How does the medicines retail sector ensure continued access to medicines during public health emergencies? Lessons from the COVID-19 pandemic in Uganda.

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The medicines retail sector (MRS) enables access to life-saving health commodities. Despite efforts to harness this market for public health goals, in low- and middle-income countries it is rarely incorporated into pandemic preparedness. This paper analyses the role of the MRS in the response to COVID-19 in Uganda, the extent to which it was incorporated into national planning and in the continuity of essential services. We conducted a cross-sectional study using sequential mixed methods in two purposively sampled rural districts in central Uganda. Qualitative research comprised 27 focus group discussions with drug shop vendors (DSVs), pharmacists, clinic staff and community members across two districts (n = 250); key informant interviews at national (n = 6) and district (n = 11) levels. Qualitative findings were used to modify a facility-based survey conducted in MRS outlets (n = 625). A household survey focusing on household dynamics and treatment seeking during COVID-19 was conducted in both districts (n = 1680). At the national level, attempts were made to involve the MRS in policy and technical advice but this was not sustained. At the district level, almost no effort was made to include the MRS in the response to COVID-19. In the community, residents described their reliance on the MRS to provide medicines, especially during lockdowns. Medicine sellers subject to stringent rules on their movement during lockdown, reported some disruptions in tracer medicine stocks and an increase in prices at their suppliers. They adapted, finding new ways to purchase medicines but overall sales of medicines fell. The MRS is critical to the distribution of medicines in many countries. This remains the case or can be heightened during health crises. Pandemic preparedness must incorporate strategies to support medicine sellers to ensure ongoing access to commodities during public health emergencies.