WASHINGTON, DC (January 8, 2016) — Yemisi, a patent medicine vendor (PMV) in Oyo State, Nigeria, sells drugs and contraceptive commodities from her small shop that is open seven days a week. Among her contraceptive offerings are male and female condoms, pills, and injectables. Yemisi not only counsels clients on injectable contraceptives and refers them to health centers for the injection, but also, if requested, administers the injection to the client on site.

Yemisi is not alone in administering injectables, despite current regulations that do not permit PMVs to do so because they lack formal training.

A PMV receives training on using the safety box to dispose of sharps.

These regulations may soon change, however, as a result of implementation research by the Evidence Project in collaboration with the Nigerian Federal Ministry of Health (FMOH). That is because Yemisi is among 80 PMVs in Oyo State and another 80 in Nasarawa State being trained and mentored on how to provide information and counseling to clients on family planning methods as well as how to safely administer all injectable contraceptives, including Sayana Press.

“This research could really be a game changer for task shifting in Nigeria,” explained Dr. Salisu Mohammed Ishaku, Deputy Director of Reproductive Health at the Population Council and a study co-investigator. “For years, many believed that family planning tasks could only be shifted between cadres of formally trained health providers. We aim to provide the evidence showing PMVs, who are informal providers found throughout the country, can be trained in the proper administration of injectables, the most popular modern method in Nigeria.”

Given PMVs’ reach in both rural and urban areas and the popularity of injectables (they account for 30 percent of modern method use), such a policy change could increase the country’s modern contraceptive prevalence rate, which now stands at just 10 percent.

“For years, many believed that family planning tasks could only be shifted between cadres of formally trained health providers. We aim to provide the evidence showing PMVs… can be trained in the proper administration of injectables”

Led by the Evidence Project and the FMOH, the seven-day participatory training included sessions on family planning methods available in Nigeria, their medical eligibility criteria, screening and counseling clients on injectable contraceptives, storage and disposal of sharps, and a practicum on administering Depo Provera, NET-EN, and Sayana Press injections.

The pre- and post-training questionnaire showed positive changes in PMVs’ knowledge, an important first step in the proper administration of injectables. For example, in Oyo State almost all PMVs now know the time interval between injections for Depo Provera, the site of the body where Depo Provers is injected, and that Depo Provera is given intra-muscularly. Before the training, the proportion of PMVs who knew the correct answers hovered around 70 percent. Improvements in knowledge about Sayana Press were even greater, not surprising since Sayana Press was only introduced in Nigeria in 2014.

But the training went beyond knowledge of injectables to include how to counsel clients on choosing a family planning method. As one participant said, “I now understand that I am not supposed to make a choice for my client.”

Despite important gains, the post-training questionnaire revealed that some participants remained confused about such things as whether to give an injection during a women’s menstrual cycle (it can be given at any time provided the client is not pregnant).

“We built into the study a series of mentoring visits in 2016 to address such misconceptions, and to give feedback to PMVs on counseling clients and administering injections,” noted Dr. Ademola Ajuwon, a co-investigator and professor of public health at the University of Ibadan. “During these visits we also collect monitoring data to document progress.”

PMVs who participated in the Oyo State training.

As part of the study, the researchers are interviewing PMV clients who received injectable contraceptive services to understand their experiences and perspectives. This information, combined with the monitoring data and information from a final PMV questionnaire will form the basis by which to judge the ability of PMVs to successfully administer injectable contraceptives, providing the evidence for policy change.

Recognizing that evidence is not enough to change national policy, the Evidence Project has engaged a broad range of stakeholders from the beginning to guide the study, interpret the data, and act on the findings. In addition to the Federal Ministry of Health, the project is working with the National Association of Patent and Proprietary Medicine Dealers (NAPMED), local government health officials, the Pharmacy Council of Nigeria, donors, and family planning NGOs.

Results are expected in late 2016.