Poor-quality medicines are a major threat to healthcare provision in low-income countries. The pr... more Poor-quality medicines are a major threat to healthcare provision in low-income countries. The problem exacerbates disease vulnerabilities of already disadvantaged populations including children, women, and the elderly. However, while the higher-level structural drivers of this problem are well established, little is known about decision-making lower down pharmaceutical supply chains, and whether this might produce vulnerabilities for medicine quality. We conducted a mixed-methods study to explore retailer–supplier interactions and decision-making dynamics for antimalarial medicines in three regions of Tanzania: Tabora, Dodoma and Mbeya. A survey questionnaire was administered to 118 small scale-and mid-range retailers in urban and rural districts of the regions. We then conducted 12 in-depth interviews with staff and owners of medicine outlets in 2 districts of Tabora region to explore further the decision-making dynamics. Results show that private-sector retailers are driven first...
This chapter attempts to get to the heart of the matter and asks why the punishment administered ... more This chapter attempts to get to the heart of the matter and asks why the punishment administered by the paramilitaries and/or the state does not deter these young people from further recidivism. This lack of a specific deterrent effect violates the rational norm on which deterrence is founded, that certainty and severity of punishment will prevent reoffending, and has bewildered many local people, paramilitaries, criminal justice practitioners, and politicians for some time. The explanatory model proposed in this chapter is that of a signaling game whereby hoods engage in specific behaviors to prove their toughness and status to other hoods. The model, developed from economics, game theory, and biology, explains why people engage in self-destructive behaviors in order to gain group acceptance: often the qualities they wish to display are hard to observe by others who are interested in them and can be easily mimicked by purely verbal claims.
This chapter explains the dominant features of working-class culture. In particular, the ways in ... more This chapter explains the dominant features of working-class culture. In particular, the ways in which status and prestige can be gained among the adult male population, and the fact that the hoods are excluded from these paths to power, are explored. This chapter also examines the relationships between the hoods and the influence of their friends and associates on their offending. The analysis here is framed in terms of the understandings that both the hoods and ex-hoods either have or had of their antisocial behavior. Thus studying the world of the hoods in their own terms opens the way to an increased understanding of their behavior. In the process, the data revealed that rather than being anomic the hoods do adhere to a set of norms. The challenge remains to understand the hoods' subculture and make sense of their behaviors.
Research in Social and Administrative Pharmacy, 2022
In this paper, we argue that understanding and addressing the problem of poor-quality medical pro... more In this paper, we argue that understanding and addressing the problem of poor-quality medical products requires a more interdisciplinary approach than has been evident to date. While prospective studies based on rigorous standardized methodologies are the gold standard for measuring the prevalence of poor-quality medical products and understanding their distribution nationally and internationally, they should be complemented by social science research to unpack the complex set of social, economic, and governance factors that underlie these patterns. In the following sections, we discuss specific examples of prospective quality surveys and of social science studies, highlighting the value of cross-sector partnerships in driving high-quality, policy-relevant research in this area.
In 2012, the WHO launched its Global Surveillance and Monitoring System (GSMS) for substandard an... more In 2012, the WHO launched its Global Surveillance and Monitoring System (GSMS) for substandard and falsified medicines, with the aim of improving the quality of reporting and using the data to inform post-market surveillance and build regulatory capacity. However, from a regulatory governance perspective, its effectiveness depends on the willingness and ability of actors ‘on the ground’ to identify, report and investigate possible infringements and to enforce penalties. This paper presents findings from 27 interviews with representatives of agencies charged with regulating pharmaceutical markets and 4 interviews with pharmaceutical industry representatives in Tanzania. Their experiences provide important insights into how the theorised mechanism between reporting and a reduction in undesirable behaviours can play out in a low-income context, revealing hidden assumptions about regulator behaviour and motivations. A combination of chronic under-resourcing, information gaps and enforce...
This chapter turns to the Protestant community and examines paramilitary punishment attacks (PPAs... more This chapter turns to the Protestant community and examines paramilitary punishment attacks (PPAs) perpetrated by Loyalist paramilitaries. Although the violent methods used by Republican and Loyalist armed groups are similar, their motivation is somewhat different. In particular, the supply of PPAs carried out by Loyalist paramilitaries outweighs the demand from the local population. In this case, PPAs are used against delinquent young people, but they are also used to discipline members and settle scores within and between groups to a greater extent than in the Republican case. The chapter also examines antisocial behavior among young people in Protestant areas and finds differences between Protestants and Catholics in the specific types of offending. The explanation for this variation lies in the structure and number of Loyalist armed groups and the different types of opportunities for community recognition, which the respective political and paramilitary organizations offer to them.
This chapter argues that, from the early days of the political conflict in the 1970s the conditio... more This chapter argues that, from the early days of the political conflict in the 1970s the conditions were such that the Irish Republican Army (IRA) adopted some of the functions of the state, namely the provision of policing and punishment of ordinary crime. The hostility of the statutory criminal justice system, particularly the police, toward the working-class Catholic community dramatically increased the costs of using state services. The high levels of disaffection and aggression among working-class Catholics toward the police meant that the state could no longer fulfill its function and police the community in any “normal” way. A demand for policing therefore existed. Simultaneously, this demand was met and fostered by the IRA, which had the motivation, the manpower, and the monopoly on the use of violence necessary to carry out this role.
A distinctive feature of the conflict in Northern Ireland over the past forty years has been the ... more A distinctive feature of the conflict in Northern Ireland over the past forty years has been the way Catholic and Protestant paramilitaries have policed their own communities. This has mainly involved the violent punishment of petty criminals involved in joyriding and other types of antisocial behavior. Between 1973 and 2007, more than 5,000 nonmilitary shootings and assaults were attributed to paramilitaries punishing their own people. But despite the risk of severe punishment, young petty offenders—known locally as “hoods”—continue to offend, creating a puzzle for the rational theory of criminal deterrence. Why do hoods behave in ways that invite violent punishment? This book explains why this informal system of policing and punishment developed and endured and why such harsh punishments as beatings, “kneecappings,” and exile have not stopped hoods from offending. Drawing on a variety of sources, including interviews with perpetrators and victims of this violence, the book argues ...
Driving a taxi is dangerous, and picking up the wrong fare can be devastating. Yet drivers only h... more Driving a taxi is dangerous, and picking up the wrong fare can be devastating. Yet drivers only have a moment to make a choice.
Poor-quality medicines are a major threat to healthcare provision in low-income countries. The pr... more Poor-quality medicines are a major threat to healthcare provision in low-income countries. The problem exacerbates disease vulnerabilities of already disadvantaged populations including children, women, and the elderly. However, while the higher-level structural drivers of this problem are well established, little is known about decision-making lower down pharmaceutical supply chains, and whether this might produce vulnerabilities for medicine quality. We conducted a mixed-methods study to explore retailer–supplier interactions and decision-making dynamics for antimalarial medicines in three regions of Tanzania: Tabora, Dodoma and Mbeya. A survey questionnaire was administered to 118 small scale-and mid-range retailers in urban and rural districts of the regions. We then conducted 12 in-depth interviews with staff and owners of medicine outlets in 2 districts of Tabora region to explore further the decision-making dynamics. Results show that private-sector retailers are driven first...
This chapter attempts to get to the heart of the matter and asks why the punishment administered ... more This chapter attempts to get to the heart of the matter and asks why the punishment administered by the paramilitaries and/or the state does not deter these young people from further recidivism. This lack of a specific deterrent effect violates the rational norm on which deterrence is founded, that certainty and severity of punishment will prevent reoffending, and has bewildered many local people, paramilitaries, criminal justice practitioners, and politicians for some time. The explanatory model proposed in this chapter is that of a signaling game whereby hoods engage in specific behaviors to prove their toughness and status to other hoods. The model, developed from economics, game theory, and biology, explains why people engage in self-destructive behaviors in order to gain group acceptance: often the qualities they wish to display are hard to observe by others who are interested in them and can be easily mimicked by purely verbal claims.
This chapter explains the dominant features of working-class culture. In particular, the ways in ... more This chapter explains the dominant features of working-class culture. In particular, the ways in which status and prestige can be gained among the adult male population, and the fact that the hoods are excluded from these paths to power, are explored. This chapter also examines the relationships between the hoods and the influence of their friends and associates on their offending. The analysis here is framed in terms of the understandings that both the hoods and ex-hoods either have or had of their antisocial behavior. Thus studying the world of the hoods in their own terms opens the way to an increased understanding of their behavior. In the process, the data revealed that rather than being anomic the hoods do adhere to a set of norms. The challenge remains to understand the hoods' subculture and make sense of their behaviors.
Research in Social and Administrative Pharmacy, 2022
In this paper, we argue that understanding and addressing the problem of poor-quality medical pro... more In this paper, we argue that understanding and addressing the problem of poor-quality medical products requires a more interdisciplinary approach than has been evident to date. While prospective studies based on rigorous standardized methodologies are the gold standard for measuring the prevalence of poor-quality medical products and understanding their distribution nationally and internationally, they should be complemented by social science research to unpack the complex set of social, economic, and governance factors that underlie these patterns. In the following sections, we discuss specific examples of prospective quality surveys and of social science studies, highlighting the value of cross-sector partnerships in driving high-quality, policy-relevant research in this area.
In 2012, the WHO launched its Global Surveillance and Monitoring System (GSMS) for substandard an... more In 2012, the WHO launched its Global Surveillance and Monitoring System (GSMS) for substandard and falsified medicines, with the aim of improving the quality of reporting and using the data to inform post-market surveillance and build regulatory capacity. However, from a regulatory governance perspective, its effectiveness depends on the willingness and ability of actors ‘on the ground’ to identify, report and investigate possible infringements and to enforce penalties. This paper presents findings from 27 interviews with representatives of agencies charged with regulating pharmaceutical markets and 4 interviews with pharmaceutical industry representatives in Tanzania. Their experiences provide important insights into how the theorised mechanism between reporting and a reduction in undesirable behaviours can play out in a low-income context, revealing hidden assumptions about regulator behaviour and motivations. A combination of chronic under-resourcing, information gaps and enforce...
This chapter turns to the Protestant community and examines paramilitary punishment attacks (PPAs... more This chapter turns to the Protestant community and examines paramilitary punishment attacks (PPAs) perpetrated by Loyalist paramilitaries. Although the violent methods used by Republican and Loyalist armed groups are similar, their motivation is somewhat different. In particular, the supply of PPAs carried out by Loyalist paramilitaries outweighs the demand from the local population. In this case, PPAs are used against delinquent young people, but they are also used to discipline members and settle scores within and between groups to a greater extent than in the Republican case. The chapter also examines antisocial behavior among young people in Protestant areas and finds differences between Protestants and Catholics in the specific types of offending. The explanation for this variation lies in the structure and number of Loyalist armed groups and the different types of opportunities for community recognition, which the respective political and paramilitary organizations offer to them.
This chapter argues that, from the early days of the political conflict in the 1970s the conditio... more This chapter argues that, from the early days of the political conflict in the 1970s the conditions were such that the Irish Republican Army (IRA) adopted some of the functions of the state, namely the provision of policing and punishment of ordinary crime. The hostility of the statutory criminal justice system, particularly the police, toward the working-class Catholic community dramatically increased the costs of using state services. The high levels of disaffection and aggression among working-class Catholics toward the police meant that the state could no longer fulfill its function and police the community in any “normal” way. A demand for policing therefore existed. Simultaneously, this demand was met and fostered by the IRA, which had the motivation, the manpower, and the monopoly on the use of violence necessary to carry out this role.
A distinctive feature of the conflict in Northern Ireland over the past forty years has been the ... more A distinctive feature of the conflict in Northern Ireland over the past forty years has been the way Catholic and Protestant paramilitaries have policed their own communities. This has mainly involved the violent punishment of petty criminals involved in joyriding and other types of antisocial behavior. Between 1973 and 2007, more than 5,000 nonmilitary shootings and assaults were attributed to paramilitaries punishing their own people. But despite the risk of severe punishment, young petty offenders—known locally as “hoods”—continue to offend, creating a puzzle for the rational theory of criminal deterrence. Why do hoods behave in ways that invite violent punishment? This book explains why this informal system of policing and punishment developed and endured and why such harsh punishments as beatings, “kneecappings,” and exile have not stopped hoods from offending. Drawing on a variety of sources, including interviews with perpetrators and victims of this violence, the book argues ...
Driving a taxi is dangerous, and picking up the wrong fare can be devastating. Yet drivers only h... more Driving a taxi is dangerous, and picking up the wrong fare can be devastating. Yet drivers only have a moment to make a choice.
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