221 - Exploring the acceptability of the hub and spoke supervisory model among private sector providers: A theory-informed qualitative study

Abstract Information: In most underserved health communities in sub-Saharan Africa including Nigeria, Patent and Proprietary Medicine Vendors (PPMVs), popularly known as drug shops, are the preferred source of information, advice, and care for most common illnesses, as well as widespread coverage. However, the quality of care and medications provided by these PPMVs falls below optimal standards, primarily due to lack of sufficient knowledge concerning appropriate treatment guidelines for common illnesses and inadequate stocking practices. Recognizing these gaps in service delivery by PPMVs, the Pharmacy Council of Nigeria (PCN), the regulatory body for community pharmacists (CPs) and PPMVs piloted the Hub and Spoke supervision model. CPs with the requisite formal education to competently manage, stock, dispense, and retail medicines, though limited coverage in mostly urban areas and major cities, were trained to act as hub supervising a few PPMVs within a cluster (acting as spokes). The current study explored the acceptability of the Hub and Spoke supervision model from the perspectives of CPs and PPMVs, using the Theoretical Framework of Acceptability (TFA). Using the TFA informed guides, we conducted in-depth interviews with eight (8) pharmacists and two (2) focus group discussions with 19 PPMVs participating in the pilot in two (2) states (Lagos and Kaduna) to identify the enablers and barriers for participants. Data were analyzed using the Framework Method. We found that the collaborative and interactive nature of the supervisory visits, regular check-ins by PCN, incentives, and desire for knowledge were some of the factors that facilitated acceptance. However, both CPs and PPMVs expressed increased workload and time as barriers to the success of the pilot. The post-intervention assessment of the pilot strongly suggests that hub and spoke supervisory model is acceptable, a good fit and highly valued by both CPs and PPMVs. Our findings of acceptability make a compelling case for further stakeholders’ engagement for scaling-up hub and spoke supervisory model in communities in Nigeria with similar healthcare infrastructure.