Study reveals the causes and consequences of informal sale of medicines in Maputo

The sale of medicines in informal markets poses a serious risk to public health. However, these markets are the first point of contact for healthcare for a large part of the population.

The lack of medication in the health units, the time spent waiting in lines at pharmacies and the unavailability to go to an appointment, were the main reasons given for the purchase of drugs in the informal market.

Access to safe and affordable medicines is a key aspect for people to enjoy the best possible health status. However, WHO data estimate that in the world more than 50% of medicines are prescribed, dispensed or sold inappropriately, half of all patients who access medicines take them incorrectly, and one third of the world population does not have access to essential medicines (WHO 2002). The lack of availability of medicines in developing countries, including Mozambique, is caused by different factors such as weakness in the logistics supply chain, deficient infrastructure network and insufficient human resources, in addition to deficient financing from the health sector. All of this contributes to fueling corruption and the parallel business around medicines. Studies carried out in Mozambique (CIP, Newsletter 15, 2012) estimate that around 40% of medicines are diverted. According to the results of the inspections carried out at the Drug Deposits and Health Units, between 2011 and 2014 the State lost more than 87.267.420 MZN (MISAU, 2016).

The sale of medicines in informal markets poses a serious risk to public health. To better understand its causes and consequences, medicusmundi conducted a study in the city of Maputo, with the support of the Municipality of Barcelona. The research was carried out using surveys in informal markets (sellers and consumers) and semi-structured interviews with health professionals (managers, clinicians and pharmacists), local authorities and other key players in the sector.

The lack of medicines in health units, the time spent in long waiting lines at pharmacies and the lack of time for consumers to go to an appointment, were the main reasons given to justify the purchase of medicines in the informal market, where there is no shortage of product. The fact that the medicine is marketed by unit (separate), the shame in some cases of going to the health unit and some situations of extreme urgency in purchasing the medicines were other reasons cited by the respondents.

The study also revealed that the most sought-after drugs in the informal market are analgesics (49.2%), antibiotics (20.4%) and cough syrups (18.3%). Also noteworthy are the deworming, antihypertensive, antidiabetic, antihistamine, antimalarial, antiretroviral and tuberculostatic drugs.

Evidence shows that informal drug sellers are often the first point of contact for healthcare for a large part of the population (Lowe & Montagu, 2009). In fact, approximately 54% of consumers interviewed by medicusmundi admitted to having purchased the drugs without any prescription. However, the study also reports that 82.1% of salespeople (mostly men) do not have any training in the field of pharmacy. It is known that the inappropriate and irrational use of medications has serious consequences such as adverse reactions, resistance, or even death.

According to the same study, the main suppliers of the informal sector are health personnel, public and private pharmacies and importers of medicines. The vendors surveyed by medicusmundi also report that about 42.9% of the medicines sold in these markets come from South Africa and 25% of them come from the National Health System.

Street vending represents the most commonly used form of informal drug sales. The sellers are transported with a folder on their backs where the medicines are stored and, in some cases, they are requested by means of a telephone call. Most of them do not have a fixed place for the sale of medicines, which makes it difficult for market inspectors to control them. There are no good conditions for conservation and storage, and the handling of medicines is done without respecting the rules. As an activity that benefits both (buyer and seller), there is not often a complaint from buyers.

The study also made it possible to know the profile of the buyer, realizing that more women than men buy drugs in the informal market and that, contrary to expectations, people with a higher level of education (namely secondary) represent a great deal slice of consumers. The relationship between low financial resources (monthly income below 5000 MZN) and the purchase of medicines in informal markets was also notorious, although many of them are for sale at 5 MZN in public pharmacies. It is believed that these people have less time to go to the health unit to purchase the drugs, subjecting them to the purchase in the informal markets.

The report with the complete results of this research is available for consultation here.

Published on 24/08/2020