Paper short abstract:

We report on a project that combines the richness of ethnographic enquiry with Behavioural Game Theory to understand how trust/mistrust in medicines operates in Ghana and Tanzania, where widespread counterfeiting and inadequate regulation lead to huge uncertainty and risk.

Paper long abstract:

Medicines, which have played such a major role in reducing disease burden over the last half century, are now at the centre of a major global public health crisis. Widespread counterfeiting and unprecedented global traffic of pharmaceuticals have created significant trust problems for patients, retailers, manufacturers and others, particularly where regulation is weak, with serious risks for individual and public health. In this paper we report preliminary findings and reflections from a research project, conducted in Ghana and Tanzania, that aims to bring analytical clarity to this pressing global public health problem. Our question is: how, under conditions of uncertainty and informational asymmetry, do actors (consumers and providers) come to trust and distrust particular medicines, and how does this shape practice? Our goal is to bring together the richness of ethnographic enquiry with the powerful analytical approaches offered by Signalling Theory (a variant of Behavioural Game Theory) in order to enhance our understanding of the mechanisms that foster the production of trust in medicinal transactions in sub-Saharan Africa.