Enablers and barriers of the Hub and Spoke Supervision Model among private sector providers in Nigeria: A theory-informed qualitative study

Patent and Proprietary Medicine Vendors (PPMVs) are important sources of information and care for many Nigerians, meeting a notable gap in healthcare supply, especially in rural and hard-to-reach areas. The Hub and Spoke Supervisory Model (HSSM) implemented by the IntegratE Project aims to address the persistent challenge of suboptimal care provided by PPMVs by strengthening PPMVs’ capacity to consistently deliver quality services to their clients. The Project conducted in-depth interviews with all (8) pharmacists supervising PPMVs and focus group discussions (FGDs) with 19 purposively selected PPMVs participating in the pilot in Kaduna and Lagos, Nigeria between June and July 2023 to identify the enablers and barriers to the HSSM. The study used Semi structured IDI and FGD guides developed based on the seven constructs of the theoretical framework of acceptability (TFA): affective attitude, ethicality, burden, opportunity cost, intervention coherence, perceived effectiveness, and self-efficacy to obtain information from the pharmacists and PPMVs, respectively. All the interviews and discussions were audio-recorded, transcribed verbatim and analyzed thematically.

专利与专有药品供应商（Patent and Proprietary Medicine Vendors, PPMVs）是众多尼日利亚民众获取信息与医疗服务的重要渠道，填补了医疗供应领域的显著缺口，尤其在农村及偏远难达地区。由整合项目（IntegratE Project）推行的辐轴式监管模型（Hub and Spoke Supervisory Model, HSSM），旨在解决PPMVs提供的医疗服务质量欠佳这一长期难题，通过提升PPMVs的服务能力，使其能够持续为服务对象提供优质服务。该项目于2023年6月至7月间，在尼日利亚卡杜纳州与拉各斯州开展调研：对负责监管PPMVs的全部8名药剂师开展深度访谈，并对19名经目的性抽样入选的试点参与PPMVs开展焦点小组讨论（FGDs），以识别辐轴式监管模型落地的促进因素与阻碍因素。研究采用了基于可接受性理论框架（Theoretical Framework of Acceptability, TFA）七大构念开发的半结构化深度访谈（Semi-structured IDI）与焦点小组讨论指南，分别面向药剂师与PPMVs采集调研信息。该七大构念具体为：情感态度、伦理合理性、负担程度、机会成本、干预连贯性、感知有效性与自我效能感。所有访谈与讨论均进行了录音、逐字转录，并开展了主题分析。