Drug shops for stronger health systems: learning from initiatives in six LMICs

Abstract

Background Private sector retail pharmacies, or drug shops, play an important role in access to essential medicines and services in low-and-middle-income countries. Recognising that they have the potential to contribute to health system strengthening efforts, many recent initiatives to engage with drug shops have been launched. These include initiatives that focus on changes in policy, regulation and training. However, the specific factors that influence their success remain poorly understood. Seven country case studies supported under the Alliance’s programme of work ‘Strengthening health systems: the role of drug shops’ help to explore this issue. Methods Country case studies from the above programme of research from Bangladesh, Indonesia, Myanmar, Nigeria, Tanzania and Zambia were used as the main sources of data for this paper. A modified version of Bigdeli et al.’s Access to Medicines framework was applied within a partially grounded approach to analyze each country case study and compare themes between countries. Results Many factors may help initiatives targeting drug shops successfully achieve their intended outcomes. At the micro level, these include community demand for drug shops and a positive relationship between drug shops and their clients. At the meso level, facilitators of initiative success include training and positive attitudes from drug shops towards the initiative. Barriers include client pressure, procurement challenges and financial and administrative costs associated with initiatives. At the macro level, collaboration between stakeholders, high-level buy in and supervision, monitoring and regulation may influence initiative success. These factors are inter-dependent and interact with each other in a dynamic way. Conclusions Using a framework approach, these country case studies demonstrate common factors that influence how drug shops can strengthen health systems. These learnings can help inform the design and implementation of successful strategies to engage drug shops towards sustainable systems change.

Delivering maternal and child health interventions through the private sector in LMIC: a scoping review of strategies and effective approaches

“…Pharmaceutical market regulation aims to limit the availability of harmful drugs and unregistered products, minimise drug misuse, control the sale of specific drugs through prescriptions and regulate drug manufacture and importation. Regulation has a crucial balancing role within the private sector, although, inadequate resources are typically allocated for monitoring and enforcing regulations (Wiysonge et al, 2016, Montagu and Goodman, 2016, Shroff et al, 2018, Lamba et al, 2021). Co-regulation with professional associations, civil society, and communities provides additional benefit.…”

“…Co-regulation with professional associations, civil society, and communities provides additional benefit. (Lamba et al, 2021, WHO, 2020a, WHO, 2020b). See table 2 for more detailed information on the studies and recommendations related to regulation.…”

“…This group of providers has been effectively engaged through various ways. Training, accreditation, supervision and monitoring are effective ways of improving knowledge and compliance to guidelines when working with drug shops for improved primary health care outcomes (Lamba et al, 2021, Awor et al, 2018, Embrey et al, 2016). Organizing these drug shops through intermediary organizations like franchise networks and accreditation bodies has also been effective (Embrey et al, 2016, PSI, 2016).…”

Is it possible for drug shops to abide by the formal rules? The structural determinants of community medicine sales in Uganda

“…In many countries in Africa, and South and Southeast Asia, the medicines retail sector (MRS) constitutes an essential element of the health system 1–3. Its role in enabling access to medicines is well recognised2 4 but so too are the regulatory infringements and poor practices (the over and underdosing of prescription only medicines and sale of poor quality or degraded pharmaceuticals) that are commonplace 5–7…”

“…Twenty years of research on medicine sellers suggests that the difficulty of governing this sector is related to the widespread rule breaking among the inspectors, regulators and the sellers themselves 1 4 17–19. Despite this, no effective strategies have been designed to manage rule breaking and rent seeking in the market.…”