Health Policy and Planning Advance Access published online on October 4, 2007
Health Policy and Planning, doi:10.1093/heapol/czm033
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Drug shop regulation and malaria treatment in Tanzania—why do shops break the rules, and does it matter?
1 Lecturer (Health Economics and Policy), Health Policy Unit, London School of Hygiene & Tropical Medicine, London, UK.
2 KEMRI/Wellcome Trust Collaborative Research Programme, PO Box 43640, Nairobi, Kenya.
3 Director for CDC/IHRDC Malaria Programme in Tanzania, Ifakara Health Research and Development Centre, Dar es Salaam, Tanzania.
4 Malaria Branch, Centers for Disease Control and Prevention, United States Public Health Service, Atlanta, USA.
5 Senior Research Scientist (Epidemiology), Ifakara Health Research and Development Centre, Dar es Salaam, Tanzania.
6 Senior Advisor for Global Health, National Center for Zoonotic, Vector-borne, and Enteric Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, United States Public Health Service, Atlanta, USA.
7 Professor of Health Economics and Policy, Health Policy Unit, London School of Hygiene and Tropical Medicine, London, UK.
* Corresponding author. KEMRI/Wellcome Trust Collaborative Research Programme, PO Box 43640, Nairobi, Kenya. Tel: +254 20 272 0163/271 5160/271 0672. Fax: +254 20 271 1673. E-mail: catherine.goodman{at}lshtm.ac.uk
Regulatory infringements are extremely common in low-income countries, especially with respect to retail pharmaceutical sales. There have been few practical suggestions on public policy responses other than stricter regulatory enforcement, which governments are often unable, or unwilling, to do. This paper explores the challenges of regulating retail drug sellers, and potential solutions, through a case study of malaria treatment in rural Tanzania where small drug shops are a common source of medicine.
Infringement of health-related regulation was extremely common. Most stores lacked valid permits, and illegal stocking of prescription-only medicines and unpackaged tablets was the norm. Most stocked unregistered drugs, and no serving staff met the qualification requirements. Infringements are likely to have reflected infrequent regulatory inspections, a failure of regulatory authorities to implement sanctions, successful concealment of regulatory violations, and the tacit permission of local regulatory staff.
Eliminating regulatory infringements is unlikely to be feasible, and could be undesirable if access to essential medicines is reduced. Alternatives include bringing official drug regulation closer into line with locally legitimate practices; greater use of positive incentives for providers; and consumer involvement. Such a change in approach has the potential to provide a firmer platform for public-private collaboration to improve shop-based treatment.
Key Words: Regulation, shopkeepers, drugs, private sector, malaria
Accepted for publication 9 July 2007.
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  C. Goodman, W. Brieger, A. Unwin, A. Mills, S. Meek, and G. Greer Medicine Sellers and Malaria Treatment in Sub-Saharan Africa: What Do They Do and How Can Their Practice Be Improved? Am J Trop Med Hyg, December 1, 2007; 77(6_Suppl): 203 - 218. [Abstract] [Full Text] [PDF]
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