Empty stocks and loose paper: Governing access to medicines through informality in Northern India

Abstract

Based upon research in the state of Bihar, India, this article argues that informal access to medicines in Northern India is a core element of the government of healthcare. Informal providers such as unlicensed village doctors and unlicensed drug sellers play a major role in access to medicines in Bihar, in the particular context of the dismantling of public procurement services. Building on recent works in the socio-anthropology of pharmaceuticals, the article shows the importance of taking into account the political economy of drugs in India, in order to understand local problems of access more fully. If informal providers occupy such an important position in the government of healthcare in India, this is partly due to the shaping of healthcare as access to drugs on health markets. Elaborating the argument from interviews with health professionals and patients, the article first shows the situation of public healthcare and public procurement in Bihar; then it presents the role of informal medicine providers; lastly, it shows how patients deal with the fact that they live in a ‘pharmaceutical world’ where access to health equates with access to medicines.