Formal and informal medicine retailers in Sub-Saharan Africa: a scoping review of research trends.

Abstract

In Sub-Saharan Africa (SSA), private medicine retailers have become the first entry point to health systems, irrespective of their level of accreditation. This review aims to map the main trends in research about formal and informal medicine retailers in SSA over the past 20 years. Such an overview offers a valuable resource to understand their role and develop inclusive interventions to improve accessibility to health care in line with people's health-seeking behaviours. This review followed the steps recommended by the Joanna Briggs Institute. Four electronic databases were searched and complemented by manual web researches. A total of 293 publications from 23 countries met our inclusion criteria, 79% of which relate to six countries. The number of publications has been growing since 2010. Medicine retailers are distributed among three professional groups based on their accreditation level. Most studies used quantitative methods. Three topics - service provision; knowledge, attitudes and practices; and the expanding role of medicine retailers in the health system - accounted for 67% of included studies. Most studies focus on a specific health condition, of which malaria (26%) and sexual/reproductive health (13%) are the most common. This review reveals increasing interest in medicine retailers in SSA and increasing expectations as stakeholders within health systems. This review suggests that new research and interventions should focus on: moving beyond a disease-based approach; using qualitative methods; and understudied countries, rural areas and informal medicine retailers. A more dynamic, relational and interactive approach could help better understand the sector.