Submission ID 131082
| Issue/Objective | Community pharmacists and Patent and Proprietary Medicine Dealers (PPMDs) provide medicines to approximately 60% of the population and frequently serve as the first point of contact for care. Despite their central role in antibiotic access, antimicrobial stewardship (AMS) initiatives in Nigeria have largely focused on tertiary hospitals, with minimal engagement of private retail providers. As Nigeria advances its National Action Plan on AMR, understanding the feasibility and contextual barriers to implementing AMS interventions among pharmacists and PPMDs is essential for strengthening stewardship at scale. This study explored the perspectives of national-level stakeholders on the main challenges to introducing antimicrobial stewardship programs for community pharmacists and Patent and Proprietary Medicine Dealers, as well as the practical opportunities, partnerships, and resources needed to make these programs successful and sustainable. The project demonstrates that reclaiming global health equity in AMR requires shifting stewardship leadership and resources from hospital settings to the community-level providers who are the primary but yet systematically overlooked healthcare gatekeepers for the majority of Nigeria's population. |
|---|---|
| Methodology/Approach | We conducted in-depth interviews with ten purposively selected key informants from regulatory bodies, professional associations, laboratory services, civil society, and national coordination agencies between December 2023 and January 2024. Findings were organized using the Social Ecological Model domains to identify multi-level determinants of stewardship feasibility. |
| Results | We found that multiple system-level gaps are limiting effective AMS. At the provider level, many pharmacists and medicine vendors lack adequate training in stewardship principles, and antibiotic use is often driven by patient demand, time constraints, and financial incentives. Collaboration between prescribers, pharmacists, and laboratory professionals remains weak, reducing coordinated action. Health facilities face structural constraints, including limited access to diagnostic testing, weak laboratory quality systems, absence of standardized prescription formats, and insufficient continuing professional development. At the governance level, enforcement of existing regulations is inconsistent, over-the-counter antibiotic sales remain widespread, many medicine vendors operate outside regulatory oversight, and high-level accountability is limited. Although national guidelines aligned with WHO frameworks are in place, implementation and monitoring mechanisms are not strong enough to ensure compliance. |
| Discussion/Conclusion | Our findings suggest that AMS implementation among private retail providers in Nigeria is technically feasible but constrained by systemic, structural, and governance-related barriers. Effective stewardship will require coordinated multi-level interventions combining targeted education, strengthened regulatory enforcement, improved diagnostic infrastructure, and sustained public engagement. Embedding implementation science within national AMR strategies may help bridge the policy-practice gap and enhance accountability. Targeting pharmacists and PPMDs as frontline antibiotic gatekeepers represents a strategic pathway for reducing inappropriate antimicrobial use and advancing Nigeria's broader One Health AMR response. |
| Presenters and Affiliations | Carita Ehinomen Oko-Oboh University of Waterloo Amom Tor-Anyiin University of Waterloo Blessing Uche Institute of Human Virology, Nigeria Nnakelu Eriobu Institute of Human Virology, Nigeria Aderonke Agbaje Institute of Human Virology, Nigeria Giorgia Sulis University of Ottawa Charity Oga-Omenka University of Waterloo Ekenedilichukwu Elvis Ezekobe University of Waterloo |
