How unlicensed drug vendors in rural Uganda perceive their role in the management of childhood malaria

Abstract

BackgroundA large number of caregivers in Uganda rely on the private drug delivery sector to manage childhood illnesses such as malaria. In rural settings where the formal private sector is scarce, unlicensed retail drug outlets are an important initial source of care for households. Despite their abundance, little is known about them. This study explores unlicensed retail drug outlet vendors’ perceptions of their practice and social environment in one rural district of Uganda. Materials and methodsA qualitative design using semi-structured interviews was conducted with vendors from unlicensed retail drug outlets across all 10 sub-counties of Butaleja District. The study was conducted over a six-week period in 2011. Open-ended questions were used to gain insight into participants’ perspectives, and data were analyzed using acceptable qualitative research protocols. ResultsInterviews were carried out with 75 vendors by trained local research assistants. Most vendors operated out of drug shops, just over half were both owners and shop attendants, and only 14% had qualifications to apply for operating a licensed drug shop. Vendors’ experiences with managing malaria in children aged five and under in their community revealed five major themes, their perceptions of: 1) their role in the community, 2) their ability to manage uncomplicated malaria in young children, 3) the challenges of day-to-day operations, 4) the effect of regulatory policies on their ability to serve their communities, and 5) the prospect of future training programs. While the literature has raised concerns regarding the quality of care provided at such unlicensed outlets, most vendors in this study had a limited awareness of their deficiencies. ConclusionsThere was a general sentiment among vendors that the public health system within Butaleja was failing the community and their presence was filling an important vacuum. Given the dominance of unlicensed retail drug outlets over their formal (licensed) counterparts in many rural settings, further deliberations and research is critical to determine how best to fit in and create value from the unlicensed sector within the formal health system.