Supporting local medicine shop owners in Nigeria to help drive access to care

Nigeria’s primary health care system is under immense strain, facing a severe shortage of doctors as many emigrate overseas, leaving the country with a doctor-to-patient ratio of 1 per 9,083 people. Hospitals and clinics grapple with inadequate infrastructure, outdated technology, and limited funding, making access to quality health care a persistent challenge.

While the government is working to improve affordability and expand access, the reality is that many Nigerians still struggle to pay for medical care. Amid an ongoing economic crisis, 40% of the population lives below the poverty line, forcing many to make impossible choices — prioritizing food over essential medical treatment.

Against this backdrop, Patent and Proprietary Medicine Vendors, or PPMVs, are some people’s only access to health care. While they are not pharmacists, these community-based providers receive basic training and are authorized by the Pharmacy Council of Nigeria, or PCN, to sell a select number of over-the-counter medications — including those for family planning, malaria, and diarrhea — which they typically purchase from local markets.

“They’re like the neighborhood ‘mom-and-pop’ stores,” explained Iyadunni Olubode, programs lead for Nigeria and Kenya at MSD for Mothers. “Sometimes their shops are licensed, but other times they operate informally.”

Despite their limitations in diagnosing or treating illnesses, PPMVs have earned the trust and confidence of their communities. Their presence is a lifeline in rural areas where hospitals are scarce and travel is expensive

“We find that people in these hard-to-reach communities trust PPMVs deeply,” Olubode added. “Not only do they dispense medicines, but they also promote appropriate health-seeking behaviors, encouraging people to seek medical help when necessary.”

This is clear in Elizabeth Adenike Ogundeji’s rural community outside Lagos. As a PPMV at Lizzy Patent Medicine Store for the last decade, she and her colleague work daily from 8 a.m. until 9 p.m., providing care for a wide range of conditions, ranging from children with suspected malaria to women in need of emergency contraception.

“We don’t really have access to good health commodities in my community,” Ogundeji said. “As a PPMV, that’s why we’re here — to provide first aid treatment and guidance. If we weren’t here, I don’t know how people would manage their health-related issues.”

Despite progress, PCN has been facing challenges in getting PPMVs to renew their licenses and consistently meet regulatory requirements beyond the initial work. In 2022, a supplementary program, Promoting Accreditation for Community Health Services, or PACS, was introduced to tackle the issues regarding financing, access to quality medications, and timely license renewals.

SCIDaR conducted research that revealed PPMVs needed motivation to renew their licenses, as there was no formally defined framework to encourage renewal. Based on feedback from PPMVs regarding the support they valued most, an incentive model was developed. This model includes access to business loans for expansion, increased availability of high-quality medicines, and branding opportunities to enhance visibility and trust.

PACS project implemented by SCIDaR and SFH aimed to transform access to financial support by partnering with commercial banks, development banks, and microfinance institutions to provide tailored loan products. These financial solutions were further strengthened with assistance to help PPMVs digitize records, improve business operations, and maintain valid PCN licenses.

Wema Bank established a 200 million Nigerian naira (approximately $130,000) credit facility at a 12% interest rate, while Access Bank introduced free company registration for women-led PPMVs, lower interest rates, and free point-of-sale machines for drug shops joining as agent banking operators — creating an additional revenue stream and enhancing financial sustainability.

In the six months since the loan products were launched, over 140 PPMVs applied for loans, with nearly 50 already receiving approval, according to  SCIDaR’s internal evaluations.

These partners also worked alongside PPMVs to enhance their appeal to financial institutions. This includes assisting with official shop registration, creating business bank accounts, organizing financial records, obtaining accreditation, and digitizing processes with approved medicine vendors.

For Ogundeji, these changes have been transformative. After completing five weeks of training, she received a 1 million naira ($675) low-interest loan, which allowed her to expand her inventory with high-quality medicines from approved vendors. Ogundeji’s plan is to continue to progress to Tier 2 in the accreditation system.

The impact of these initiatives extends far beyond individual communities. By formalizing PPMVs, digitizing their records, and integrating them into Nigeria’s health care ecosystem, they are becoming vital contributors to public health data systems.

“They’re generating critical data — from family planning trends to medicine consumption patterns,” Olubode emphasized. “This isn’t just useful for the government, but for anyone working to understand health-seeking behavior in rural areas.”

SCIDaR believes this project could serve as a powerful advocacy tool for development finance institutions, Nigeria’s Ministry of Finance, the central bank, and other policymakers, demonstrating the impact of supporting small health businesses. Olubode agreed, emphasizing that empowering private community-based providers through inclusive financing and strong support systems can strengthen Nigeria’s primary health care system and advance universal health care efforts.

To drive sustainable progress in maternal and newborn health, collaboration across stakeholders is essential. Health policymakers must prioritize the inclusion of private providers in essential health programs, ensure enabling policies for accreditation, and integrate PPMV data into decision-making. Regulators play a crucial role in strengthening oversight, enhancing capacity-building efforts, and maintaining quality assurance while ensuring accessibility. Meanwhile, development partners can accelerate impact by scaling proven models like IntegratE and PACS, expanding access to finance, commodities, and branding, and fostering knowledge-sharing initiatives in order to advance access to health.

By working together, we can create an inclusive, well-regulated, and sustainable health system that ensures better access, quality, and outcomes for communities most in need. The time to act is now — strengthening private sector engagement is not just an opportunity but a necessity for achieving lasting health improvements.

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Discover more about how private sector collaboration is breaking down barriers to fund maternal health in our series — Maternity Matters: Engaging the private sector in improving maternal health.

The Funding the Future series is supported by funding from MSD, through its MSD for Mothers program, and is the sole responsibility of the authors. MSD for Mothers is an initiative of Merck & Co., Inc., Rahway, NJ, U.S.A.