Trust, risk and uncertainty in medicinal transactions in Sub-Saharan Africa: Integrating Behavioural Game Theory and Ethnography to develop a robust analytical framework to address a major global public health challenge. (360G-Wellcome-110084_Z_15_Z)

Medicines are at the centre of a major global public health crisis. Widespread counterfeiting and unprecedented global traffic of pharmaceuticals have created significant trust problems for patients and others, particularly where regulation is weak, with serious risks for individual and public health. We propose to develop a robust analytical framework to understand the mechanisms that foster the production of trust in medicinal transactions in sub-Saharan Africa. Our question is: how, under con ditions of uncertainty and informational asymmetry, do actors (consumers and providers) come to trust and distrust particular medicines, and how does this shape practice? Our goal is to bring together the richness of ethnographic enquiry with the powerful analytical approaches offered by Behavioural Game Theory in order to address this pressing global public health problem. This seed award application, to support the development of a full Wellcome Collaborative proposal, would be used to conduct a pilot and feasibility study in Ghana and Tanzania; collect preliminary data to underpin theoretical and methodological development; build/consolidate international academic and stake-holder partnerships; and develop local research capacity. This is particularly important given the theoretically-novel and ambitious nature of the proposed larger study and the new international, inter-disciplinary research consortium we are building.