Drug shops for stronger health systems: learning from initiatives in six LMICs

Table 3 Factors contributing to success or failure of initiatives

Factor	Towards or against successful outcome?	Countries in which it was present and potentially influenced outcome	Countries in which factor was absent/suboptimal and lack of factor influenced outcome
The micro level—individuals, households and communities
Communities choose drug shops	Towards success	Indonesia Nigeria (Oluwasanu) Nigeria (Uneke) Bangladesh Myanmar Zambia Tanzania
Positive relationship between drug seller and client	Towards success	Nigeria (Oluwasanu) Myanmar¹	Myanmar¹ Nigeria (Uneke) Zambia Bangladesh
The meso level—health service delivery and resources
Client pressure	Against success	Indonesia Nigeria (Oluwasanu) Nigeria (Uneke) Bangladesh Myanmar Zambia Tanzania
Training	Towards success	Myanmar Nigeria (Oluwasanu) Nigeria (Uneke) Tanzania Zambia	Bangladesh Indonesia
Procurement challenges	Against success	Nigeria (Oluwasanu) Indonesia Myanmar
Financial and administrative burden	Against success	Zambia Indonesia Myanmar
Positive drug shop owner attitudes towards initiative	Towards success	Indonesia Zambia Nigeria (Oluwasanu)	Bangladesh
The macro level—health sector and national context
Supervision, monitoring and regulation	Towards success	Nigeria (Uneke) Zambia² Myanmar	Indonesia Bangladesh Zambia² Nigeria (Oluwasanu) Tanzania
Multi-stakeholder collaboration and high-level buy-in	Towards success	Nigeria (Oluwasanu)³ Bangladesh Zambia Tanzania Myanmar Indonesia	Nigeria (Oluwasanu)³ Indonesia Tanzania

¹The presence of Myanmar in both columns should be interpreted to mean that a positive relationship between drug seller and client was noted to positively affect outcomes, and a negative relationship between drug seller and client was noted to negatively affect outcomes
²In Zambia, while supervision was noted to be helpful, regulation was inadequate which negatively influenced the ability of the initiative to contribute to stronger health systems
³In Nigeria, multi-stakeholder collaboration and buy in was noted to be helpful, but there was one stakeholder group creating opposition to the policy change, which posed a barrier

ISSN: 2052-3211