Life in the buffer zone: Social relations and surplus health workers in Uganda's medicines retail sector

Hutchinson, Eleanor; Mundua, Sunday; Ochero, Lydia; Mbonye, Anthony K.; Clarke, Siân E.

doi:10.1016/j.socscimed.2021.113941

Cited by 6 publications

(9 citation statements)

References 35 publications

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“…Studies have also identified how political elites can manipulate the policy agenda through partisan appointees who ignore technical considerations to align with the interests of appointing authorities 37. We also found that the characterisation of elites as driven by altruistic motives or self-interests depends on who is ‘losing ‘or ‘winning’ from intended policies, a phenomenon that played it self out when pharmacists pushed for stricter laws to regulate medicine vendors in Uganda 95. Despite these self-interest motives, we found examples where elites were moved by altruistic motives.…”

Section: Methodsmentioning

confidence: 71%

“…37 We also found that the characterisation of elites as driven by altruistic motives or self-interests depends on who is 'losing 'or 'winning' from intended policies, a phenomenon that played it self out when pharmacists pushed for stricter laws to regulate medicine vendors in Uganda. 95 Despite these self-interest motives, we found examples where elites were moved by altruistic motives. In South Africa, government officials who came from underprivileged communities found it important and necessary to change poor maternal health conditions of those communities and successfully lobbied for progressive reforms.…”

Section: Bmj Global Healthmentioning

confidence: 76%

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Beyond political will: unpacking the drivers of (non) health reforms in sub-Saharan Africa

Mhazo

Maponga

2022

BMJ Glob Health

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BackgroundLack of political will is frequently invoked as a rhetorical tool to explain the gap between commitment and action for health reforms in sub-Saharan Africa (SSA). However, the concept remains vague, ill defined and risks being used as a scapegoat to actually examine what shapes reforms in a given context, and what to do about it. This study sought to go beyond the rhetoric of political will to gain a deeper understanding of what drives health reforms in SSA.MethodsWe conducted a scoping review using Arksey and O’Malley (2005) to understand the drivers of health reforms in SSA.ResultsWe reviewed 84 published papers that focused on the politics of health reforms in SSA covering the period 2002–2022. Out of these, more than half of the papers covered aspects related to health financing, HIV/AIDS and maternal health with a dominant focus on policy agenda setting and formulation. We found that health reforms in SSA are influenced by six; often interconnected drivers namely (1) the distribution of costs and benefits arising from policy reforms; (2) the form and expression of power among actors; (3) the desire to win or stay in government; (4) political ideologies; (5) elite interests and (6) policy diffusion.ConclusionPolitical will is relevant but insufficient to drive health reform in SSA. A framework of differential reform politics that considers how the power and beliefs of policy elites is likely to shape policies within a given context can be useful in guiding future policy analysis.

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Section: Methodsmentioning

confidence: 71%

Section: Bmj Global Healthmentioning

confidence: 76%

Beyond political will: unpacking the drivers of (non) health reforms in sub-Saharan Africa

Mhazo

Maponga

2022

BMJ Glob Health

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“…This concurs with recent ethnographic findings by this research team which have highlighted the importance of drug shops for employment of midwives and nurses who are unable to find work in the formal institutions of the health system in Uganda. 54 . Future research should ascertain the extent to which this is replicated in other districts in the country, and whether the numbers/proportion of trained health workers in drug shops are similar in urban and rural settings.…”

Section: Discussionmentioning

confidence: 99%

“…The only recourse to political power for DSVs was through their membership group, the NDAI. Research suggests that this group is able to successfully contest some potentially detrimental policy changes 54 but they have yet to be involved in strategies to improve practice in these markets. Patent medicine sellers in Nigeria have similarly organised themselves into local associations that challenge policy 57.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings suggest that the sales of antibiotics are important for drug shops’ economic survival. Previous research has shown that the government of Uganda relies on these shops to distribute antibiotics,54 but the nature of anti-microbial resistance makes unregulated sales of antibiotics a global concern 60. Those calling for stricter regulation and enforcement of antibiotic sales60–62 need to attend to structural factors that drive poor practice 63.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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The medicines retail sector is an essential element of many health systems in Africa and Asia, but it is also well known for poor practice. In the literature, it is recognised that improvements in the sector can only be made if more effective forms of governance and regulation can be identified. Recent debate suggests that interventions responsive to structural constraints that shape and underpin poor practice is a useful way forward. This paper presents data from a mixed-methods study conducted to explore regulation and the professional, economic and social constraints that shape rule breaking among drug shops in one district in Uganda. Our findings show that regulatory systems are undermined by frequent informal payments, and that although drug shops are often run by qualified staff, many are unlicensed and sell medicines beyond their legal permits. Most shops have either a small profit or a loss and rely on family and friends for additional resources as they compete in a highly saturated market. We argue that in the current context, drug shop vendors are survivalist entrepreneurs operating in a market in which it is extremely difficult to abide by policy, remain profitable and provide a service to the community. Structural changes in the medicines market, including removing unqualified sellers and making adjustments to policy are likely prerequisite if drug shops are to become places where individuals can earn a living, abide by the rules and facilitate access to medicines for people living in some of the world’s poorest countries.

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The paradoxical surplus of health workers in Africa: The need for research and policy engagement

Hutchinson,

Kiwanuka,

Muhindo

et al. 2024

Health Planning & Management

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In many countries in Africa, there is a ‘paradoxical surplus’ of under and unemployed nurses, midwives, doctors and pharmacists which exists amidst a shortage of staff within the formal health system. By 2030, the World Health Organisation Africa Region may find itself with a shortage of 6.1 million health workers alongside 700,000 un‐ or underemployed health staff. The emphasis in policy debates about human resources for health at most national and global levels is on staff shortage and the need to train more health workers. In contrast, these ‘surplus’ health workers are both understudied and underacknowledged. Little time is given over to understand the economic, political and social factors that have driven their emergence; the ways in which they seek to make a living; the governance challenges that they raise; nor potential interventions that could be implemented to improve employment rates and leverage their expertise. This short communication reflects on current research findings and calls for improved quantitative and qualitative research to support policy engagement at national, regional and global levels.

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Life in the buffer zone: Social relations and surplus health workers in Uganda's medicines retail sector

Cited by 6 publications

References 35 publications

Beyond political will: unpacking the drivers of (non) health reforms in sub-Saharan Africa

Beyond political will: unpacking the drivers of (non) health reforms in sub-Saharan Africa

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

The paradoxical surplus of health workers in Africa: The need for research and policy engagement

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