Private Retail Research Articles

Current Legal Management in Drug Retail by Private Retailers in Vietnam

Aim: This article aims to analyze the current state of private drug retailers in Vietnam's lower-middle-income context, investigating the causes and consequences of inadequacies in drug retail practices. The study intends to offer effective solutions to address these issues and serve as a reference for other lower-middle-income countries facing similar challenges. Method: Employing data gathered from documentation, legal analysis, and comparative methods, this study examines the state of drug retail by private retailers in Vietnam. By analyzing the existing practices and regulations, the study identifies the factors contributing to the inadequacies in the drug retail sector. Implications: The research reveals substantial inadequacies in the drug retail sector in Vietnam, stemming from a lack of robust regulations, inadequate oversight, and other systemic issues. These inadequacies have significant adverse effects on consumer health and the overall economy, hindering sustainable development efforts. Addressing the inadequacies in drug retail in lower-middle-income countries like Vietnam requires comprehensive regulatory reforms, improved oversight mechanisms, and enhanced collaboration between government agencies and private sector stakeholders. Results and conclusion: By rectifying these issues, countries can better protect the health and well-being of their citizens while fostering an environment conducive to sustainable development. This study's findings and recommendations offer valuable insights for other LMICs grappling with similar challenges in their drug retail systems.

Point-of-care testing in private pharmacy and drug retail settings: a narrative review

BackgroundPoint-of-care testing (POCT) using rapid diagnostic tests for infectious disease can potentially guide appropriate use of antimicrobials, reduce antimicrobial resistance, and economise use of healthcare resources. POCT implementation in private retail settings such as pharmacies and drug shops could lessen the burden on public healthcare. We performed a narrative review on studies of POCTs in low- and middle-income countries (LMICs), and explored uptake, impact on treatment, and feasibility of implementation.MethodsWe searched MEDLINE/PubMed for interventional studies on the implementation of POCT for infectious diseases performed by personnel in private retail settings. Data were extracted and analysed by two independent reviewers.ResultsOf the 848 studies retrieved, 23 were included in the review. Studies were on malaria (19/23), malaria and pneumonia (3/23) or respiratory tract infection (1/23). Nine randomised controlled studies, four controlled, non-randomised studies, five uncontrolled interventions, one interventional pre-post study, one cross-over interventional study and three retrospective analyses of RCTs were included. Study quality was poor. Overall, studies showed that POCT can be implemented successfully, leading to improvements in appropriate treatment as measured by outcomes like adherence to treatment guidelines. Despite some concerns by health workers, customers and shop providers were welcoming of POCT implementation in private retail settings. Main themes that arose from the review included the need for well-structured training with post-training certification covering guidelines for test-negative patients, integrated waste management, community sensitization and demand generation activities, financial remuneration and pricing schemes for providers, and formal linkage to healthcare and support.ConclusionOur review found evidence that POCT can be implemented successfully in private retail settings in LMICs, but comprehensive protocols are needed. High-quality randomised studies are needed to understand POCTs for infectious diseases other than malaria.

An absence of evidence breeds contempt: A qualitative study of health system stakeholder perceptions of the quality of medicines available in Senegal.

Poor-quality medicines pose a significant challenge for health systems in low- to middle-income countries (LMICs),with recent deaths in multiple countries following ingestion of substandard cough syrups emphasising the need for quality-assurance of medicines in our increasingly interconnected global markets. Research also suggests that the source (country of manufacture) and type of medicine (generic/brand) are perceived to be associated with medicine quality. This study explores perceptions of medicines quality among national stakeholders of a medicines quality assurance system (MQAS) in sub-Saharan Africa. Through semi-structured interviews (n = 29) with managers from organisations responsible for the MQAS, public-sector doctors and nurses, and regulated private-sector pharmacists in three urban centres in Senegal in 2013. A thematic approach to analysis was undertaken with themes organised under three main categories, the source of drugs, the type of medicine, and medicines storage. A key emerging theme was the perception of the inferior quality of generic medicines, especially those produced in Asia and Africa, as they were lower in cost and thus believed to be less effective in alleviating symptoms than their brand versions. Medicines in Senegal's less regulated (informal) street markets were also thought to be of poor-quality as they were not subjected to national regulatory processes or stored appropriately, resulting in exposure to direct sunlight and high temperatures. In contrast, the interviewees expressed confidence in medicines quality within the regulated sectors (public and private retail pharmacies) attributed to stringent national medicines regulation, secure medicines supply chains and adequate technical capacity to survey and analyse for medicines quality. Also, the views expressed typically described a medicine's quality in terms of its effectiveness in alleviating the symptoms of ill health (efficacy of a medicine).These perceptions may have implications for developing national medicines policy, the procurement and supply of affordable medicines and consumers' decision-making when purchasing medicines. Indeed, a proclivity for supplying and purchasing more expensive brand medicines may act as a barrier to accessing essential medicines.

The Developing Factors of Purchase Intentions: The Emerging Trend of Private to Mega Store Environment in Pakistan

This research study is highlighting the shifting trend of purchasing from private retail shops to mega/big box stores. Currently, many developing economies like Pakistan are witnessing a growing trend of the shift in shopping options, and moving on mega/big box stores is one of them. This research identifies some underlying factors of big box stores which affect purchase intentions. In this study store environment is considered as an independent variable whereas purchase intention is taken as the dependent variable. Customer satisfaction and behavioral loyalty are considered mediators and the effect of price (factor) has been checked as a moderator. The philosophy of positivism is followed for this research. The research design is explanatory in nature. Data is collected through structured questionnaires from the customers of FMCG and daily routine products. The sample size is 174 and both (male and female customers were considered). Non- Probability convenience sampling technique is used. For data analysis, SMART PLS 3 software and structural equation modeling are used. The results of this research suggested that the store environment has a significant impact on purchase intention. Similarly, the store environment significantly develops purchase intention with the mediation of customer satisfaction as well. Store environment has a positive impact on behavioral loyalty, whereas behavioral loyalty does not significantly impact purchase intentions. Prices have a significant impact as moderators on store environment and customer satisfaction.

Assessing Quality of Self Medication Services in Pharmacies in Indonesia: A Pilot Study using Mystery Customer in Bandung, West Java, Indonesia.

Self-medication practice is currently increasing in global population. Apart from the benefits, it is undeniable that self-medication can also have several negative impacts. The outcome of self-medication is affected by pharmacist’s clinical ability to provide self-medication services to the patient. This study was aimed to assess the quality of self-medication services in Indonesia using mystery customer approach. A pilot project had been conducted in Bandung, West Java, Indonesia. Mystery customers act as patients who come to the pharmacy seeking self-medication medications for cough/common cold, diarrhea/constipation, pain/fever, and gastritis cases. A total 232 pharmacies were involved in this study and selected through stratified random sampling. The quality of self-medication services was measured by four subdomains: patient assessment, the accuracy of drug selection, the drug information provided to mystery customer, and lifestyle modification counselling. Result showed that patient assessment regarding signs and symptoms only performed by 42,82% pharmacies in Bandung, 14,44% assessed pharmacological and nonpharmacological therapy prior to visit, and only 10,56% assessed patients’ specific medical condition. Although the percentage of patient assessment performed by pharmacies in Bandung were low, interestingly the accuracy of drug selection is relatively high (85,34%). The most prevalent information provided to patient was instruction to consume the medication (59,09%), meanwhile the least delivered information was about side effect (5,17%). Information about lifestyle modification only delivered by 10,34% pharmacies. The quality of self-medication services in Bandung varies depending on the type of pharmacy and service provider. State-owned pharmacy has a higher overall score of self-medication service than private retail pharmacy and private standalone pharmacy (p<0,05). Based on the service provider, pharmacist have a higher score of self-medication service compared to pharmacy technicians and other personnel in pharmacies (p<0,05). This study emphasizes the importance of the pharmacist’s role in self-medication services to ensure rational and safe treatment for patients.

Access to legal cannabis market in Canada over the four years following non-medical cannabis legalisation.

An increasing number of countries are inthe process of legalising non-medical cannabis. We described how the legal market has changed over the first 4 years following legalisation in Canada. We collected longitudinal data on operating status and location of all legal cannabis stores in Canada for the first 4 years following legalisation. We examined per capita stores and sales, store closures, and the drive time between stores and each neighbourhood in Canada. We compared measures between public and private retail systems. Four years after legalisation, there were 3305 cannabis stores open in Canada (10.6 stores per 100,000 individuals aged 15+ years). Canadians spent $11.85CAD a month on cannabis per individual aged 15+ years, and 59% of neighbourhoods were within a 5-minute drive of a cannabis store. Over 4 years, per capita stores and per capita sales increased each year by an average of 122.3% and 91.7%, respectively, with larger increases in private versus public systems (4.01 times greater for per capita stores and 2.46 times greater for per capita sales). The annual increase in per capita stores and sales during the first 3 years was 6.0 and 15.5 times greater, respectively, than the increase in the fourth year following legalisation. Over 4 years, 7% of retail store locations permanently closed. The legal cannabis market in Canada expanded enormously over the first 4 years following legalisation, with considerable variation in access between jurisdictions. The rapid retail expansion has implications for evaluation of health impacts of non-medical legalisation.

Assessment of medicines cold chain storage conformity with the requirements of the World Health Organization in health facilities of the Eastern Province of Rwanda

BackgroundDespite the prominent evidence of cold chain monitoring in the health system to reduce wastage and maintain product potency, there are still inefficiencies in the storage and transportation of cold chain products. This study assessed medicine cold chain storage conformity in health facilities in the Eastern Province of Rwanda.MethodsA cross-sectional and prospective with quantitative and qualitative approaches study was approved, and 44 health facilities (public, faith-based and private) were selected using both convenience, stratified, and purposive sampling techniques. Temperature data loggers were mounted in refrigerators to measure the Mean Kinetic Temperature (MKT).ResultsThe overall performance of cold chain storage conformity of refrigerators assessed was 54 (73.0%). The conformity found in refrigerators of pharmacy stock in public health facilities was 22 (56.0%), in vaccination program was 25 (100.0%), and in private retail pharmacies was 7 (70.0%). The MKT measured fit the required cold chain storage at this rate. Most refrigerators used in pharmacy stock (27.0%) were aged between 8 and 10 years, while those used in vaccination programs were less than 4 years. Regular calibration of refrigerator and temperature monitoring device (TMD) was 39.0% and 24.0%, respectively. Most respondents, 44 (80.0%), knew the proper cold chain storage. However, few identified the impact of storing cold chain products with vaccines at 16 (29.1%). The transportation of cold chain products from two central medical stores assessed showed inefficiencies as only one of them uses temperature data loggers during transportations of the products mentioned above.ConclusionsThe medicines cold chain storage conformity investigated in seven districts of the Eastern Province in Rwanda was better than reported previously in other LMICs. However, cold chain storage for pharmacy stock often did not meet the requirements. The observed drawback represented a serious risk to public health. Calibrating cold chain equipment, regular maintenance, and commissioning new cold chain equipment should be done to improve cold chain storage.

PS-P07-6: ACCESS TO ESSENTIAL MEDICINES AND DIAGNOSTIC TESTS FOR HYPERTENSION AND HEART FAILURE IN MAPUTO CITY, MOZAMBIQUE

Objective: To evaluate access (availability, price, affordability) to essential medicines (EMs) and diagnostic tests and technologies for management of hypertension and heart failure (HF) in Maputo City, Mozambique. Design and method: In a cross sectional survey, using a modified version of World Health Organization (WHO)/Health Action International methodology, data from a representative sample comprising 6 public and 6 private sector hospitals and 30 private sector retail pharmacies was collected. Upon reviewing WHO Model EM List (EML), Priority Medicines for Children and Women list, Mozambique National EML and guidelines, 50 EMs, including 14 WHO Core and 36 cardiovascular diseases (CVD) EMs were selected. Of those, data for 19 EMs (including different formulations and dosages) for management of hypertension and HF are presented here. Data on 19 diagnostic tests and 17 devices was collected from hospitals. Availability was calculated as percentage of surveyed facilities where a medicine or diagnostic tool was found on the day of survey. Median price ratio (MPR) refers to median consumer price of a medicine compared to respective international reference price (IRP). Medicines were considered unaffordable if to purchase a monthly supply, the lowest paid government worker had to spend more than one day wage. Results: Mean availability of anti hypertensive and HF medicines combined was far below WHO target (80%), both in private (retail: 35.0%, hospital pharmacies: 30.6%) and public sectors (hospital pharmacies: 27.8%). Only two surveyed medicines were available in over 80% of public-sector hospital pharmacies. Most (11/19) medicines were available in less than 50% of retail pharmacies. Median MPR (range) of medicines was high [Lowest Priced Generic (LPG): 3.2 (0.98;19.84); Most Sold Generic (MSG): 4.8 (1.67;19.98)] compared to WHO recommendation (no one should pay greater than 4 times the IRP). LPG versions above that recommendation included amlodipine, enalapril, spironolactone. The lowest paid worker, on average, would spend more than one day wage to purchase a monthly supply of most EMs. Mean availability of CVD diagnostic tests and devices was lower in public (54.6% and 61.1%, respectively) compared to private (89.5% and 91.7%, respectively) sector. Conclusion: Access to EMs for management of hypertension and HF is very limited in Maputo City, characterized by high prices, low availability and affordability. Access to CVD diagnostic tests and devices is particularly low in public-sector. These data raise important concerns and may guide policies and interventions for improving access to cardiovascular care and serve as benchmark for future comparations.

Linking the Community Health Fund with Accredited Drug Dispensing Outlets in Tanzania: exploring potentials, pitfalls, and modalities

BackgroundIn low- and middle-income countries, too, public–private partnerships in health insurance schemes are crucial for improving access to health services. Problems in the public supply chain of medicines often lead to medicine stock-outs which then negatively influence enrolment in and satisfaction with health insurance schemes. To address this challenge, the government of Tanzania embarked on a redesign of the Community Health Fund (CHF) and established a Prime Vendor System (Jazia PVS). Informal and rural population groups, however, rely heavily on another public–private partnership, the Accredited Drug Dispensing Outlets (ADDOs). This study takes up this public demand and explores the potentials, pitfalls, and modalities for linking the improved CHF (iCHF) with ADDOs.MethodsThis was a qualitative exploratory study employing different methods of data collection: in-depth interviews, focus group discussions, and document reviews.ResultsStudy participants saw a great potential for linking ADDOs with iCHF, following continuous community complaints about medicine stock-out challenges at public health facilities, a situation that also affects the healthcare staff’s working environment. The Jazia PVS was said to have improved the situation of medicine availability at public health facilities, although not fully measuring up to the challenge. Study participants thought linking ADDOs with the iCHF would not only improve access to medicine but also increase member enrolment in the scheme. The main pitfalls that may threaten this linkage include the high price of medicines at ADDOs that cannot be accommodated within the iCHF payment model and inadequate digital skills relevant for communication between iCHF and ADDOs. Participants recommended linking ADDOs with the iCHF by piloting the connection with a few ADDOs meeting the selected criteria, while applying similar modalities for linking private retail outlets with the National Health Insurance Fund (NHIF).ConclusionsAs the government of Tanzania is moving toward the Single National Health Insurance Fund, there is a great opportunity to link the iCHF with ADDOs, building on established connections between the NHIF and ADDOs and the lessons learnt from the Jazia PVS. This study provides insights into the relevance of expanding public–private partnership in health insurance schemes in low- and middle-income countries.

Supply Chain Assessment of Maternal, Newborn and Child Health Commodities in Ghana’s Private Sector Facilities, Wholesalers, and Retail Pharmacies

Background: The private sector in Ghana provides 50% of health services in the country yet there is limited information on the supply chain management of MNCH commodities in this sector. Aim: To understand how MNCH commodities are managed within the private sector. Method: A mixed methods approach was used to capture supply chain related data on a subset of MNCH commodities in the private sector. The sampling strategy included the selection of four regions (Ashanti, Greater Accra, Northern, and Upper East) in Ghana. Quantitative data on product management, availability, source, pricing and registration were collected from retail pharmacies, private health facilities and wholesalers. Additionally qualitative data on factors influencing supply decisions were collected from wholesalers. Results: The study showed that retail pharmacies and wholesalers were less likely to manage injectable products like gentamicin, magnesium sulphate and oxytocin as compared to private health facilities. At all three facility types, amoxicillin DT, chlorhexidine gel and ORS + zinc co-pack were the least managed products. The main reason for non-management of MNCH products was “low or no client demand”. Majority of MNCH products had at least half of the most prevalent brands registered. Regarding product pricing, the results showed lower NHIS prices for certain products compared to selling prices at retail pharmacies and health facilities. Ninety percent of all three facility types met at least half of the storage requirements; with 100% of wholesalers and 96% of health facilities storing oxytocin in a working refrigerator. However, 25% of retail pharmacies did not store oxytocin within the recommended temperature range of 2-8 degrees. Conclusion: The private sector is influenced by commercial factors, which could come at a high cost in terms of availability, accessibility, and affordability for individuals and families. There is the need to create a cost incentive that encourages the private sector to offer and improve access to critical MNCH commodities, including amoxicillin DT, ORS + zinc co-pack, chlorhexidine gel and injectable MNCH products. Keywords: Private sector, MNCH, Supply Chain, Wholesale pharmacies, Retail pharmacies

Behavior of Private Retailers in a Regulated Input Market: An Empirical Analysis of the Fertilizer Subsidy Policy in Nepal

The private sector in Nepal participates in the regulated import and distribution of three types of subsidized fertilizer. However, almost 55% of the agrovets (family-owned microenterprises) that retail agricultural inputs do not comply. Many farmers rely on the fertilizer purchased through these agrovets, including subsidized ones. There is no private sector importer of the three types of fertilizer covered by the subsidy program, which indicates that the agrovets either acquire these through leakage in the government distribution system or through illegal cross-border trade from India, both of which are considered legal noncompliance. We discern the determinants for this noncompliant behavior of agrovets using logistic regression. The results from logistic regression suggest that the agrovets that are more likely to comply are registered, have membership in business associations, and have a higher number of competitors. Those with diversified business portfolios and covering a greater number of districts are less likely to comply. Key informants, consisting of both public and private sector stakeholders, were solicited for their views on solving this noncompliant behavior. The private sector unanimously asserts the need for deregulation of fertilizer imports and the participation of agrovets in the distribution of the subsidized fertilizer. In contrast, the public sector is skeptical of the ability and trustworthiness of the private sector in the import and distribution of quality fertilizer. We propose a middle ground to mitigate private sector noncompliance and suggest a policy revisit to increase the fertilizer supply and distribution efficiency.

Private Labels Strategy, Retail Profitability and Bargaining Power in the Fluid Milk Market

Abstract This paper studies the competition between private labels and the role of private labels in determining the bargaining outcomes between retailers and manufacturers as well as retailer profitability in the fluid milk market. We differentiate private labels from different retailers and develop a structural model of demand and a Nash-in-Nash vertical bargaining model of supply. Using 2004–2011 Nielsen Homescan data at monthly-county level, we estimated the average bargaining power of retailers and how various factors influence their bargaining power with a random-coefficient discrete choice model of demand. With the full bargaining model specification, this paper then conducts simulations to isolate the role of private label in bargaining and retailer profitability, comparing the effectiveness of alternative private label strategies. Results indicate private label milk from different retailers are close competitors and retailers have more bargaining power than manufacturers. Further, factors such as the manufacturer size, private label share, and their private label position can significantly affect retailers’ bargaining power. Moreover, the counterfactual analysis shows that lowering private label prices and other private label strategies such as private label program expansion and retailer advertising could not only increase their profitability but also allow retailers to benefit from the bargaining with manufacturers.

Experiences of and response to the COVID-19 pandemic at private retail pharmacies in Kenya: a mixed-methods study

ObjectivesTo assess experiences of and response to the COVID-19 pandemic at community pharmacies in Kenya.Design, setting and participantsThis was a mixed-methods study conducted from November 2020 to April 2021, targeting...

Investigation of the Quality of the 12 Most-Used Antibiotics Available in Retail Private Pharmacies in Rwanda.

Using poor-quality antibiotics leads to increased risk of the development of microorganism-resistant strains, treatment failure, loss of confidence in health systems, and associated socio-economic impacts. The prevalence of poor-quality antibiotics has been found to be high in some of the Low and Middle-Income Countries (LMICs), but no data were available on the situation in Rwanda. This study was conducted to obtain data and inform health professionals on the quality of the 12 most-used selected antibiotics from private retail pharmacies in Rwanda. The investigation was conducted on 232 batches collected from randomly selected private retail pharmacies in all provinces of Rwanda, and concerned only with visual inspection and assay tests. Visual inspection was performed using a tool adopted by the International Pharmaceutical Federation (FIP) to identify manufacturing defects. An assay test quantified the Active Pharmaceutical Ingredient (API) in each collected batch using high-performance liquid chromatography (HPLC) coupled with an ultraviolet-visible (UV) detector, and the results were reported as the percentage content of the amount of APIs stated on the label. A total of 232 batches were analyzed, manufactured in 10 countries; the main country of manufacture was Kenya, with almost half of the batches (49.6%). The results of the visual inspection did not show the presence of counterfeit/ falsified antibiotics on the Rwandan market in this study but revealed weaknesses in labeling: more than 90% of the analyzed batches of the 12 antibiotics did not present the dosage statement on their label, and the complete list of excipients was missing in more than 20% of the analyzed batches. The assay test using HPLC confirmed the presence of APIs in 100% of the analyzed batches. However, moderate deviations from acceptable ranges of the API content defined by M. M. Nasr & C. M. Stanley in 2006 for erythromycin and the United States Pharmacopoeia 2018 for the other 11 molecules were found. The failure rate to meet the quality requirements in terms of the percentage content of active pharmaceutical ingredients declared on the labels was estimated at 8.2% in total, with 3.9% and 4.3% containing more and less than the amount of APIs stated on the labels respectively. The most-represented antibiotics on the Rwandan market were amoxicillin, co-trimoxazole and cloxacillin. No counterfeit antibiotics were found in this study. However, substandard batches with moderate deviations were found, suggesting that regular quality control of antibiotics is needed in Rwanda.

Municipal regulation of cannabis and public health in Canada: A comparison of Alberta, Ontario, and Québec.

Canada legalized nonmedical cannabis in October 2018, but significant variations in municipal regulations exist. This study explored the variations that exist and pondered their potential public health consequences. A comparative analysis was completed on the regulations and guidelines that addressed retailers' location and public consumption in the municipalities of Alberta, Ontario, and Québec. Municipal regulations that addressed the location of retailers were more numerous and extensive in Alberta and Ontario (in the context of provincial private retail models) than in Québec (government-based model). Municipalities in Alberta added more restrictions to public consumption laws as compared to municipalities in Ontario and in Québec. These additions were made to Alberta's and Ontario's provincial-level smoking and vaping bans which used tobacco-inspired frameworks, and to Québec's ban on smoking and vaping in all public spaces. The comparative analysis showed the importance of considering municipal cannabis regulations when studying the impact of legalization, given the significant variations that exist. Policy makers should be made aware of these variations in the regulation of cannabis in order to limit health harms and further social inequalities.

Compliance of Private Pharmacy Retail Outlets to Narcotic Drug Regulations in Ethiopia: A Cross-Sectional and Simulated Client Study Method.

Background:Inappropriate use of narcotic drugs is a growing worldwide health challenge. The problem is even worse in Sub-Saharan Africa where organized supply chain regulations on dispensing and stock management are poor for controlling these global challenges.Methods:A mixed method, descriptive cross-sectional and simulated client study design was used from September 10, 2020 to November 26, 2020 to assess the extent of utilization and compliance of narcotic drug dispensing in private pharmacy retail outlets of Gondar and Bahir Dar town of Amhara region, Ethiopia. A total of 107 private pharmacy outlets were on duty. But in simulated study, purposive sampling is a method that prioritizes study units having the data of interest.Results:A total of 107 private pharmacy retails outlets were included in the survey. The average compliance to the controlled prescription regulation of Ethiopia in all pharmacy outlets (107) of the five drugs were calculated and found to be poor, 23.9% (SD = 18.3%). Compliance to strong narcotics is extremely low, 3.3 % for pethidine and 8% for morphine. Religion of the professionals has significant association with compliance to the prescription of narcotic drugs (p < .001).Discussion:In the era of narcotic epidemics, as a result of growing global inappropriate use of controlled drugs, the finding of this study gives an insight for a serious and strict regulation in managing and controlling the overall distribution of the narcotic drugs.Conclusions:The compliance of the private retail pharmacies of Ethiopia to the regulation of controlled drugs is low.

Understanding dynamics of private tuberculosis pharmacy market: a qualitative inquiry from a South Indian district

ObjectivesIn India, retail private pharmacists (RPPs) are often patients’ first point of contact for diseases, including tuberculosis (TB). We assessed the factors influencing RPPs’ referral of patients with chest symptoms...

Incorporating craft: An experiment in community ownership in postliberalization India

This article traces the efforts of India's largest private retailer of craft—Fabindia—to realize its vision of “inclusive capitalism” by creating a network of “community‐owned companies” in which artisan‐suppliers own shares. The contradictions and tensions inherent to this corporate project offer a critical vantage from which to examine processes of economic and political change both in India and globally. This ethnography reveals how the proposal to replace the traditional middleperson with a corporate body introduced new complications and conflicting interests throughout the supply chain. The competing efforts to determine the terms and nature of the relationships between supplier‐shareholders, the community‐owned companies, and Fabindia illuminate the on‐the‐ground negotiation of corporate social responsibility.

\u201cBurnt by the scorching sun\u201d: climate-induced livelihood transformations, reproductive health, and fertility trajectories in drought-affected communities of Zambia

BackgroundClimate-induced disruptions like drought can destabilize household and community livelihoods, particularly in low- and middle-income countries. This qualitative study explores the impact of severe and prolonged droughts on gendered livelihood transitions, women’s social and financial wellbeing, and sexual and reproductive health (SRH) outcomes in two Zambian provinces.MethodsIn September 2020, in-depth interviews (n = 20) and focus group discussions (n = 16) with 165 adult women and men in five drought-affected districts, as well as key informant interviews (n = 16) with civic leaders and healthcare providers, were conducted. A team-based thematic analysis approach, guided by the Framework Method, was used to code transcript text segments, facilitating identification and interpretation of salient thematic patterns.ResultsAcross districts, participants emphasized the toll drought had taken on their livelihoods and communities, leaving farming households with reduced income and food, with many turning to alternative income sources. Female-headed households were perceived as particularly vulnerable to drought, as women’s breadwinning and caregiving responsibilities increased, especially in households where women’s partners out-migrated in search of employment prospects. As household incomes declined, women and girls’ vulnerabilities increased: young children increasingly entered the workforce, and young girls were married when families could not afford school fees and struggled to support them financially. With less income due to drought, many participants could not afford travel to health facilities or would resort to purchasing health commodities, including family planning, from private retail pharmacies when unavailable from government facilities. Most participants described changes in fertility intentions motivated by drought: women, in particular, expressed desires for smaller families, fearing drought would constrain their capacity to support larger families. While participants cited some ongoing activities in their communities to support climate change adaptation, most acknowledged current interventions were insufficient.ConclusionsDrought highlighted persistent and unaddressed vulnerabilities in women, increasing demand for health services while shrinking household resources to access those services. Policy solutions are proposed to mitigate drought-induced challenges meaningfully and sustainably, and foster climate resilience.

Using the 3I+E Framework to assess provincial policy decisions for the sale of cannabis in Ontario, Saskatchewan and Quebec

Objective: This paper examines policy decisions regarding public or private retail models chosen for the recreational use of cannabis in the provinces of Ontario, Saskatchewan and Quebec to demonstrate the application of the 3I+E framework for policy analysis.&#x0D; Methods: The 3I+E framework includes considerations of institutions, interests, ideas and external factors that play a role in adopting a particular policy. A retrospective comparative approach using this framework was conducted. Relevant newspaper articles, press releases, consultation reports and primary policy papers were reviewed.&#x0D; Results: Ontario employed a mixed model for the sale of cannabis while Saskatchewan chose to fully privatize cannabis retail within the province and Quebec decided to sell through the public sector. Government institutions, particularly the party in power and the number of seats they hold, as well as existing policy legacies for alcohol retail, appeared to have a strong ability to influence policy decisions in all three jurisdictions. Interest groups, including municipal and labor unions and private cannabis companies had a limited role in swaying government decisions toward a particular model. Beliefs and values of citizens regarding cannabis retail did not appear to play a large role. In Ontario particularly, an external factor, namely a major political shift towards a conservative government had a large role in the mixed model chosen in the jurisdiction.&#x0D; Conclusion: Overall, the policy decision for cannabis retail is multifactorial and the interaction between stakeholders and interest groups with the government influences which model was ultimately chosen in each jurisdiction.