Informal Healthcare Provision in Urban Ethiopia: A Policy Analysis of Maternal Medicine,

In urban Ethiopia, informal, unregulated channels provide a substantial portion of maternal healthcare and medicines. This sector operates alongside the formal health system, creating a complex policy environment with implications for maternal health outcomes, medicine safety, and regulatory governance. This policy analysis critically examines policies addressing the informal provision of maternal medicines in urban Ethiopia. It aims to identify key policy gaps, analyse the coherence of the regulatory framework, and assess implications for women's access to safe maternal healthcare. The study employed qualitative document analysis of national health policies, pharmaceutical regulations, and strategic plans. A stakeholder-inclusive framework was used to analyse policy content, context, and processes, focusing on alignment with informal sector practices. Analysis revealed a persistent policy-practice disconnect. A dominant theme was the repeated failure of punitive regulatory approaches to curb informal provision, which supplies a substantial minority of urban maternal medicines. Policies largely neglect the socioeconomic drivers of informal sector use and lack integrated strategies to improve formal sector accessibility. Current policy frameworks are inadequate for managing the informal maternal medicine sector. An over-reliance on restrictive measures, without addressing underlying access barriers in the formal system, perpetuates risks and limits progress towards safe motherhood targets. Policymakers should shift towards a pragmatic, risk-proportionate regulatory model. This includes piloting accreditation programmes for informal vendors of essential maternal medicines, strengthening public pharmacovigilance, and implementing demand-side financing to improve access to formal sector care. maternal health, informal sector, medicine access, policy analysis, pharmaceutical regulation, urban health, Ethiopia This analysis provides a structured critique of the policy landscape governing informal maternal healthcare, offering evidence to inform more effective and realistic regulatory strategies.