Strengthening private-sector medicine systems to tackle the persistence of poor-quality medicines in Africa: a proof-of-concept study


Principal Investigator: Heather Hamill

External Hosting Institution and Principal Investigator: Kate Hampshire, Durham University


Poor-quality medicines, containing little or no active ingredient - whether through deliberate fraud, poor manufacturing practice or post-manufacture deterioration - represent a major public health threat in low/middle-income countries (LMICs): responsible for more than 200,000 under-5 deaths each year in Africa and contributing to antimicrobial drug resistance. 

Efforts by governments and international agencies to curb the problem through improving detection rates, tightening regulation and public education have been hampered by the economic realities of medicine supply in resource-poor, high need contexts, but also - we suggest - by a failure to apprehend fully the complex workings of medicine supply systems, particularly beyond the public sector. Private-sector medicine systems can be characterised as 'complex systems' involving multiple dispersed actors with no central organising authority.

Recent developments in the study of complex systems have revealed how the actions of individuals can combine to have non-intuitive effects on the system as whole. This has significant implications for well-intentioned policy interventions based on 'common sense' intuition, which may have unwelcome unanticipated consequences. Our ultimate goal is to understand - and predict - the workings of complex medicine systems in order to inform effective interventions to minimise the penetration of poor-quality products in LMICs.