Table 3 Qualitative observations of pharmacy characteristics

Premises

Premises ranged from small street stalls (e.g. 3ftx4ft) to larger independent medical stores (e.g. 10ftx12ft) and, in Kenya, Nigeria and Pakistan, dispensaries operating within clinics, health centres, and a sub-county hospital (KE1). Most were located along busy roads, within markets or near transport hubs and were often in close proximity to each other.

Goods and services

Depending on pharmacy size and scope, medical goods ranged from a few boxes of over-the-counter-drugs to shelves ‘loaded with tablets and syrups.’ Some also stocked herbal remedies. Most sold non-medical goods (e.g. soft drinks, soaps, sweets) and almost all offered mobile SIM and recharge services. In Kenya, Nigeria and Bangladesh, few displayed contact details, opening hours and authentication certificates. In Kenya and Bangladesh, some pharmacies were adjoined by a small doctor’s consulting chamber (e.g. 5ftx7ft). Drugs were often dispensed in small quantities (e.g. two tablets) in unlabeled containers, although some providers wrote or gave verbal directions to customers.

Privacy

Privacy was limited by space in all sites and customers often had to discuss and purchase items while standing on the street or a pavement step.

Cleanliness

In all sites, most facilities were located near to open drainage and ‘a lot of garbage’. Many sought to improve customer accessibility with wooden planks and elevated entrances. Inside, some stores were very dusty or ‘grimey’, others clean, well-lit and cooled by electric fans.

Opening hours

In all sites, most facilities stayed open late at night, 6–7 days per week, with owners on call after hours. For many, this was largely to accommodate ‘people who return late from work and need to get drugs especially pain relievers, most even call to book drugs and plead [for me to wait for them]’

Staff

In all sites, the owner/main provider was often referred to as ‘doctor’. Most drug vendors had undergone ‘in field’ training as apprentices and many in Nigeria and Bangladesh now employed apprentices themselves. A few mentioned medical backgrounds as nurses (NG, KE) or clinical medical officers (KE). Some were working elsewhere in ‘day jobs’ (in other health facilities or different industries outside of the site). During quiet times (e.g. mornings), young apprentices, family members or neighbours might be left to attend to occasional customers but at busier times and in larger facilities, teams of 3–6 assistants might work together to keep queues moving. In all sites, most providers were seen to be courteous and professional. Often a customer would first consult about their symptoms (no fee charged). Providers would then prescribe and sell treatment; or occasionally refer to a doctor/clinic.

Prices

Most transactions were in cash. In Nigeria, drug prices and quantities were negotiable, depending on ‘the severity of the case and the bargaining power’ of the customer. In Nigeria and Kenya, drugs were sold at government-subsidized rates in the primary healthcare centres. At the community primary healthcare centre in NG1, anti-malaria drugs were free and staff said they were always available (NG1). In Bangladesh, one pharmacy had a reimbursement arrangement to supply medicine at no cost to patients with prescriptions from a donor-funded clinic in the site.