Across several low and middle-income countries (LMICs), national health systems have been functioning sub-optimally due to recurring challenges within the health sector, with this particularly affecting the delivery of accessible and affordable healthcare services . The health system, in most cases, is synonymous with publicly owned health facilities, with several important private and non-state actors being downplayed . The functional capacities of the health system in these settings have gradually weakened, having failed to recognize and maximize efforts of all parastatal primarily devoted to improving health (including organizations, institutions, structures, and resources) [1, 3].
Health workforce is an integral part of the health system and plays a critical role in achieving effective healthcare delivery. According to the World Health Organization (WHO), they are people “primarily engaged in action with the intent of enhancing health” diagnosing illnesses, healing, caring for people, monitoring health outcomes, supporting treatment adherence, providing medical information, and preventing diseases [4–5]. They consist of physicians, nurses, midwives, dentists, pharmacists, laboratory workers, environment & public health workers, community health workers, other health workers, and health management, and support staff [6–7]. The correlation between the availability of health workforce and positive health outcomes has been observed by several studies [1, 8].
In 2007, there was an inadequate figure of 35 doctors and 86 nurses per 100,000 populations of Nigerians comparable to Sub-Saharan average of 15 doctors and 72 nurses per 100,000 population; a region that contributes to a quarter of the global burden of disease [5, 9]. These figures have remained inadequate over the years; with Nigeria reporting a health workforce of 195 (doctors and nurses) per 100,000 ten years from the 2006 world health report . This scenario has been linked to inadequate production and inequitable distribution across the country [3, 10–11]. With massive historical brain drain which already has been documented to have caused setbacks in the country’s health system  and declining recent brain drain still being experienced in Africa (including Nigeria); especially of doctors (25%)  and nurses (5%) , the number of Community Pharmacists are also grossly inadequate  and hence the need for other cadres of staff to fill in the gap and improve healthcare (especially basic public health services).
Although not always recognized as front-line health workers, across many countries in Sub-Saharan Africa (including Nigeria), medicine shops offer an alternative, when there are shortages in the health sector (including human resource shortage) and are usually the first point of care-seeking in most communities [15–18]. As reported by the National demographic health survey, nearly half (41%) of contraceptives users in Nigeria obtain their contraceptives from the private sector, with more than half of all mothers/guardians seeking care from this sector for childhood illness such as Diarrhea (54.1%) and Fever (57.7%) . Major reasons noted for this occurrence in several studies include the absence of formalities, reduced waiting time at the Medicine shop, the proximity of the outlets to clients, and the perception of clients that they will pay more at a health facility [20–21]. Patent and Proprietary Medicine Vendors (PPMVs) are increasingly being recognized as important providers of health commodities, as interest continues to grow among policymakers and Program implementers regarding their engagement in Primary Health Care delivery in Nigeria . In some settings, training medicine vendors to provide high-quality basic services, such as family planning (FP) services, treatment of common childhood illnesses and malaria, may offer a cost-effective way of delivering community-based health programs [17, 20, 22]. The Pharmacists Council of Nigeria (PCN) undertakes the registration, regulation, and licensure of PPMVs, conducting orientation programs for new PPMVs, continuing education programs for existing PPMVs, inspection, and publishing the Approved Patent Medicine List (APML) . Studies have however shown a reluctance of medicine vendors to register with the regulatory body and preferring to register with their trade associations, which also provide drug stocking support, facilitate education and training, and give business and financial assistance [18, 24–25].
In 2014, Nigeria issued the task-shifting and task-sharing (TSTS) policy for essential health services in Nigeria which aimed to fill the human resource gap and improve the delivery of health services across the country . The policy highlighted the need to expand services to community-based personnel including Medicine vendors to provide treatment, counseling, and referral for some reproductive, maternal, and child health services (including FP) [26–27]. Previous studies have shown that different professionals may be operating within the PPMV space (even some with medical training [17, 28]. Thus, the integration of this group of private providers into the formal healthcare system could increase access to high quality, primary health care services throughout the country .
In an initial study conducted in 2014, Liu and colleagues estimated the number of vendors in Nigeria and offered clues to drug stocking practices and how this group of healthcare workers could be better engaged to improve healthcare across the country . However, it has been four years since the initial study and with the support recently showed to this group of health workers through the TSTS policy, there is the need to conduct further characterization and distribution of medicine vendors. This study focuses on the characteristics, spread, and FP stocking practices of PPMVs in Lagos and Kaduna states of Nigeria. It also assesses the influence of health training and other factors on the provision and stocking of FP services and commodities respectively by medicine vendors.