African Journal of Public Health and Health Systems | 21 October 2026
A Systematic Review of the Political Economy of Substandard and Falsified Antimalarial Medicines in West African Cross-Border Markets: An African Perspective,
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Abstract
<strong>Background:</strong> The circulation of substandard and falsified (SF) antimalarial medicines in West African cross-border markets presents a persistent public health and governance crisis. These informal markets are vital supply channels but are underpinned by complex political and economic factors that facilitate the trade in SF medicines.
<strong>Purpose and objectives:</strong> This systematic review aimed to synthesise evidence from an African scholarly perspective on the political economy drivers, key actors, and governance structures influencing the trade in SF antimalarials within West African cross-border markets between 2021 and 2026.
<strong>Methodology:</strong> A systematic search was conducted across five academic databases and African institutional repositories for relevant qualitative, quantitative, and mixed-methods studies published in English or French. Included studies were critically appraised using standard tools, with data extracted and analysed thematically.
<strong>Findings/Key insights:</strong> Analysis identified pervasive governance failures as a central theme, including weak regulatory harmonisation between states and corruption at border points. A recurring finding was the economic rationale for traders, whereby formal tariffs and poverty incentivise sourcing cheaper, unverified medicines. Evidence indicated significant community reliance on these markets, with one study quantifying approximately 30% of antimalarial purchases in specific border regions as originating from informal cross-border sources.
<strong>Conclusion:</strong> The trade in SF antimalarials is entrenched in regional political economies, characterised by fragmented regulation, economic vulnerability, and illicit rent-seeking. This directly undermines malaria control efforts and erodes public trust in health systems.
<strong>Recommendations:</strong> Key recommendations include strengthening regional pharmacovigilance networks, establishing joint border inspection protocols, and designing economic interventions to formalise and support legitimate small-scale medicine traders.
<strong>Key words:</strong> substandard and falsified medicines, antimalarials, political economy, cross-border trade, West Africa, public health governance
<strong>Contribution statement:</strong> This review consolidates contemporary African research to provide a region-specific analysis for policymakers, elucidating the critical interplay between governance, economics, and health security in addressing SF antimalarials.