TY - JOUR
T1 - How conflicts of interest hinder effective regulation of healthcare
T2 - an analysis of antimicrobial use regulation in Cambodia, Indonesia and Pakistan
AU - Khan, Mishal
AU - Rahman-Shepherd, Afifah
AU - Bory, Sothavireak
AU - Chhorn, Sophea
AU - Durrance-Bagale, Anna
AU - Hasan, Rumina
AU - Heng, Sotheara
AU - Phou, Socheata
AU - Prien, Chanra
AU - Probandari, Ari
AU - Saphonn, Vonthanak
AU - Suy, Sovanthida
AU - Wiseman, Virginia
AU - Wulandari, Luh Putu Lila
AU - Hanefeld, Johanna
N1 - Publisher Copyright:
©
PY - 2022/5/3
Y1 - 2022/5/3
N2 - Background There has been insufficient attention to a fundamental force shaping healthcare policies - conflicts of interest (COI). We investigated COI, which results in the professional judgement of a policymaker or healthcare provider being compromised by a secondary interest, in relation to antimicrobial use, thereby illuminating challenges to the regulation of medicines use more broadly. Our objectives were to characterise connections between three groups - policymakers, healthcare providers and pharmaceutical companies - that can create COI, and elucidate the impacts of COI on stages of the policy process. Methods Using an interpretive approach, we systematically analysed qualitative data from 136 in-depth interviews and five focus group discussions in three Asian countries with dominant private healthcare sectors: Cambodia, Indonesia and Pakistan. Findings We characterised four types of connections that were pervasive between the three groups: financial, political, social and familial. These connections created strong COI that could impact all stages of the policy process by: preventing issues related to medicines sales from featuring prominently on the agenda; influencing policy formulation towards softer regulatory measures; determining resource availability for, and opposition to, policy implementation; and shaping how accurately the success of contested policies is reported. Interpretation Our multicountry study fills a gap in empirical evidence on how COI can impede effective policies to improve the quality of healthcare. It shows that COI can be pervasive, rather than sporadic, in influencing regulation of medicine use, and highlights that, in addition to financial connections, other types of connections should be examined as important drivers of COI.
AB - Background There has been insufficient attention to a fundamental force shaping healthcare policies - conflicts of interest (COI). We investigated COI, which results in the professional judgement of a policymaker or healthcare provider being compromised by a secondary interest, in relation to antimicrobial use, thereby illuminating challenges to the regulation of medicines use more broadly. Our objectives were to characterise connections between three groups - policymakers, healthcare providers and pharmaceutical companies - that can create COI, and elucidate the impacts of COI on stages of the policy process. Methods Using an interpretive approach, we systematically analysed qualitative data from 136 in-depth interviews and five focus group discussions in three Asian countries with dominant private healthcare sectors: Cambodia, Indonesia and Pakistan. Findings We characterised four types of connections that were pervasive between the three groups: financial, political, social and familial. These connections created strong COI that could impact all stages of the policy process by: preventing issues related to medicines sales from featuring prominently on the agenda; influencing policy formulation towards softer regulatory measures; determining resource availability for, and opposition to, policy implementation; and shaping how accurately the success of contested policies is reported. Interpretation Our multicountry study fills a gap in empirical evidence on how COI can impede effective policies to improve the quality of healthcare. It shows that COI can be pervasive, rather than sporadic, in influencing regulation of medicine use, and highlights that, in addition to financial connections, other types of connections should be examined as important drivers of COI.
KW - health policy
KW - qualitative study
UR - http://www.scopus.com/inward/record.url?scp=85130976078&partnerID=8YFLogxK
U2 - 10.1136/bmjgh-2022-008596
DO - 10.1136/bmjgh-2022-008596
M3 - Article
AN - SCOPUS:85130976078
SN - 2059-7908
VL - 7
JO - BMJ Global Health
JF - BMJ Global Health
IS - 5
M1 - e008596
ER -