Toward a Regulated Future: Assessing Management of Zimbabwe's Informal Pharmaceutical Market

The study investigated the drivers of Zimbabwe's informal pharmaceutical market, focusing on its sources, distribution, and public health impact in Harare's Central Business District. This market raises significant concerns about medicinal drug quality and safety, contributing to antimicrobial resistance and undermining legitimate pharmaceutical businesses. The study employed a sequential explanatory mixed-methods design, collecting data from 51 participants, including consumers, vendors, regulators, and distributors, through questionnaires. The findings indicate that unregistered vendors source medicinal drugs primarily from locals and international suppliers. The distribution occurs directly to consumers through sachets at transport hubs, from car boots and street corners. Despite the perception among sellers and customers that these medicinal drugs are benign unless abused, the study highlights an urgent need for intervention. The study recommended policy actions, including public awareness campaigns on the dangers of unregulated medicinal drugs, strengthening border screening, and the implementation of a national health insurance policy to improve health delivery and outcomes in Zimbabwe. The study suggested an Informal Pharmaceutical Market Elimination Framework to protect consumers from unregulated medicinal products and promote the formal pharmaceutical market. The framework is legitimacy-sensitive and synchronous digital hierarchy–driven, escalates punishment for corrupt actors, and targets all involved stakeholders.

Informal Pharmaceutical Market, Unregulated Medicinal Drugs, Social Determinants of Health (SDOH), Social Network Analysis (SNA), Balloon-Squeeze Concept

1. AHFOZ. (2021). Association of Healthcare Funders of Zimbabwe. Healthcare financing report. [Google Scholar] [Crossref]

2. Ayres, I., & Braithwaite, J. (1992). Responsive Regulation: Transcending the Deregulation Debate. Oxford: Oxford University Press. [Google Scholar] [Crossref]

3. Belachew, A. S., Hall, L., & Selvey, A. L. (2021). Antimicrob Resist Infect Control, 10(13), 1-15. doi:https://doi.org/10.1186/s13756-020-00880-w [Google Scholar] [Crossref]

4. Braveman, P., Egerter, S., & Williams, D. R. (2011). The social determinants of health: coming of age. Annu Rev Public Health, 32(1), 381–398. [Google Scholar] [Crossref]

5. CDC. (2024, January 17). Social Determinants of Health (SDOH). Retrieved from CDC: https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html [Google Scholar] [Crossref]

6. Chabalenge, B., Sahota, T., Ermolina, I., & Tanna, S. (2025). Substandard and falsified medicines in Africa: healthcare systems challenges, supply chain issues, regulatory challenges and strategies to increase access to quality medicines. Frontiers in Pharmacology, 1 - 18. doi:10.3389/fphar.2025.1708784 [Google Scholar] [Crossref]

7. Chibamu, A. (2021, June 16). Drug Companies’ Production Remains Low As Forex Shortages Bite. New Zimbabwe. Retrieved June 22, 2026, from https://www.newzimbabwe.com/drug-companies-production-remains-low-as-forex-shortages-bite/?fbclid=IwY2xjawSlvdxleHRuA2FlbQIxMQBicmlkETF2SWVCZFE3WTl6cWZ1bFVrc3J0YwZhcHBfaWQQMjIyMDM5MTc4ODIwMDg5MgABHpn_WD0ilNtzh1rq0xxzP1OfwSphOwL4VvviRog-lPLlKKXJhPYa3lnYME1 [Google Scholar] [Crossref]

8. Chimbwanda, C., & Rukwata, R. (2026, June 27). Warning against Illegal Medical Practice and the Illicit Purchase of Scheduled Medicines from Unauthorised Sources. Media Release. Harare, 2026, Zimbabwe. doi:https://portal.mcaz.co.zw/wp-content/uploads/2026/06/press-statement-WARNING-AGAINST-ILLEGAL-MEDICAL-PRACTICE-AND-THE-ILLICIT-PURCHASE-OF-SCHEDULED-MEDICINES-FROM-UNAUTHORIZED-SOURCES.pdf [Google Scholar] [Crossref]

9. Chimhete, C. (2024, March 25). Zimbabweans turn to medicinal herbs as the cost of drugs soars. Retrieved from Community Working Group on Health: Health Is Your Right & Responsibility: https://www.cwgh.co.zw/zimbabweans-turn-to-medicinal-herbs-as-the-cost-of-drugs-soars/ [Google Scholar] [Crossref]

10. Conway, M., Holt, T., Sabow, A., & Sun, I. Y. (2019). Should Sub-Saharan Africa make its own drugs? New York, United States: McKinsey and Company. [Google Scholar] [Crossref]

11. Dahlgren, G., & Whitehead, M. (1991). Policies and Strategies to Promote Social Equity in Health. Stockholm, Sweden: Institute for Futures Studies. [Google Scholar] [Crossref]

12. Gaudiano, M. C., Di Maggio, A., Cocchieri, E., Antoniella, E., Bertocchi, P., Alimonti, S., & Valvo, L. (2007). Medicines' informal market in Congo, Burundi and Angola: counterfeit and sub-standard antimalarials. Malaria Journal, 6(22). doi:10.1186/1475-2875-6-22. [Google Scholar] [Crossref]

13. Ghebreyesus, A. T. (2022). World Health Statistics 2022: Monitoring Health for the SDGs. World Health Organisation. Retrieved from file:///C:/Users/USER/Downloads/9789240051140-eng.pdf [Google Scholar] [Crossref]

14. Gonzalez, K., Chikanda, A., & Mavhunga, C. (2021). The informal pharmaceutical sector in Zimbabwe: Challenges and opportunities. Health Systems and Reform, 7(2). [Google Scholar] [Crossref]

15. Hauk, C., Hagen, N., & Heide, L. (2021). Identification of substandard and falsified medicines. Influence of different tolerance limits and use of authenticity inquiries. The American Journal of Tropical Medicine and Hygiene, 104(5), 1936–1945. doi:https://doi. org/10.4269/ajtmh.20-1612 [Google Scholar] [Crossref]

16. HP2030. (n.d.). Social Determinants of Health. Retrieved from Healthy People 2030: https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health [Google Scholar] [Crossref]

17. Joi, P. (2024, September 17). Antimicrobial resistance emerges as a bigger killer in Africa than malaria, HIV or TB. Retrieved from VaccinesWork: https://www.gavi.org/vaccineswork/antimicrobial-resistance-emerges-bigger-killer-africa-malaria-hiv-or-tb#:~:text=2024/Achuoth%20Deng-,Antimicrobial%20resistance%20(AMR)%20has%20emerged%20as%20a%20bigger%20killer%20in,African%20perspective%20on%20the%20is [Google Scholar] [Crossref]

18. Kamat, V. R., & Nyato, D. J. (2010). Soft enforcement: The tacit acceptance of the informal drug market in Tanzania. Anthropology and Medicine, 17(2), 155-169. [Google Scholar] [Crossref]

19. Kohler, J. C., Pavignani, E., Michael, M., Ovtcharenko, N., Murru, M., & Hill, P. S. (2012). An examination of pharmaceutical systems in severely disrupted countries. BMC International Health and Human Rights, 12(34), 1-11. doi:https://doi.org/10.1186/1472-698X-12-34 [Google Scholar] [Crossref]

20. Levy, B. S., & Sidel, V. W. (2009). Health effects of combat: A life-course perspective. Annual Review of Public Health, 30, 123-136. doi: https://doi.org/10.1146/annurev.publhealth.031308.100147 [Google Scholar] [Crossref]

21. Mackintosh, M., Tibandebage, P., & Kessler, S. (2018). The pharmaceutical sector and the informal market in Tanzania: A review of the literature. United Nations University. [Google Scholar] [Crossref]

22. Mashe, T., Chaibva, B. V., Nair, P., Sani, K. A., Jallow, M., Tarupiwa, A., . . . Phiri, I. (2023). Descriptive epidemiology of the cholera outbreak in Zimbabwe 2018-2019: role of multi-sectorial approach in cholera epidemic control. 13(1), 1-8. doi:10.1136/bmjopen-2021-059134 [Google Scholar] [Crossref]

23. Masiyiwa, G. (2025). Healing or Hustle? Smuggled Meds Are Big Draw in Zimbabwe’s Hidden Markets. Global Press Journal. Retrieved from https://globalpressjournal.com/africa/zimbabwe/healing-or-hustle-smuggled-meds-are-big-draw-in-zimbabwes-hidden-markets/index.html#:~:text=Zimbabwe%20is%20overwhelmed%20with%20counterfeit,intercepting%20counterfeit%20medicines%20at%20borders. [Google Scholar] [Crossref]

24. Maunga, T. (2021). Customer Complaints Trend Analysis Form. Harare: Medicines Control Authority of Zimbabwe. Retrieved from https://www.mcaz.co.zw/wp-content/uploads/2022/05/2020-Customer-Complaints-Trend-Analysis-.pdf [Google Scholar] [Crossref]

25. Mok, W., Chikanda, A., & Mureverwi, M. (2020). Regulating the informal pharmaceutical market in Zimbabwe: Challenges and opportunities. Health Policy and Planning, 35(9), 1155–1163. doi: https://doi.org/10.1093/heapol/czaa059 [Google Scholar] [Crossref]

26. Moreno, J. L. (1934). Who Shall Survive? A New Approach to the Problem of Human Interrelations. Beacon House. ISBN 978-9992695722. [Google Scholar] [Crossref]

27. Müller, R., Drouin, N., & Sankaran, S. (2019). Institutional theory and OPM. In Organisational Project Management (pp. 140–152). Edward Elgar Publishing. doi:https://doi.org/10.4337/9781788110976.00017 [Google Scholar] [Crossref]

28. Murairwa, S. (2015). Voluntary Sampling Design. International Journal of Advanced Research in Management and Social Sciences, 185 - 200. [Google Scholar] [Crossref]

29. Murairwa, S. (2019). RESEARCH AND STATISTICS with Application Procedures in Statistical Package for Social Sciences (1st ed.). Harare, Zimbabwe: Media Essentials. [Google Scholar] [Crossref]

30. Nichter, M. (2021). Pharmaceuticals, governance, and health policy. Anthropology & Medicine, 28(1), 1 - 17. [Google Scholar] [Crossref]

31. Oleffe, A., Sako, B., Paul, E., & Mahieu, C. (2022). Formal and informal medicine retailers in Sub-Saharan Africa: a scoping review of research trends. International Journal of Pharmacy Practice, 30, 315–325. doi:https://doi.org/10.1093/ijpp/riac038 [Google Scholar] [Crossref]

32. Salam, M. A., Al-Amin, M. Y., Salam, M. T., Pawar, J. S., Akhter, N., Rabaan, A. A., & Alqumber, M. A. (2023). Antimicrobial Resistance: A Growing Serious Threat for Global Public Health. Healthcare, 11(13), 1946. doi:10.3390/healthcare11131946 [Google Scholar] [Crossref]

33. Scott, J. (2000). Social Network Analysis: A Handbook, Second Edition. London: Sage Publications. [Google Scholar] [Crossref]

34. Smith, R. D. (2019). Global health governance and the informal pharmaceutical market. Globalisation and Health, 15(1), 73. [Google Scholar] [Crossref]

35. StaffReporter. (2025, June 1). Counterfeit medicine crisis grows in Zimbabwe's informal markets. Bulawayo24 NEWS. Retrieved from https://bulawayo24.com/index-id-news-sc-national-byo-253730.html [Google Scholar] [Crossref]

36. StaffReporter2. (2025, March 31). Healing or hustle? Smuggled meds are a big draw in Zimbabwe’s hidden markets. Retrieved from CITE: https://cite.org.zw/healing-or-hustle-smuggled-meds-are-big-draw-in-zimbabwes-hidden-markets/ [Google Scholar] [Crossref]

37. Stein, C. M., Gora, N. P., & Macheka, B. M. (1989). Self-medication in urban and rural Zimbabwean communities. British Journal of Clinical Pharmacology, 27, 741-747. doi:https://doi.org/10.1111/j.1365-2125.1989.tb03435.x [Google Scholar] [Crossref]

38. Tembo, A. (2023, January 13). Medicines Control Authority of Zimbabwe speaks on unregistered remedies. Retrieved from ZBCNews: https://www.zbcnews.co.zw/medicines-control-authority-of-zimbabwe-speaks-on-unregistered-remedies/ [Google Scholar] [Crossref]

39. UN. (2019). Sustainable Development Goal 3: Ensure healthy lives. United Nations. Retrieved from https://www.un.org/sustainabledevelopment/health/ [Google Scholar] [Crossref]

40. Ushie, M. A., Ugal, D. B., & Ingwu, J. A. (2016). Overdependence on For-Profit Pharmacies: A Descriptive Survey of User Evaluation of Medicines Availability in Public Hospitals in Selected Nigerian States. PLOS One, 11(11). doi:https://doi.org/10.1371/journal.pone.0165707 [Google Scholar] [Crossref]

41. Wafula, F., Miriti, E. M., & Goodman, C. A. (2021). Examining characteristics, knowledge and regulatory practices of specialised drug shops in Sub-Saharan Africa. Tropical Medicine & International Health, 17(9), 1079-1087. [Google Scholar] [Crossref]

42. Wasserman, S., & Faust, K. (1997). Social Network Analysis: Methods and Applications. Cambridge, UK and New York: Cambridge University Press. [Google Scholar] [Crossref]

43. Wertheim et al. (2014). Providing policy makers with the evidence to implement the Global Action Plan on Antimicrobial Resistance. The Lancet, 385(9974), 1222-1223. [Google Scholar] [Crossref]

44. WHO. (2012). Substandard, spurious, falsely labelled, falsified and counterfeit (SSFFC) medical products. World Health Organisation. Retrieved from https://apps.who.int/gb/sf/pdf_files/A64_16-en.pdf [Google Scholar] [Crossref]

45. WHO. (2017). A study on the public health and socioeconomic impact of substandard and falsified medical products. World Health Organisation. Retrieved from https://www.who.int/publications/i/item/9789241513432 [Google Scholar] [Crossref]

46. WHO. (2018). Substandard and falsified medical products. WHO Fact Sheet. World Health Organisation. Retrieved from https://www.who.int/news-room/fact-sheets/detail/substandard-and-falsified-medical-products [Google Scholar] [Crossref]

47. WHO. (2019). Ten threats to global health in 2019. World Health Organisation. Retrieved from https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019 [Google Scholar] [Crossref]

48. WHO. (2021). Quality assurance of medicines in Uganda: The role of informal markets. WHO Bulletin, 99(4), 300–310. Retrieved from https://www.who.int/bulletin/volumes/99/4/20-030456 [Google Scholar] [Crossref]

49. WHO. (2025, May 6). Social determinants of health. Retrieved from World Health Organisation (WHO): https://www.who.int/news-room/fact-sheets/detail/social-determinants-of-health [Google Scholar] [Crossref]

50. Yadav, P., Stapleton, O., & Van Wassenhove, L. N. (2012). Assessing medicine availability and distribution systems in developing countries. Working Paper. MIT-Zaragoza International Logistics Program. [Google Scholar] [Crossref]

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