Private Pharmacies Research Articles

A National Survey of Dispensing Practice and Customer Knowledge on Antibiotic Use in Vietnam and the Implications.

Misconceptions and pressures have increased the sales of antibiotics without a prescription across countries. There are concerns with such practices in Vietnam given rising antimicrobial resistance rates. A national survey was conducted among 360 private drugstores located in nine provinces in Vietnam. Anonymous interviews were conducted with participants selected by convenience sampling. Subsequently, multivariable logistic regression analyses were undertaken evaluating the relationship between customer characteristics and antibiotic purchases. A total of 480 out of 1626 surveyed participants purchased antibiotics, 81.7% of which did not have a prescription, involving 29 different antibiotics. In 86.4% of these, participants were prescribed antibiotics by drug sellers. Most antibiotics were sold to treat respiratory tract infections (61.4%), with the ‘Access’ antibiotics (amoxicillin and cephalexin) being the most frequently sold. Only one-fifth of participants understood that they were breaking the law by purchasing antibiotics without a prescription. Participants purchasing antibiotics without a prescription had lower awareness concerning antibiotic laws and treatment duration (p < 0.05). Under 50% agreed to having a doctors’ prescription in the future when purchasing antibiotics. Freelancer occupation (OR = 0.52, 95% CI = 0.83–0.96) and a lower educational level (OR = 0.49, 95% CI = 0.25–0.96) were factors related to purchasing antibiotics without a prescription. Overall, we recommend increasing fines and monitoring of drugs stores, greater promotion of the family doctor system as well as increasing media and educational campaigns to limit self-purchasing of antibiotics in Vietnam and reduce resistance.

Assessing Job Satisfaction and Stress among Pharmacists in Cyprus.

Background: Inadequate staffing, increased responsibilities and a high workload are some of the factors that are directly related to stress levels experienced by pharmacists, which in turn affect job satisfaction. Objective: The aim of this study was to assess job satisfaction and stress levels of pharmacists in Cyprus, involving those working in the public and private sector. Materials and Methods: A cross-sectional study was performed which involved the completion of the Job Satisfaction Survey (JSS) questionnaire to estimate job satisfaction, and the Perceived Stress Scale-14 (PSS-14) questionnaire to evaluate perceived stress. Data collection took place between January and March 2020 and the participation rate was 71.6% (n = 585). Results: Employees in private pharmacies overall reported higher levels of job satisfaction compared to public sector pharmacists. Public sector pharmacists were found to have stronger self-efficacy beliefs compared to other groups (p < 0.001). Female pharmacists had a higher average level of perceived helplessness than male pharmacists (p = 0.001). Regarding public sector pharmacists, it was generally observed that pharmacists working under the management of the Ministry of Health (MoH) had reduced job satisfaction than those working for other organizations. Additionally, pharmacists working under the management of the State Health Services Organization (SHSO) had the least overall perceived stress levels (p = 0.008), high self-efficacy beliefs (p = 0.006) and low perceived helplessness (p = 0.031) compared to pharmacists in other workplaces. Employees of private pharmacies were found to have higher levels of job satisfaction (p < 0.001) than SHSO pharmacists. However, those employees demonstrated increased perceived stress levels (p < 0.001) in comparison with SHSO pharmacists. Conclusions: Pharmacists’ job satisfaction is negatively correlated with perceived stress levels and helplessness, and positively correlated with self-efficacy beliefs. In the public sector, it seems that a re-evaluation is critical regarding the determinants that adversely influence job satisfaction amongst pharmacists.

Effect of prior knowledge and peer evaluation ratings on final exam performance in a team-based learning chemistry course

IntroductionVarious reports have been published regarding adoption of team-based learning (TBL) in pharmacy education. However, there is insufficient published evidence on the effect of student characteristics on student learning outcomes in a TBL curriculum. The purpose of this research was to evaluate the effects of pre-study examination results and peer evaluation ratings on learning outcomes. MethodsThe TBL strategy was adopted for a basic chemistry exercise for first-year students at a private pharmacy school in Japan (2012–2019). For the analysis, students were divided into four analytical groups according to quartiles of pre-study examination results. The students were further divided into the high-peer evaluation rating group and low-peer evaluation rating group. We compared the final exam performance results between these groups. ResultsIn all four groups by quartiles of pre-study examination results, the course final exam performance was higher for the high-peer evaluation rating students than for the low-peer evaluation rating students. ConclusionsWithin the TBL framework, students with higher peer evaluation scores performed better on the final exam, regardless of the pre-study examination results.

Health insurance coverage and out-of pocket expenditure

Introduction: Catastrophic health spending is one of the major factors pushing people into poverty. Reducing “out-of-pocket expenditure (OOPE)” on health through health insurance coverage is an effective approach. The objectives of this study are (1) to estimate health insurance coverage among rural and urban households (HHs) and (2) to determine the proportion of income spent on health as OOPE among the selected HHs. Material and Methods: A cross-sectional study was conducted in rural and urban parts of district Faridabad, Haryana. A sample of 374 were taken from rural and urban areas. The unit of the study was HHs in both the areas. The proportion of income spent on health care (both direct and indirect expenses included) as OOPE was taken as outcome variable. Results: Health insurance coverage was higher among urban HHs (58.0%) as compared to the rural (38.5%). The rural population was availing of private consultation, laboratory, and pharmacy services to a greater extent than the urban; hence, they were spending a substantial proportion of their income on health-care services. The majority of the HHs in the rural and urban areas spent up to 20% of their income on health care. Conclusion: Universal health coverage without health insurance is unlikely.

Job Motivation and Satisfaction Among Female Pharmacists Working in Private Pharmacy Professional Sectors in Saudi Arabia

BackgroundPharmacists’ job satisfaction has been of interest for many years and is of great importance in several respects, such as productivity and ultimately organizational performance.ObjectiveThis study aimed to investigate the perceived motivational factors and levels of job satisfaction of female pharmacists working in private pharmaceutical sectors.MethodsThis was a cross-sectional study using a web-based survey of randomly selected female pharmacists working in different private settings including community pharmacies, pharmaceutical companies, private hospitals, and other private sectors using a pre-validated satisfaction scale (Warr–Cook–Wall scale).ResultsA total of 232 female pharmacists participated in the study with a mean age of 26.1±2.4 years. Of the total respondents, more than half (58%) worked for pharmaceutical companies, 25% worked in community pharmacies, and 16.8% were from hospital pharmacies. The most attractive motivating factors that encourage female pharmacists toward better performance were having the opportunity to learn new skills, being in contact with people both locally and internationally, gaining a sense of achievement, and being recognized, appreciated, and rewarded. The participants of this study were shown to have a moderate job satisfaction level.ConclusionThis study revealed that the non-Saudi, part-time pharmacists who never expected a promotion were less satisfied than the Saudi, full-time employees who expected a promotion within a year.

Valentin Feliksovich VOINO-YASENETSKY - Archbishop, professor-surgeon. To the 145th of birthday

Valentin Feliksovich VOINO-YASENETSKY - Archbishop, professor-surgeon. To the 145th of birthday

Antimalarial drugs quality monitoring in some provinces of Viet Nam

This study was conducted between January and August, 2016 in some malarial prevalence areas of Vietnam including Dak Nong and Gia Lai provinces. Total of 114 anti-malarial medicine samples (of which 55 available antimalarials and 59 selected antibiotics for malaria treatment) were collected from public and private health facilities. All of the collected samples were screen analized by GPHF-minilab kits at National Institute of Malariology, Parasitology and Entomology (NIMPE) according to GPHF monographs for specifications of visual and physical inspections, disintergration tests and thin layer chromatography assays. None of them was suspicious as substandard quality drugs. Fifteen randomly chosen samples (13.16% of total samples) were sent to National Institute of Drug Quality Control (NIDQC) for comfirmatory tests according to United States Pharmacopoeia or Vietnamese Pharmacopoeia criteria. The results showed that: three of them (03/114, 2.63%) were found as substandard drugs. All three artesunate 50 mg tablet samples (had the same lot 012013, expiry date in March, 2016, registration number VD-13186-10, collected from private pharmacies in Dak Nong and Gia Lai) did not pass purity tests. All three substandard drug samples were antimalarials with proportion of 2.63% of total samples and 5.45% of altimalarials.

Exploring for-profit healthcare providers' perceptions of inclusion in the Zambia National Health Insurance Scheme: A qualitative content analysis.

In 2019, Zambia introduced the national health insurance (NHI) as a healthcare financing strategy to increase universal access to health care services. The private health sector can complement public sector providers as service providers under the NHI. As such, the NHI Management Authority seeks to accredit for-profit private healthcare facilities in the NHI. Ascertaining factors that influence private-for-profit health providers to participate in the NHI is essential, but the evidence is lacking. In this study, we aimed to explore and characterize perceptions and experiences of for-profit private hospitals, dental clinics, eye clinics, diagnostic centres, and pharmacies regarding their inclusion in the NHI. We conducted in-depth interviews with owners or management officers of purposively sampled private health care providers in Lusaka, Zambia (n = 22) between May and June 2020. Qualitative content analysis was used to analyse data. The findings highlight low awareness of the NHI among providers and a need to understand the NHI. Providers revealed their positions and views on the accreditation process and payment arrangements and stated that their participation would complement the NHI. They also cited conditions to participate in the NHI, highlighted opportunities and challenges of engaging in the NHI, and expressed a need for sustainable ways of governing the scheme. The assessment of health providers' inclusion in the NHI scheme is multifaceted. The results of this study surfaced factors such as raising awareness on the NHI among providers and how their concerns on aspects such as payments can be considered as inputs to enlighten consensual agreements between the NHI authority and health providers in leveraging the private health sector. Private providers' concerns must be further understood and considered as the NHI strives to include this group as health care providers in the scheme.

The Know-Do Gap: Understanding and Improving Service Quality Among Pharmacies Providing Injectable Contraceptives Through a Mystery Client Study in Nepal.

Nepal is one of the first countries to license pharmacists to administer injectable contraceptives, through Nepal CRS Company's (CRS) Sangini private pharmacy network. There are more than 3,400 Sangini pharmacies in Nepal, including in hard-to-reach mountain areas, where these outlets are a key access point to injectables and other short-acting methods for those who lack access through the public sector or prefer the private sector.We compared the performance of Sangini pharmacists in (1) CRS-led technical support visits, when providers were aware of being observed, and (2) mystery client visits, when providers were not aware of being observed, to assess any gaps between pharmacists' knowledge and practices. We also assessed how well Sangini providers counseled on injectables and compared counseling on injectables with counseling for oral contraceptives.We found high levels of adherence to training guidelines on counseling on injectables. However, we identified significant differences between pharmacists' understanding of what they should do and what they actually do in practice, referred to as the know-do gap, in providing privacy, assessing client needs, and determining medical eligibility for hormonal methods. CRS took several steps to narrow the know-do gap through its programming, which may be a useful example for other countries as they expand the role of pharmacies in family planning service provision. Despite highlighting several areas for improvement, the findings show that Sangini providers both know how to and practice appropriate counseling on both injectable and oral contraceptives, suggesting that pharmacists can successfully expand their family planning offerings and equip clients with the information needed to select an appropriate method of their choice.

Engaging private pharmacies to help end TB in India.

Engaging private pharmacies to help end TB in India.

Availability and affordability of priority lifesaving maternal health medicines in Addis Ababa, Ethiopia

BackgroundAccess to life-saving medicines for maternal health remains a major challenge in numerous developing nations. Periodic and continuous assessment of access to lifesaving commodities is of enormous importance to measure progress and ensure sustainable supply. This study aimed to assess the availability and affordability of priority lifesaving maternal medicines in Addis Ababa in January 2021.MethodsAn institutional-based cross-sectional study design was employed to assess 33 representative private pharmacies, public health facilities, NGO and private hospitals providing maternal health care and dispensing medicines from January 12 to 27, 2021 in Addis Ababa, the capital city of Ethiopia. WHO and Health Action International procedures were followed to determine sample size, sampling of health facilities, and data collection. WHO and UNFPA priority lifesaving maternal health medicines included in the Ethiopia essential medicine list were included in the study. Data were cleaned and entered into SPSS version 25 for analysis.ResultThe overall mean availability of maternal health medicines was fairly high, 59% (range 6%-94%), as per the WHO availability index. Among the four sectors, the private pharmacy had the lowest availability (40%), while the mean availability in private hospitals, public and NGO/mission sector facilities were 70%, 72% and 72% respectively. Medicines used only for the management of maternal health conditions had lower availability (47%) compared to commodities used for the broader indication (65%). Compared based on source, the average availability of maternal health medicines which could be sourced locally was (68%) higher than imported medicines (55%). Affordability was not an issue in the public sector, public facilities offered maternal health medicines at no cost to the client. On the other hand, the private hospitals dispensed only 13% of the medicines at affordable prices followed by the private pharmacies (17%) and NGO/Mission facilities (29%). Furthermore, key challenges to access maternal health medicines were frequent stockouts in the public sector and the high cost of medicines in the private sector.ConclusionEven though it was below the recommended 80% availability, fairly high availability with variabilities across sectors was observed. Except in the public sector, maternal health medicines were unaffordable in Addis Ababa.

Inappropriate supply of antibiotics for common viral infections by community pharmacies in Vietnam: A standardised patient survey

SummaryBackgroundThis study aimed to evaluate the appropriateness of antibiotic dispensing of private pharmacies in Vietnam.MethodsStandardised patient surveys were conducted in randomly selected community pharmacies across 40 districts in Vietnam. Four clinical scenarios were represented by patient actors: (a) an adult requesting treatment for a sibling with a viral upper respiratory tract infection (URTI), (b) a parent requesting treatment for a child with acute diarrhoea, (c) an adult making a direct antibiotic request, and (d) an adult presenting with an antibiotic prescription. We calculated the proportion of interactions that resulted in inappropriate supply of antibiotics and patient advice. Predictors of inappropriate antibiotic supply were assessed.FindingsPatient actors attended 949 pharmacies, resulting in 1266 clinical interactions. Antibiotics were inappropriately supplied to 92% (291/316) of adults requesting treatment for URTI symptoms, 43% (135/316) for children with acute diarrhoea symptoms and to 84% (267/317) of direct request for antibiotics. Only 49% of pharmacies advised patients regarding their antibiotic use. Female actors were more likely to be given antibiotics than male actors for URTI (aOR 2·71, 1·12–6·60) but not for diarrhoeal disease. Pharmacies in northern Vietnam were more likely than those in southern Vietnam to supply antibiotics without a prescription: for adult URTI (aOR=5·8, 95% CI: 2·2–14·9) and childhood diarrhoea (aOR=3·5, 95% CI: 2·0–6·0) symptoms, but less likely to dispense for direct antibiotics request.InterpretationInappropriate antibiotic supply was common in Vietnamese private pharmacies. Multifaceted measures are urgently needed to achieve WHO's global action plan for the optimal use of antimicrobials.FundingThis study was funded by a grant from the Australian Department of Foreign Affairs and Trade.

Paradoxical consequences of CBHI scheme in rural Ethiopia: Enrollees’ perceived preferential treatment to paying clients and concomitant problems

Though financial protection and improvement in health seeking behavior of rural societies is the intended role of health insurance schemes, empirical evidence indicated that the scheme faced multitude of implementation challenges. This paper examined insurance enrollees’ perceived preferential treatment for paying clients and other concomitant problems in Eastern Gojjam district of north western Ethiopia. Researchers conducted in-depth interviews with 53 enrollees, six FGDs (with a total of 48 discussants) and 7 key informants with professionals from public healthcare facilities and other health insurance administrators. The data encoding, transcription, and thematic analysis process was all conducted manually. Findings indicated that, despite the economic relief households gained, the thrust on the service delivery process seems to be far behind. Comparing them with paying patients combined with the presumed “free medical treatment” that they associated with the insurance, the perceived preferential treatment for paying patients by practitioners seems common. Due to this, most participants hold a belief that visiting private health facilities during critical illness appears preferable to get quality health service. The perceived preferential treatment is alleged to be happening during consultation with physicians, medicine prescription, referral service, patient flow management, and others. Shortage of drugs induced frequent stock out and thereby prolonged reimbursement process, high patient flow induced over load in public health facilities, unnecessary price increment by private pharmacies on insurance beneficiaries and confusion on annual renewal payment without using service are all concomitant problems. Necessary awareness creation interventions and also improvements of public health facilities are recommended.

Public financing for primary health care is the key to universal health coverage and strengthening health security

Public financing for primary health care is the key to universal health coverage and strengthening health security

Access to Insulin Products in Pakistan: A National Scale Cross-Sectional Survey on Prices, Availability, and Affordability.

Background: Diabetes is among the top ten most prevalent diseases in Pakistan, and the availability of medicines to treat the disease is vital for a great percentage of the country’s population. Insulin was discovered a century ago; however, its access in several parts of the globe remains an issue. This study aims to evaluate prices, availability, and affordability (access components) of insulin and five comparator medicine access in Pakistan. Methods: A nationwide cross-sectional survey was conducted to evaluate the access to insulin and some comparator medicines in eight cities of Pakistan, using a modified WHO/HAI methodology. The survey included 80 medicine outlets, i.e., 40 private pharmacies and 40 public hospitals. Data for every unique insulin product available in the Pakistani market were obtained, including five comparator medicines. Percentage availability, median unit prices (MUPs), and affordability (the number of days’ wages (NDWs) required for a month’s course by the lowest-paid unskilled government worker) of all products were calculated, including originator brands (OBs) and biosimilar (BS) products. Results: Of all insulin products surveyed (n = 320), 87.5% were manufactured by foreign multinational companies (MNCs). None of the insulin products had an ideal availability of 80% in any of the surveyed health facilities. In the public sector, none of the insulin products had an availability of more than 50%. In the public sector, the overall availability of human insulin was 70% (including OB and BS). While in the private sector, the overall availability of human insulin was 90% and that of analog insulin was 62.5%. The analog insulin products were 72.8% costlier than the human insulin products. The median prices of BS insulin were 25.4% lower than the OB products, indicating that almost one-fourth of the cost could be saved by switching to BS human insulin from OB human insulin. All oral anti-diabetic medicines were found to be affordable, whereas none of the insulin was affordable. The NDWs for human and analog insulin were 1.38 and 5.06. Conclusion: In Pakistan, the insulin availability falls short of the WHO’s benchmark of 80%. Insulin continues to be unaffordable in both private and government sectors. To increase insulin access, the government should optimize insulin procurement at all levels, promote local production, enforce biosimilar prescribing, and provide financial subsidies for these products.

An online survey to describe pharmacy student spirituality and spiritual care perspectives

IntroductionLittle is known about student pharmacists' perspectives of spirituality and spiritual care (SC) in pharmacy education and practice. The purpose of this study was to examine student pharmacists' perspectives about spirituality and incorporating SC in pharmacy education and practice. MethodsStudent pharmacists were recruited from two private pharmacy schools in California, one religiously-affiliated and one non-religiously affiliated. A faculty member at each school invited student pharmacists via email or through Zoom (Zoom Video Communications) chat to complete the 37-item online survey through an embedded link. The investigator-designed survey was comprised of 22 items inquiring about spirituality and SC as well as several items assessing demographic and religious characteristics. ResultsParticipants included 470 student pharmacists (87.2% response rate) who were 28.9 ± 5.7 years old on average. Half of the respondents (50.5%) attended the non-religiously affiliated university. Most of the respondents were female (67%), Christian (67.8%), spiritual (79.2%), and religious (75.2%). They “agreed” or “strongly agreed” that: “understanding patients' spiritual beliefs is an important part of pharmacy practice” (83%), “I would pray with my patients as a pharmacist” (54.8%), “it is appropriate for a pharmacist to have spiritual or religious conversations with patients” (52.9%), and “it is appropriate for a pharmacist to pray with and for patients who request it” (66.9%). These beliefs were positively correlated with self-reported religiosity and spirituality. ConclusionsMost students considered themselves spiritual and religious and felt that spirituality and learning about SC were important. The respondents' SC perspectives were associated with their religiosity and spirituality.

Final year pharmacy students’ knowledge and perceptions towards generic medicines: A survey-based pilot study from Eastern province, Saudi Arabia

Objective: A prospective cross-sectional survey-based pilot study was conducted amongst final year pharmacy students at a private pharmacy college in Eastern Province, Saudi Arabia, to evaluate the knowledge and perception toward generic medicines. Methods: This online survey-based study was carried out amongst all final year students enrolled in the pharmacy programme between 1 February and 30 April 2020. Results: The response rate was 95.56%. Most participants (66.27%) agreed that generic products are therapeutically equivalent to the innovator brand product, and 75.57% reported the need for more information on how bioequivalence tests are conducted for generic medicines. Furthermore, 34.88% agreed that generic medicines are of inferior quality to brand drugs and 73.24% reported the need for more information on the issues pertaining to the safety and efficacy of generic medicines. Conclusion: This study showed that fifth-year pharmacy students had a basic knowledge of generic medicines, with an ambivalent perception of generics’ quality and safety standards. A number of collaborative initiatives should be planned and executed to equip future pharmacists with broad knowledge concerning generic medications.

HIV Self-testing Among Previously Diagnosed HIV-Positive People in Khayelitsha, South Africa: No Evidence of Harm but may Facilitate Re-engagement in ART Care

In South Africa, where an estimated 34% of nearly 7-million HIV-positive people were not on antiretroviral therapy (ART) in 2019, innovative strategies to diagnose and link people to care are needed. HIV self-testing (HIVST) is one such strategy. However, there is concern that access to HIVST might result in re-testing among people on ART, with a risk of false negative results and disengagement from care. Between November 2017 and December 2018, HIVST kits were distributed at a private pharmacy and at HIV testing outreach events. Each participant was instructed to report their result via SMS and those who did not were followed-up telephonically 10 days later. Electronic medical records of participants were searched for evidence of HIV services 6 months before and after enrollment. Of 1482 participants, 163 (11%) were previously diagnosed HIV-positive prior to taking the test. Of these, 123 reported a result, however 87% reported a negative result. Of the 163 previously diagnosed, 84 were not in ART care prior to the test, with 15 (18%) linking to care post-test. Of 79 who were in ART care prior to the test, 76 (96%) remained in care, even though 51 (67%) had reported a negative result. Overall, 29% of participants reported their result via SMS, and 48% when telephoned. Despite efforts to dissuade them, some previously diagnosed HIV-positive utilised HIVST. For those disengaged from care this may facilitate re-engagement. Self-testing among those already in care, regardless of the reported result, did not disrupt their treatment, and their reasons for doing the test remain unclear.

Investigation of the Quality of the 12 Most-Used Antibiotics Available in Retail Private Pharmacies in Rwanda.

Using poor-quality antibiotics leads to increased risk of the development of microorganism-resistant strains, treatment failure, loss of confidence in health systems, and associated socio-economic impacts. The prevalence of poor-quality antibiotics has been found to be high in some of the Low and Middle-Income Countries (LMICs), but no data were available on the situation in Rwanda. This study was conducted to obtain data and inform health professionals on the quality of the 12 most-used selected antibiotics from private retail pharmacies in Rwanda. The investigation was conducted on 232 batches collected from randomly selected private retail pharmacies in all provinces of Rwanda, and concerned only with visual inspection and assay tests. Visual inspection was performed using a tool adopted by the International Pharmaceutical Federation (FIP) to identify manufacturing defects. An assay test quantified the Active Pharmaceutical Ingredient (API) in each collected batch using high-performance liquid chromatography (HPLC) coupled with an ultraviolet-visible (UV) detector, and the results were reported as the percentage content of the amount of APIs stated on the label. A total of 232 batches were analyzed, manufactured in 10 countries; the main country of manufacture was Kenya, with almost half of the batches (49.6%). The results of the visual inspection did not show the presence of counterfeit/ falsified antibiotics on the Rwandan market in this study but revealed weaknesses in labeling: more than 90% of the analyzed batches of the 12 antibiotics did not present the dosage statement on their label, and the complete list of excipients was missing in more than 20% of the analyzed batches. The assay test using HPLC confirmed the presence of APIs in 100% of the analyzed batches. However, moderate deviations from acceptable ranges of the API content defined by M. M. Nasr & C. M. Stanley in 2006 for erythromycin and the United States Pharmacopoeia 2018 for the other 11 molecules were found. The failure rate to meet the quality requirements in terms of the percentage content of active pharmaceutical ingredients declared on the labels was estimated at 8.2% in total, with 3.9% and 4.3% containing more and less than the amount of APIs stated on the labels respectively. The most-represented antibiotics on the Rwandan market were amoxicillin, co-trimoxazole and cloxacillin. No counterfeit antibiotics were found in this study. However, substandard batches with moderate deviations were found, suggesting that regular quality control of antibiotics is needed in Rwanda.

The impact of the private sector co-payment mechanism (PSCM) on the private market for ACT in Nigeria: results of the 2018 cross-sectional outlet and household market surveys

BackgroundThe private sector plays a large role in malaria treatment provision in Nigeria. To improve access to, and affordability of, quality-assured artemisinin-based combination therapy (QA-ACT) within this sector, the Affordable Medicines Facility-Malaria began operations in 2010 and transitioned to a private sector co-payment mechanism (PSCM) until 2017. To assess the impact of the scheme on the ACT market, cross-sectional household and outlet surveys were conducted in 2018 to coincide with the final stockages of ACT medicines procured under the PSCM.MethodsAn outlet survey was conducted targeting private pharmacies and Proprietary and Patent Medicine Vendors (PPMVs) across different regions of Nigeria to assess supply-side market factors related to availability and cost of anti-malarials, including artemisinin-based combinations subsidised under the PSCM (called green leaf ACT on account of their green leaf logo) and those not subsidised (non-green leaf ACT). A concurrent household survey was conducted to determine demand-side factors related to treatment-seeking practices, ACT brand preference and purchase decision. Data were compared with previous ACTWatch surveys to consider change over time.ResultsAvailability of artemisinin-based combinations increased significantly over the PSCM period and was almost universal by the time of the 2018 market survey. This increase was seen particularly among PPMVs. While the cost of green leaf ACT remained relatively stable over time, the cost of non-green leaf ACT reduced significantly so that by 2018 they had equivalent affordability. Unsubsidised brands were also available in different formulations and dosages, with double-strength artemisinin-based combination reported as the most frequently purchased dosage type, and child artemisinin-based combinations popular in suspension and dispersible forms (forms not subsidised by the PSCM).ConclusionsThe PSCM had a clear impact on increasing not only the reach of subsidized QA brands, but also of non-subsidised brands. Increased market competition led to innovation from unsubsidised brands and large reductions in costs to make them competitive with subsidised brands. Concerns are drawn from the large market share that non-QA brands have managed to gain as well as the continued market share of oral artemisinin monotherapies. Continued monitoring of the market is recommended, along with improved local capacity for QA-certification and monitoring.