How conflicts of interest hinder effective regulation of healthcare: an analysis of antimicrobial use regulation in Cambodia, Indonesia and Pakistan

Abstract

BackgroundThere has been insufficient attention to a fundamental force shaping healthcare policies—conflicts of interest (COI). We investigated COI, which results in the professional judgement of a policymaker or healthcare provider being compromised by a secondary interest, in relation to antimicrobial use, thereby illuminating challenges to the regulation of medicines use more broadly. Our objectives were to characterise connections between three groups—policymakers, healthcare providers and pharmaceutical companies—that can create COI, and elucidate the impacts of COI on stages of the policy process.MethodsUsing an interpretive approach, we systematically analysed qualitative data from 136 in-depth interviews and five focus group discussions in three Asian countries with dominant private healthcare sectors: Cambodia, Indonesia and Pakistan.FindingsWe characterised four types of connections that were pervasive between the three groups: financial, political, social and familial. These connections created strong COI that could impact all stages of the policy process by: preventing issues related to medicines sales from featuring prominently on the agenda; influencing policy formulation towards softer regulatory measures; determining resource availability for, and opposition to, policy implementation; and shaping how accurately the success of contested policies is reported.InterpretationOur multicountry study fills a gap in empirical evidence on how COI can impede effective policies to improve the quality of healthcare. It shows that COI can be pervasive, rather than sporadic, in influencing regulation of medicine use, and highlights that, in addition to financial connections, other types of connections should be examined as important drivers of COI.

Good manufacturing practice in low‐ and middle‐income countries: Challenges and solutions for compliance

“…Procurement agencies might focus on making medicines available, whereas NRAs are responsible for ensuring quality medicines, so situations where supply is limited yet quality is sub-par may create tension between these agencies. Conflicts of interest can be pervasive and may influence the regulation of medicines [13]. Governments slashing the prices of medicines to achieve universal health coverage (possibly due to conflict of interest) may influence the quality of medicines.…”

“…NRAs also need to function independently of the procurement agencies to prevent possible conflicts of interest. For this, there is a need for a guideline to assess, monitor and manage possible conflicts of interest between manufacturers, procurement agencies and NRAs which is currently lacking in LMICs [13].…”

“…Most NRAs function within the Ministry of Health or a health department risking possible conflict of interest between NRAs and procurement agencies. Although they both work towards protecting public health, inherent conflicts of interest may exist along the line of their duty [13]. Procurement agencies might focus on making medicines available, whereas NRAs are responsible for ensuring quality medicines, so situations where supply is limited yet quality is sub-par may create tension between these agencies.…”

The Challenges of Inventory Management in Medical Supply Chain

“…Over time, Pakistan's healthcare system now offers better care. Currently, 92% of people in rural areas and 100% of city dwellers have access to healthcare (Khan et al, 2022). Thus, the study's primary audience consists of CEOs and SC professionals working in Pakistani hospitals and healthcare facilities.…”

In Syria, Unqualified People are Renting Pharmacists’ Licenses to Open Drugstores: A Phenomenon that Threatens Public Health

“…The pharmacy profession in Syria and other countries, including Pakistan, Cambodia, Vietnam, and Yemen, has been harmed by the widespread practice of non-pharmacists renting a pharmacist’s professional license ( 1 – 3 ). In Syria, the problem usually begins when pharmacy students graduate and face barriers to entering the market, such as the considerable sum of money needed to start a private community pharmacy ( 4 ).…”