The Political Economy of Substandard and Falsified Medicines in Southern Africa: A Scoping Review and Eswatini Case Analysis

This scoping review examines the political economy of substandard and falsified (SF) medicines in Southern Africa, incorporating a focused case analysis of Eswatini. It addresses the critical public health challenge posed by SF medicines, arguing their prevalence is driven not merely by regulatory shortcomings but by deeper structural determinants. These include governance deficits, pronounced economic inequality, and sophisticated transnational criminal networks. The methodology entailed a systematic search of academic and grey literature from 2000 to 2023, followed by application of a political economy analysis framework. This framework synthesised evidence on the key actors, incentives, and power dynamics facilitating the trade. Key findings indicate that SF medicines are entrenched within complex systems encompassing informal economies, institutional corruption, and inadequate cross-border collaboration. The Eswatini case underscores specific national vulnerabilities, such as porous borders and dependence on regional supply chains, which are exploited by organised syndicates. The review concludes that purely technical-regulatory solutions are inadequate unless they concurrently address these underlying political and economic determinants. Its significance lies in offering an evidence-based, contextual analysis to inform policymakers, advocating for integrated, multi-sectoral strategies. These must strengthen governance, enhance regional cooperation, and mitigate the socio-economic drivers of demand. This African-centred perspective is crucial for developing effective and sustainable interventions to safeguard public health and medicine security across the region.