Private medicine retailers are often the first port of call when people need essential medicines and basic health care, especially in rural areas. However, these drug shops and retailers often operate outside the formal medical system in low- and middle-income countries, raising concerns about the quality of the products and services on offer. This poses a challenge for formal health care systems: what regulations and restrictions should there be on these informal providers and how can they be engaged to improve the reach of health services?
A new special issue of the Journal of Pharmaceutical Policy and Practice showcases findings from six research studies on drug shops across Bangladesh, Indonesia, Myanmar, Nigeria, the United Republic of Tanzania and Zambia. The special issue also includes one cross-cutting article on factors that make initiatives to engage with drug shops successful and one editorial outlining the importance of supply chain management in health systems strengthening efforts.
The studies in the supplement were part of a multi-country implementation research programme developed by the Alliance for Health Policy and Systems Research and the Implementing Best Practices (IBP) Network – both at WHO – with support from the United States Agency for International Development (USAID).
The country-level articles focus on two sides of the same coin: improving access to drugs and services while ensuring there is not inappropriate or overuse of certain drugs. The articles from Myanmar, Indonesia and Zambia all touch upon the potential role for drug shops in helping to control infectious diseases like malaria, in particular in rural areas. And one article from Nigeria also looks at whether these vendors’ could help extend access to injectable contraceptives. On the other hand, articles from Nigeria and Bangladesh also look at how to manage the over-dispensing of antibiotics, the inappropriate use of which can contribute to anti-microbial resistance.
The cross-cutting article identifies a series of micro-level, meso-level and macro-level factors that influence the successful engagement of drug shops. At the micro level, they highlight the importance of good pre-existing relationships between community members and drug shops. At the meso level, training of drug shop owners and their openness to new approaches were keys to success, while client pressure to provide drugs on demand hindered efforts. And at the macro level, having buy-on from stakeholders at all levels was key. The interplay between these factors and levels is also important.
An editorial in the special issue also call attention to the issue of supply chain management in health systems. Noting the issues faced during the COVID-19 pandemic, the authors suggest that: “supply chain management in response to the pandemic has been reactive, with a focus on short-term needs, rather than being proactive”. They make the case for investment in essential public health functions towards building stronger and more resilient health systems for the future.