Table 2 Reported outcomes of initiatives
From: Drug shops for stronger health systems: learning from initiatives in six LMICs
Country and Authors | Description of initiative and study aims | Outcome measured | Method of measurement | Finding |
|---|---|---|---|---|
Service delivery initiatives | ||||
Indonesia Ferdiana et al. | Public Private partnership implemented for antimalarials in Indonesia. Research group analyzed secondary data on malaria cases and the use of antimalarials by drug shops, as well as conducted interviews and focus group discussions on the acceptability of the partnership among key stakeholders | Malaria cases specifically reported by drug shops pre and post intervention as a percentage of malaria cases reported in the district overall | Malaria case reporting data to district health information system | Increase from 6.9 to 30.7% in percentage of overall cases of malaria reported by drug shops |
Myanmar Thein et al. | PSI/Myanmar provided training on guidelines and appointed one field supervisor per township to support drug sellers and patients with TB and malaria services. Research group aimed to understand provision of these services and any barriers drug shops currently engaged in the program | Percentage of drug sellers who used correct criteria for determining a client as a presumptive TB case | Quantitative questionnaire developed by PSI/Myanmar | 86.4% Referring all symptomatic TB clients using the correct criteria TB |
Percentage of drug sellers using correct definition for suspected malaria cases and referring these according to guidelines | 87.7% Using correct definition and referring according to guidelines | |||
Nigeria Oluwasanu et al. | Training on injectable contraception, as well as monitoring and follow-up at 3, 6 and 9 months conducted in Nigeria. Research group aimed to elucidate the processes through which this intervention influenced women’s increased utilization of injectable contraception | Percentage of PMVs knowledge assessed as complete on injectable contraception after participation in training | Quantitative questionnaires of PMVs administered by research group | 96% of PMVs for Depo Provera 86.4% of PMVs for Noristerat 83.6% of PMVs for Sayana press |
Percentage of PMVs that perceived training improved knowledge and skills in injectable contraceptive service provision | 85.7% Perceived that training improved knowledge and skills | |||
Percentage of PMVs that perceived training improved knowledge and skills in family planning counselling | 85% Perceived that training improved knowledge and skills | |||
Tanzania Shekalaghe et al. | Training initiative to educate each of these groups on the roles and responsibilities of other groups, and informally convene ADDOs, Community health workers and health facilities in Tanzania. Research group aimed to understand relationships and referrals between these three groups, as well as barriers and facilitators to linkage | Whether CHWs refer manageable cases of under five children to ADDO shops | In-depth interviews | 25% Pre-training, 95.8% post-training |
Whether CHWs felt to be appreciated by health facility staff | 65% Pre-training, 91.7% post-training | |||
Qualitative assessment of relationships | Relationships did not exist pre-training, therefore, much improved relationships among the three groups post training | |||
Nigeria Uneke et al. | National Drug Policy on family planning services, malaria care and antibiotic dispensing by PPMV was implemented in Nigeria. Research group aimed to understand PPMVs knowledge of this policy and subsequent behaviours, as well as nursing mothers and young people’s access to these services | Mean level of agreement by nursing mothers on various domains of accessibility (1 = Strongly disagree, 2 = disagree 3 = Unsure, 4 = agree 5 strongly agree) | Questionnaire for nursing mothers developed by research group | PPMVs are easily accessible to rural populations—4.2 Sale of medicines without prescription is rampant—3.8 |
Mean level of agreement by youth on various domains regarding PPMVs (1 = Strongly disagree, 2 = disagree 3 = Unsure, 4 = agree 5 strongly agree) | Questionnaire for youth developed by research group | PPMV shop owners and operators generally have low health knowledge about proper treatment for common illnesses, such as malaria and diarrhoea and poor health treatment practices—3.1 Dispensing medicines without prescription should not be encouraged—4.0 | ||
Policy initiatives | ||||
Zambia Zulu et al. | Guidelines on operating Health Shops developed by Zambian Medicines Regulatory authority (ZAMRA). Research group aimed to understand the current acceptability of these guidelines among key stakeholders | Qualitative assessment of acceptability of guidelines | In depth interviews | Facilitators to acceptability: Comprehensive training on guidelines High level buy-in among stakeholders Barriers to acceptability: High cost of implementation Limited infrastructure and capacity to upgrade current shop to fit guidelines |
Bangladesh Nizame et al. | Government of Bangladesh developed a National Drug Policy to lay out guidelines for appropriate sale and dispensing of antibiotics. Research group explored knowledge of and attitudes towards this policy | Knowledge of national drug policy and barriers to compliance with appropriate antibiotic stewardship as laid out by this policy | Qualitative assessment from key informant interviews and co-design workshops with drug shop operators | Low awareness of policy among drug shop owners Barriers: Drug shops demanded right to prescribe antibiotics Lack of qualified physicians available to prescribe antibiotics Customer demand for antibiotics |