Pharmaceutical Industry Partnerships and Prescribing Practices in Mali: A Mixed-Methods Study of Influence on Clinical Decisions and Care Protocols

Objectives: To assess how pharmaceutical industry partnerships influence prescribing practices and the development of clinical care protocols in Mali, where out-of-pocket health expenditures reach nearly 40% of total health spending. Methods: We conducted a sequential mixed-methods study from January to December 2026 in Commune III of Bamako. The quantitative phase surveyed 331 health professionals, 90 patients, and 94 pharmaceutical industry representatives using electronic questionnaires. The qualitative phase involved semi-structured interviews with protocol drafters and health decisionmakers. We used descriptive statistics, Spearman correlations, and multivariate regressions to analyze associations between industry exposure and prescribing outcomes. Results: Partnerships were intense and nearly universal. All professionals (100%) reported receiving promotional gifts, 87.3% received free samples, and 52.9% received offered meals. Medical representatives averaged 17.4 professional contacts per day. Brand-name prescribing dominated: professionals prescribed brand-name specialties in 73.2% of prescriptions on average, and 68.7% did so in 7 or more of every 10 prescriptions (Figure 1). We found no significant correlation between industry exposure score and brand-name prescribing (r = 0.13; P = .535). Being a physician was the only factor significantly associated with increased brand-name prescribing (β = 1.57; P < .001; Table 1). All patients (100%) were aware of medical representatives' influence, and 42.2% had forgone care because of cost (Table 2). One-third of protocol drafters considered industry participation in guideline development unacceptable. Conclusions: Pharmaceutical partnerships in Mali are intense and coexist with high rates of brand-name prescribing an indicator of irrational prescribing. Although exposure to industry benefits was not directly correlated with brand-name prescribing in this study, the normalization of these practices and their financial impact on patients demand urgent, context-adapted regulation.