Can Systemic Corruption be Prevented by Legal Means? The Market for Pharmaceuticals in Southern Ethiopia

Abstract
Some international and national regulatory and policy actors assume that strengthening domestic laws and tightening enforcement measures will be sufficient to reduce the extra-legal supply of medicines, whether legal, substandard, or falsified, to patients in low- and middle-income countries. This paper uses a qualitative study of the pharmaceutical market in Southern Ethiopia to argue that this assumption is unjustified, given the common lack of institutional capacity and the complexity of supply chains by which medicines reach local markets. Data are drawn from interviews with pharmacists, wholesalers, pharmacy owners, regulators, law enforcement agents, and health professionals, supplemented by participant observation and review of relevant policy and legal documents. These data were analyzed through the frame of Actor-Network Theory, to trace the journey of medicines from producer to consumer. Officially endorsed regulatory and enforcement mechanisms are entangled in an intricate web of practices involving different actors responding to local demands. The extra-legal supply of medicine, particularly if substandard or falsified, is an important global public health concern, but it will only be reduced by measures that place law and regulation within the context of the social, economic, and cultural factors that shape local markets and undermine the integrity of legal supply chains.

PLAIN LANGUAGE SUMMARY
This research investigates whether the strengthening laws and increasing enforcement can effectively reduce corruption in the pharmaceutical market in Southern Ethiopia. Policy makers often assume that stricter legal measures will solve the problem of substandard and falsified medicines. However, this study shows that legal measures alone are not enough. Through interviews with pharmacists, regulators, pharmacy owners, law enforcement agents and consumers as well as observation and document reviews, this study found that corruption in the pharmaceutical sector is linked to weak regulatory systems, complex supply chains, social and economic pressures. The findings emphasize that, while enforcing stronger laws is important, addressing corruption in this sector requires a combination of legal reforms and practical strategies that consider the realities of local markets and health care needs. Comprehensive approach is important to strengthen governance, improve public trust and ensure access to safe and effective medicines.