The Political Economy of Substandard and Falsified Medicines: A Theoretical Framework for Supply Chain Analysis in the Greater Horn of Africa

This article proposes a theoretical framework for analysing the political economy of substandard and falsified (SF) medical products within the supply chains of the Greater Horn of Africa. It contends that prevailing regulatory and public health approaches, which predominantly emphasise technical capacities, fail to engage with the entrenched political and economic structures that perpetuate this crisis. The objective is to delineate a novel analytical lens that systematically examines the interplay between state fragility, informal economies, and vested commercial interests facilitating the infiltration of SF medicines. Methodologically, the framework synthesises concepts from political economy, institutional analysis, and supply chain governance, drawing upon documented empirical evidence and regional case studies from 2021 to 2026. The central thesis posits that the proliferation of SF medicines constitutes not merely a regulatory failure but a symptom of deeper systemic pathologies, including institutionalised corruption, transnational illicit trade networks, and the political marginalisation of specific regions. The framework’s significance lies in its capacity to inform more effective, context-sensitive interventions by shifting the analytical focus from downstream detection towards upstream political and economic drivers. It advocates for integrated strategies that strengthen public accountability, enhance regional cooperation, and promote equitable access to quality-assured medicines as foundational pillars of health security across the continent.