Is it possible for drug shops to abide by the formal rules? The structural determinants of community medicine sales in Uganda.
Is it possible for drug shops to abide by the formal rules? The structural determinants of community medicine sales in Uganda.
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DOI：
10.1136/bmjgh-2022-011097
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发表时间：
2023-02
影响因子：
8.1
通讯作者：
Kitutu, Freddy Eric
中科院分区：
文献类型：
--
作者：
Hutchinson, Eleanor;Hansen, Kristian Schultz;Sanyu, Jacquellyn;Amonya, Lydia Peace;Mundua, Sunday;Balabanova, Dina;Clarke, Sian E.;Kitutu, Freddy Eric
药品零售部门是非洲和亚洲许多卫生系统的基本要素，但它也以实践不善而闻名。在文献中，人们认识到，只有确定更有效的治理和监管形式，才能改善该部门。最近的辩论表明，针对塑造和支撑不良做法的结构性限制进行干预是一条有用的前进道路。本文提供了一项混合方法研究的数据，该研究旨在探索在乌干达一个地区的药店中形成违规行为的监管和专业、经济和社会制约因素。我们的研究结果表明，监管体系因频繁的非正式付款而受到破坏，尽管药店通常由合格的员工经营，但许多药店没有许可证，并在合法许可之外销售药品。大多数商店要么盈利，要么亏损，在高度饱和的市场中竞争时，依赖家人和朋友提供额外的资源。我们认为，在目前的背景下，药店小贩是在一个极难遵守政策、保持盈利并为社区提供服务的市场上经营的生存主义企业家。如果药店要成为个人能够谋生、遵守规则并方便生活在世界上一些最贫穷国家的人获得药品的地方，药品市场的结构性改革，包括清除不合格的卖家和调整政策，可能是先决条件。
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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影响因子：
8.1
作者：
Dasari M;David SD;Miller E;Puyana JC;Roy N
通讯作者：
Roy N
影响因子：
4.2
作者：
Frempong BK;Amalba A;Donkor N;Akuffo KO
通讯作者：
Akuffo KO
影响因子：
5.4
作者：
Hutchinson, Eleanor;Mundua, Sunday;Ochero, Lydia;Mbonye, Anthony;Clarke, Sian E.
通讯作者：
Clarke, Sian E.
影响因子：
4.2
作者：
Bagonza, Arthur;Peterson, Stefan;Kitutu, Freddy Eric
通讯作者：
Kitutu, Freddy Eric
影响因子：
5.5
作者：
Dillip, Angel;Embrey, Martha;Chalker, John
通讯作者：
Chalker, John