The authors have declared no competing interests.
JCK developed research paper design and was the primary author. EP developed the research concept, completed field work for case studies, and took part in critical revision. M. Markus developed the research concept, completed field work for case studies and took part in critical revision. NO took part in analysis and interpretation of field research and helped draft the manuscript. M. Murru completed field work for case studies and took part in critical revision. PH completed field work for case studies and took part in critical revision. All authors read and approved the final manuscript.
This research assesses informal markets that dominate pharmaceutical systems in severely disrupted countries and identifies areas for further investigation. Findings are based on recent academic papers, policy and grey literature, and field studies in Somalia, Afghanistan, the Democratic Republic of Congo and Haiti. The public sector in the studied countries is characterized in part by weak Ministries of Health and low donor coordination. Informal markets, where medicines are regularly sold in market stalls and unregulated pharmacies, often accompanied by unqualified medical advice, have proliferated. Counterfeit and sub-standard medicines trade networks have also developed. To help increase medicine availability for citizens, informal markets should be integrated into existing access to medicines initiatives.