Healthy Markets CoP Session - September 28, 2022

The September meeting of the Total Market Approach Technical Working Group (TMA TWG) marked an opportunity for FHM Engage to reconvene this group and hold its first meeting since July 2022. This meeting was also an opportunity to implement the changes that you requested and introduce members as to how the group will be evolving moving forward.

In this meeting we had Emeka Okafor from SFH Nigeria presenting on The IntegratE Project- a project targeted at increasing service delivery for contraceptive mix and primary health care among Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) in Lagos and Kaduna States. 

IntegratE is a Proof-of-Concept that Community Pharmacists and PPMVs have the capacity to provide a wider range of FP and PHC services than they are currently authorized by law to provide.​ It is a four-year project co-funded by BMGF & MSD for Mothers Foundation (Nov 2017 – Sept 2021)​ with the first phase implemented in Kaduna and Lagos. The goal of the project is to ​improve the quality of FP and PHC services provided by CPs and PPMVs and support the creation of an enabling environment that will sustain these services.​ 

Please use this link to access the presentation 
https://mcusercontent.com/d03190271968e898a9ed9e8c6/files/53403e82-527a-ccd2-705d-1f46fd8f469e/Working_with_Pharmacies_and_Drug_stores_IntegratE_experience_at_Total_Market_Approach_TWG_meeting_1_.pdf

Q&A Sessions

 

IntegratE is a great example of a beautifully designed and well executed project and Emeka's presentation prompted several interesting questions from participants. 
* Responses have been edited for clarity

Question: What explains the different distributions of Tier 3 PPMVs and of CPs? Do the different states have different regulatory regimes or incentives around these various categories?

 

Answer: We are not as a project trying to find out where they should be placed, we found what already exists and were looking at how to best to engage them. Distribution is not something that the project has direct control over and the PPMVs set up outlets wherever they wish, but we found that most of them are in rural communities, while the community pharmacies are in urban areas. The pharmacies require the presence of infrastructure like electricity and other networks to be able to operate because the standards for the pharmacies are slightly different from the PPMVs. The Pharmacist Council of Nigeria requires that every pharmacy must have an air conditioner and refrigerator because they stock drugs. As a result a lot of them tend to aggregate towards the urban centers where theses facilities are commonly available. The project set out to work with the private sector without necessarily stimulating the private sector through incentives because we were considering sustainability in designing the project. Our experience with similar projects in the past tell us that if you apply incentives, once you remove that incentive, the whole thing crashes. So that's one of the things that we are very mindful of. As a result the only incentive the project has is that the cost of the training is currently being borne by the project and not the PPMV.  A recent study done has actually shown that a lot of PPMVs are willing to pay for this training because they have seen a positive impact on their businesses. So that's one of the things that we think may sustain our work beyond the life of project,  which is why were very careful about incentivizing our intervention.

Question: Are clients aware of these tiers when they select an outlet? Are they aware of the different levels?
Answer: No they are not aware of the tiers. But for each PPMV fully trained, the FMOH puts in a sign that FP services are offered there -that is the green logo for FP that FMOH uses. I think that is the next phase of our work, to be able to market the different brands of the tiers so that the client will know that these are the package of services I can get from different locations.  That hasn't happened yet, but those are in the plans for the future. We set out to commence family planning so we used a uniform logo for family planning services, which is a green dot sign that cuts across wherever there are family planning services. 

Question: Has there been any quality testing of commodities, i.e. post marketing surveillance, to better understand the quality of meds/products?
Answer: No, not exactly because quality testing is slightly beyond the scope of the project. Quality testing can only be done by NAFDAC (National Agency for Food and Drug Administration and Control), who are regulators of the quality of medicines in the country. However, part of the training that the PPMVS were exposed to is on how to identify potential fake medicines but the project doesn't plan to do any post surveillance on quality assurance.

Question: How are you collaborating with other projects/funders/partners to scale this work, for example the USAID/IHP project which is now training roughly 1200 PPMVs in Bauchi, Kebbi and Sokoto States?
Answer: They have been partnering very well and the the USAID IHP project is actually adopting the same strategy. They are using the manual developed to be able to implement this in states and we also found ourselves working in the states. What we have decided to do was to find a way to map the States and then make sure that we don't duplicate resources in terms of the PPMVs that will be trained. So we are working very closely with the IHP project. The Quality assurance training or model that the PPMVs are receiving under the theater accreditation system was actually developed by the USD DPM, which looked at easy ways the PNV's can identify fake medicine, so those models were incorporated into the training because essentially everybody is interested in making sure that the PPMV is able to identify and stock genuine drugs.

From The Group

Here resources that members shared during the meeting 
https://mcusercontent.com/d03190271968e898a9ed9e8c6/files/ce28f05b-4505-a039-60a7-3191dad4020c/2021RH_CPs_PPMVs_QualityFP.pdf

https://mcusercontent.com/d03190271968e898a9ed9e8c6/files/b1c3cdd7-6ae4-dd13-6a4a-2892c14e4ba3/2021SBSR_IntegratE_COVID19_FP_Nigeria.pdf

https://medium.com/nivi-inc/nivi-integrate-putting-the-power-of-information-in-the-hands-of-youth-940b29ad966d


Toward Resilient Sexual and Reproductive Health Procurement and Financing: A New Analysis of Key Challenges & Opportunities Webinar Registration - Zoom

Moving Forward

 

This meeting marks the evolution of the TMA TWG to the Healthy Markets Community of Practice (HMA CoP)

Key Points

• This group will retain its focus on markets that were at the heart of the TMA but will focus more explicitly on market development and private sector approaches
• Will be renamed to focus on the goal of working to develop healthy markets that are responsive, equitable, resilient, led by local actors and driven by consumer needs
• By focusing on healthy markets outcomes, the group can include the local private sector, where and when it is critical to the functioning of that market.
• Will retain a focus on family planning and reproductive health.
• Within this FP and RH focus, the group will explore two main challenges:

  1: How are global and local markets reacting to shifts in the donor landscape with its increased focus on domestic financing (and how is this shift impacting the private sector)?

  2: Which market development and private sector approaches are supporting health market outcomes?

Finally, the group will embrace a community of practice approach and will include this in its name going forward.

• The “practice” will be focused on capturing and synthesizing our collective knowledge on FP and RH market development and private sector approaches.
• The secretariat’s goal will be to revitalise keep the spirit of a “meeting place,” to keep it light, allowing for sharing, advice-seeking, networking, and, critically, providing space for country level initiatives and expanded membership from country level.

We ask members of this community of practice to:

• Provide technical updates and sessions from their initiatives
• Share technical resources and opportunities for collaboration
• Contribute to the discussion during virtual the sessions
• Join work streams to work on collaborative products
• Attend the semi-annual/annual in person session
• Convene on a monthly basis for 60 minutes with 1-2 in-person one-day meetings per year.
• Focus in on one technical presentation per meeting
• Host a technical exchange and sharing of experiences on the topic
• Allow for informal updates and exchange at the end of the session

*Access to all materials and schedule of meetings that will be kept in the project agnostic website under development by FHM Engage and/or Google documents

Deep Dive

Thoughts from Co-chair Kuyosh Kadirov                  

USAID and UNFPA worked in partnership for over 10 years in exploring and defining the total market as an approach and as an initiative.  We've really moved forward in this area and we now want to push ourselves to look forward for a more practical implementation of the total market as a vision.

The Shops Plus project really helped us to think through some of the key issues around the application of market development as a a way forward. We really hope that through this evolved TMA working group that we can look forward to working collaboratively to address some of the conditions that we see in local markets, whether it's stewardship or more systemic engagement with local private sector actors in a way that we are creating more stronger and more sustainable local private sector led markets.

The challenge for us is how do we systematically engage local partners? How do we ensure that local partner ecosystems are there for us to help take on the market facilitation role and how do we really make sure that our market based approaches for family planning are led by local private sector actors?  I think their voice is extremely important and it's very crucial and we need to proactively think about these local private sector actors. We need to create space for them and we need to listen to their experiences and to their ideas, skills and innovations and I think the presentation today is a starting point and I really hope that we do this more often and learn from them and share our thoughts and expertise that we've gathered here at the global level.

I am looking forward to this community to engage and work closely and continuing to shape our concept for how we want this group to evolve. I think it's extremely important that we know how we define health markets whether it's for family planning or it's for condoms or for use. I think this is still a huge gap and I think that defining the markets would really help us to set the standards on how we want to invest and understanding those markets would help us design our programs and would help us to strategically align where the investments are going to go.

I hope that we're gonna engage you in the next couple of meetings so we can share some of our early thoughts on how we want to start thinking about the markets in a way that really helps us to understand it from a programmatic perspective. I hope that this something that can start us off as a new evolved community of practice that looks beyond just total market approaches but opens up to a broader collaboration with other technical working groups or just CMDA pharmacists and drug shops and really helps us to put the local private sector in the center of everything we do at the country level. 

Future Meetings

Please let us know if you would like to present a topic at a future meeting and be sure to share this with anyone that you think would benefit from our group.  

Also let us know if you are no longer interested in receiving communications from this group. 

Participants

We were please to have over 30 participants engage with us at our September meeting. 

Gertrude Silungwe- John Snow Health 
Seth McGovern- Population Services International
Anne Pfitzer- JHpiego
Vienna Madrid- FP2030
Julia Byington MSI
Cindi Cisek- Palladium
Safia Ahsan- RH Supplies Coalition
Devon Cain- CHAI
Shyami de Silva- USAID GH/PRH
Saumya Ramarao- Population Council
Megan Rauscher- ThinkWell
Emily Tissot- Zenysis
Rebecca Husband- MPHG/PSI
Rodio Diallo- BMGF
Amit Bhanot- FHM Engage
Stephanie Gallagher- Palladium
Pierre Moon- PSI
Jane Wickstrom- USAID
Intissar Sarker- USAID
Mohammed Nasiruzzaman- USAID
Megan Christofield-  Jhpiego
Ben Bellows- Nivi Inc
Michelle Weinberger- Avenir Health
Douglas Call- BMGF
Sohail Agha- BMGF
Sameh Madian- MENA BDM, DKT
Mark Hellowell- University of Edinburgh / WHO
Morgan Simon- Chemonics
Clancy Broxton- USAID
Chris Jones- Mann Global Health
Peter Stephens- IMS Health