Using responsive feedback to iterate Theories of Change – NaijaCare

Problem and context

In Nigeria, patent and propriety medicine vendors (PPMVs) are a crucial component of the private sector heath system. PPMVs are defined as anyone without formal training in pharmacy who sells orthodox pharmaceutical products on a retail basis for profit. PPMVs often provide pharmaceutical products for poor and rural communities but are often not well supported in doing so. PPMVs therefore offer an opportunity to expand and strengthen primary health care and family planning services for the poor

Program approach

NaijaCare aimed to improve the service delivery of PPMVs, whilst also meeting their business and financial needs. The program aimed to provide a digital service business for PPMVs that would improve their service delivery, whilst also meeting their business needs.

The initial Theory of Change (ToC) for NaijaCare was based on a ToC used in a similar project, UJoin in Kenya. Here the premise was that the needs of low-income households could be met by driving behavioral change through leveraging the relationships between the ‘duka owners’ (Kenyan shop-keepers) and their customers. For example, UJoin provided duka owners with a digital community, which they accessed using their mobile phone. The community provided education and mentoring and credit to buy stock to PPMVs, as well as a ‘loyalty scheme’ through which discount vouchers are sent to their customers’ mobile phones.

How did the program harness responsive feedback?

The NaijaCare program revised its Theory of Change following user feedback and a landscape analysis with key stakeholders. The feedback showed that there were additional stakeholders that the initial ToC had not considered. Two insights suggested that the ToC needed adapting for the Nigerian context. Firstly, there were reports that PPMVs are a major route for sub-standard and counterfeit medicines and sell medicines not covered under their licenses. Secondly, imminent regulatory changes would create three tiers of PPMVs and require them to register with the Pharmacist Council of Nigeria (PCN).These insights showed that, in order to bring about effective change, the program needed to help PPMVs mitigate the legal contraventions, facilitate the necessary registration process and target each PPMV with content appropriate to their tier. In response, the program created a ‘digital ordering’ facility for the PPMVs. This facility would enable the PPMVs to order medicines from an assured provider, creating a secure supply chain. Further, digital ordering can provide a digital trading history that may de-risk the provision of highly-valued credit, share distribution costs through adding further products to the basket (e.g. soaps, toothpastes, skin creams) and reduce the unit cost of stock for the PPMVs by enabling group-buying.

Key learnings

  1. Responsive feedback mechanisms (RFMs) can be used to iterate and improve Theories of Change, not just implementation methods. This case study demonstrates how RFMs can be used to improve the ToC underlying development programs, not just improve implementation designs and approaches. Here, the user feedback and landscape analysis highlighted additional stakeholders that had not been addressed within the initial ToC. The program was able to iterate at a small-scale and adapt its ToC according to this feedback.
  2. Program budgets should be structured in a way that enables ToC iteration In order to build their additional digital ordering facility, NaijaCare required additional budget to fund the necessary technology development. By structuring the budget in a way that facilitated theory change, the funder allowed the program to improve its Theory of Change and achieve effective change. The case study therefore shows that funding mechanisms need to be more flexible to allow such iteration and improvement.


U: Uncover assumptions

In this step, we examine our beliefs about how we think our programs work, looking for assumptions and areas where we could benefit from learning more.

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