Photograph: Beendy234, CC0, via Wikimedia Commons

In many low- and middle-income countries, access to formal eye and ear health services is limited, particularly in rural areas where specialist services are scarce. A new mixed-methods study led by International Centre for Eye Health researchers, published in PLOS ONE, has investigated whether proprietary and patent medicine vendors (PPMVs), informal providers of medication found widely across Nigeria, could play a supportive role in primary eye and ear care.

The study, conducted in four urban and rural Local Government Areas of Kaduna State, surveyed more than 1,500 adults and engaged community members, health professionals and PPMVs through focus groups and interviews. It aimed to understand how people with eye and ear problems seek care, evaluate PPMVs’ current knowledge and practices relating to these conditions, and gauge both community and formal health provider views on the potential for extending PPMVs’ roles after appropriate training.

Results showed that eye and ear complaints are common in the community, although they are perceived as less frequent than conditions such as malaria or fever. Nearly 40% of respondents recalled eye or vision issues, and 28% reported ear-related problems, often attributing these to environmental factors like dust, smoke or dry winds. Community members generally first sought care at government facilities, but nearly half also mentioned PPMVs as a source of health advice, reflecting their accessibility and prevalence in both urban and rural settings.

Despite their prominent role as front-line providers of medicines, most PPMVs surveyed lacked formal training in eye or ear conditions and had limited capacity to detect or manage them. Their activities were primarily focused on dispensing medication, often in response to client requests, with little health education or counselling. Community perceptions mirrored this: while PPMVs were accessible, they were not widely seen as a first choice for eye or ear care specifically.

Importantly, when asked about expanding their responsibilities, many PPMVs expressed enthusiasm for training in primary eye and ear care. Similarly, community members living more than five kilometres from a health facility, and those who were male, less educated or poorer, were more likely to say they would consider accessing trained PPMVs for these conditions. Formal health care workers and eye and ear specialists, involved through interviews and focus groups, acknowledged the potential value of engaging PPMVs but emphasised the need for rigorous training, supervision, and reliable supply chains for medication.

The authors conclude that PPMVs could contribute meaningfully to basic eye and ear health services in underserved areas, provided they receive structured training and integration with formal health systems. Such a strategy, which is being used for malaria in Nigeria, could improve early detection and management of common conditions, reduce barriers to care, and help bridge the gap between communities and formal services, which is a key consideration for equitable eye health care planning in Nigeria and similar settings.

Publication

Okiebunor J, Smith A, Jolley E et al. Potential role of proprietary patent medicine vendors in primary eye and ear care: A mixed methods study in northern Nigeria. PLOS One. June 2025. https://doi.org/10.1371/journal.pone.0326132