Medicines in motion: An ethnographic exploration of the informal cross-border pharmaceutical trade in Africa

The informal cross-border trade (ICBT) in medicines in Africa is an under-explored phenomenon, with potentially serious public health implications. We conducted ethnographic research (Dec 2022–Jan 2023) at two major border crossings in East and West Africa: between Ghana-Togo at Aflao/Lomé and Kenya-Tanzania at Namanga. Observations at strategic locations were complemented by informal interviews with traders, transporters, retailers, border officials and other stake-holders. Medicines were being transported informally across borders in substantial quantities, through small-scale and larger-scale operations, drawing in multiple actors. Generic pharmaceutical products were generally moving from low-cost, high-availability regimes to higher-cost, lower-availability ones, driven by customer demand for affordable medicines and facilitated by regulatory gaps and low-level corruption. Across the Ghana-Togo border, we observed a counter-movement of supplements and sexual/body enhancers. Medicine flows reflect cross-border disparities in pharmaceutical availability, pricing and regulation, rooted in colonial histories and contemporary economic realities. This trade is an understandable response to the lack of affordable essential medicines and livelihood insecurities. However, it also poses significant public health and pharmaceutical governance risks, disproportionately affecting the poorest.