Framing the challenge of poor-quality medicines: problem definition and policy making in Cambodia, Laos, and Thailand

Abstract

Falsified and substandard medicines (poor-quality medicines) represent a pressing global health threat that necessitates a stronger policy response. They pose a considerable threat to human lives and an obstacle to infectious disease control, also due to the associated risk of antimicrobial resistance. Policy efforts against poor-quality medicines include strengthening national drug regulation systems and countering the illicit trade in falsified medicines. Current global policy endeavours to improve access quality medicines however form an array of initiatives rather than a coordinated global response. Since the 1990s, academics and policy actors recognise that the circulation of poor-quality medicines represents a pressing global public health concern. This has generated widespread debate in the literature on the drivers and determinants of this policy issue. While past studies highlight widespread disagreement on definitions of the problem of poor-quality medicines, the existing body of literature pays little attention to the way that the problem is understood among policy actors across national and institutional settings. This thesis seeks to explore varying interpretations of this problem among policy actors in three low and middle-income countries. It explores the role of ideas in policy processes by evaluating the variations in perceptions of the problem and the policy developments against poor-quality medicines. The problem of poor-quality antimalarial medicines in the Greater Mekong Subregion (GMS) offers an interesting case study. Despite notable national policy efforts against poor-quality antimalarial medicines in the GMS, evidence suggests that the problem of poor-quality antimalarials persists. As trade liberalization in the region intensifies, there are concerns that reduced custom controls and higher mobility of people and goods may cause further increase in this illicit trade. Through framing analysis, I analyse variations in perceptions of this threat across institutional and national settings. A social constructivist approach to policy analysis guides the analysis of interpretations of this problem and how these interpretations influence policy developments. This study then compares similarities and differences in framings of the problem and in policy processes across countries. I reflect on the dominant frames across the three case countries (the security, health systems and regulatory frames) and on the potential for policy coordination against poor-quality essential medicines in Southeast-Asia. To operationalize this approach, this study relies on three methods of data collection, namely; a stakeholder map, a document analysis and semi-structured interviews with key policy actors.