usually convenient, they are affordable.

Sometimes they will let people buy on credit.

This is an important thing in poor communities,

so they are accessible.

They are neighbors you can knock on their door even if the shop is closed.

So issue is not just the access,

but trying to improve the quality of

the medicines and the quality of the services they provide.

Unfortunately, there's a lot of mistrust.

People don't want to recognize that they exist.

They blame the public for not using the public services,

when in fact the public services may not be open all the time,

they may have stock outs of drugs,

they may not be convenient,

staffs attitudes may keep people away,

but the government tries to crack down.

And as we can see posters here from

Nigeria that you're not supposed to patronize these people.

The government tries to shut down the medicine shops,

and again this is in effect denying care.

But there is this concern that there are harming health.

The approach like i said is a legal approach as opposed to a training and

educational approach that takes advantage of this valuable resource in the community.

But as we said before keeping track of all these is a challenge.

We have a wide variety of places where the medicines are sold.

This man has packed up all of his things in several cartons.

Taken a bus to a rural farm market once a

week and will provide medicines there an open stall.

This woman has a little general store,

where you can see medicines among all the other commodities,

and things that she sells to people ranging

from batteries to powdered bill to hair care products.

Another example a small shed in a village,

this thatched roof probably is better in terms of keeping the place cooler,

than a roof made of iron sheets that would heat up the place.

We can see a situation here,

the man on the right is an employee of the owner.

So the owner has the license in this particular case.

I think he may have finished primary school may not have.

So the person he employs is well they usually employ relatives,

other people who have been to school so that they can read

the labels and explain to people what they're buying understand recognize,

and read what the different drugs are.

Shops like this and the village carry

fewer and less expensive medicines but

they're sort of the basic ones that people ask for.

And here again, is another aspect of the business model.

The shops respond to consumers.

It's not a situation where as in a clinic that you give your complaints you are examined,

and the health provider makes a diagnosis and then

prescribes based on what he or she thinks is the problem.

Here most of the problems are self diagnosed,

and people come in and ask for a medicine.

Maybe they've received this medicine before for similar conditions,

or their one of their relatives that maybe they've heard about it on the radio.

So they ask for what they want.

There are cases of course where people don't know exactly what they need.

They know what their problems are and they do make complaints to the shopkeeper,

and saying you know my child has fever or this or

that and then expect the shopkeeper to respond.

Well, like I said this is usually maybe a quarter or less of this cases.

Most times it's a shop and people buy what they want.

But in the cases where they ask the shopkeeper basically,

uses his or her experience,

what have other people with similar complaints come in and ask for.

People will take prescription notes from

the clinic where the clinic has no drugs available they'll take them to the shop,

and when the drug seller sees those you know he gets an idea

of what the professionals are using for certain conditions.

And so again this is part on the job learning so that if people do have

requests or questions the medicine seller can draw on the experience.

We even have very large and well stocked shops,

in some of the larger towns more variety of medicine from a variety of prices.

And one thing we've noticed in many of these cases is

that the shopkeeper is actually a trained health worker.

We've seen this in Nigeria,

where the community health extension workers,

are they front line staff?

There are more trained than the government can hire.

And so many of them will be either employed by a shopkeeper,

or they will set up their own shop because,

they know more about medicine than

your average high school graduate who gets a medicine shop license.

One thing that's also important to note is,

that if you go to a government clinic next door,

there are often two or three medicine shops.

Knowing the fact that government clinics are often run out of stock.

So we have a wide variety of types of shops and types of people running the shops.

But the key element is that they fill

a need when there are gaps in the supplies elsewhere.

We have a variety of names for these people too.

In Ghana be medicine vendors are called chemical sellers,

and their licenses are reviewed by the national chemical pharmaceutical poisons board.

We can see here a small shop in North Western Nigeria.

There are many different things on the shelves.

They are technically patent medicine.

They are obviously pre-packaged.

You can see the little box there.

Inside many of these boxes are chloroquine syrup which is a supposed malaria treatment.

Chloroquine was the common approved drug back in the 50s and 60s slowly.

The parasite developed resistance to it.

And so starting around the late 90s the research was done.

The Chinese medicine artemisinin was found to have anti-malarial properties,

and it's been incorporated into new drugs in

combination with others to try to prevent this resistance of the parasite.

But people like chloroquine and they like syrups for children.

Two things the chloroquine is no longer effective,

but these shops have it,

because suppliers and wholesalers provide it and people demand it.

Secondly, they want syrups because it's easier to give children,

but it's harder to measure.

People don't have standard sized spoons in their home.

The Syrups can expire sooner.

Even though the shop has plenty of supplies for people to buy it's not the right thing.

We talked about the medicine sellers selling

over-the-counter drugs the patent medicines have pre-packaged medicines.

But there is what I call the under the counter drugs,

you can get antibiotics which they are not supposed to sell,

you can get various drugs for mental health, such as diazepam,

you can get all kinds of things that are

kept somewhere where the inspectors will see them.

There are some antibiotics now that have been approved for patent medicine sellers,

for patent medicine in different countries,

based on the need for prompt treatment of pneumonia for example.

But generally, there are limits to the license but people can get around it.

And it's very hard with these widespread rural shops for

the inspectors to have the transport to get there often and see what's really happening.

Patent Medicine Vendors—Business or Health Care Provider?

Understanding and Strengthening Health Systems

Meet the Instructors

Patent Medicine Vendors— Business or Health Care Provider?

Understanding and Strengthening Health Systems

Meet the Instructors

Patent Medicine Vendors—Business or Health Care Provider?