Reimagining the regulation of informal pharmaceutical markets: The importance of pragmatic expertise and improvisation in Nigeria

Informal pharmaceutical markets have become an issue of major concern for international agencies and national governments, including in Nigeria, due to reports about 'fake drugs'. These concerns have at times fostered severe regulatory responses, including violent crackdowns on informal markets. This study reimagines the regulation of informal pharmaceutical markets in ways that could promote drug quality and equitable access to drugs, drawing on the concepts of improvisation and pragmatic expertise, as well as on long-term ethnographic and interview-based research in two of South-Western Nigeria's major informal pharmaceutical markets (n = 82). Our data reveals conflicts between regulatory agencies (dominated by trained pharmacists) and informal market actors, characterised by attempts to control informal markets through re-spatialisation. Data also shows how claims about fake drugs in informal markets help to frame the key problematic of pharmaceutical markets as that of drug quality, thus upholding the role and powers of regulators and expert pharmacists. Informal market actors challenged accusations of fake drugs, emphasising the availability and affordability of essential drugs through their markets and self-regulation efforts, including through informal collaborations with state regulators. In contrast to recent policy initiatives and recent research, our findings show how institutional prioritisation of drug quality may unintentionally undermine other important health objectives, such as access to essential drugs, through regulatory processes that seek to contain informal markets within narrow institutional agendas. Our study reimagines the regulation of informal pharmaceutical markets by highlighting the importance of improvisation in regulatory approaches and the role of pragmatic expertise shared among regulators and informal market actors.