How the quality of essential medicines is perceived and maintained through the pharmaceutical supply chain: A perspective from stakeholders in Nigeria

Background: Limited access to essential medicines for maternal and child health is a preventable cause of pregnancy-related deaths. This remains a predominant challenge in Nigeria, where sub-standard and falsified medications have historically been associated with maternal mortality. An in-depth understanding of perceptions surrounding quality assurance of essential medicines is pertinent for developing effective and sustainable interventions. Objective: To examine stakeholder perspectives on quality control of essential medicines for maternal and child health, while characterizing pharmaceutical distribution of medicines in Nigeria. Methods: Key informant interviews were conducted with a purposive sample of 26 participants between January and June 2018. Eligible participants included: pharmacists, pharmaceutical sales representatives (pharm reps), supply chain employees of pharmaceutical industries and regulatory agency personnel, working in the public or private health sector in either of the four states: Lagos, Enugu, Imo or Port-Harcourt. A 6-item survey was administered to collect demographic information on the participants. This was followed by 15 semi-structured questions to gather qualitative data on the subject matter. Results: Verifying vendor credibility and use of identifiable regulatory markers were the most common methods adopted by pharmacists and pharm reps with the intent to control quality of medicines. Key challenges in assuring quality included: inefficiency of regulatory agencies, illicit sales of prescription medicines by patent medicine vendors, existence of open markets and failed policy implementation. While pharmacists and pharm reps solicited improved regulations and policy implementation; NAFDAC personnel primarily recommended an increased government funding to improve their efficiency. Conclusion: Beyond stakeholder recommendations, a fervent and consistent commitment on the part of the government is needed to improve quality assurance in Nigeria's pharmaceutical system. Public-private partnerships should be explored to address funding limitations to quality assurance. Future studies need to examine challenges and opportunities surrounding policy implementation, and regulatory enforcement in pharmaceutical distribution.