Can a code of professional ethics influence the supply of substandard and falsified medicines? Insights from Ethiopia

Abstract

Substandard and falsified (SF) medicines are serious global health problems. Their highprevalence is a threat to public health in resource-limited settings. It is assumed thatprofessionals will uphold specific standards of behaviour to protect the public interestand maintain trust. This study assesses whether a professional ethical code can serve asan effective way to prevent and respond to SF medicines by enhancing ethicalbehaviours in practice. The study adopted a cross-sectional qualitative design employinginterviews and observation. Participants were selected through purposive, convenience,and snowball sampling techniques and included pharmacists, physicians, wholesalers,pharmacy owners, regulatory staff, and members of the local community. The data areanalysed within a framework from the Actor-Network Theory. The influence of theprofessional ethical code is entangled in a complex network of practices involvingvarious actors who adapt their behaviours to meet local needs and demands. Itseffectiveness depends on supportive institutions, and on economic and educationalinfrastructure. Embedding ethics as an enforceable component of a systems rather thana symbolic marker for professional identity may reduce the spread of SF medicines andstrengthen the trust, accountability and legitimacy in pharmaceutical practice.