TABLE 2.

Reported Barriers to Reporting Substandard and Falsified Medical Products Among Health Care Professionals in Tanzania and Indonesia

Theme	Subthemes	Example Quotations, Tanzania	Example Quotations, Indonesia
Difficulties in identifying substandard or falsified products	Difficulty identifying substandard and falsified products	“Knowledge among the health workers on how to identify and report counterfeit drugs/medical products.”	“To judge whether it is a fake/substandard drug or not is difficult.” “Not knowing/not being able to distinguish/recognize real/fake drugs.” “There is a fear that the report we make is wrong.”
	Lack of general awareness/knowledge about substandard and falsified products	“People are not knowledgeable on substandard and falsified medical products.”	“If no one reports to us if there is a drug that is suspected to be fake/illegal.”
Technical and logistical frustrations with current reporting systems	Current reporting process is unwieldy	“Complicated yellow form for filling substandard and falsified medical product.” “The system we use is not user-friendly - it is time consuming.”	“There is no way to quickly report drugs.” “Worry/fear the process becomes long/burdensome.” “There is no easier way of reporting yet.”
	Time/capacity constraints on reporting	“Time limitations.” “Short staff.”	“Dense work at the hospital.”
	No (prompt) feedback from national medicine regulatory authority after reporting	“Lack of quick feedback mechanism after reporting.” “Follow-up and feedback of reported cases was not easy. It reduces the morale of reporting.” “Poor feedback from authority.”	“Fear that there is no follow-up from the parties concerned.”
	Health care professional and public do not know how to report	“Health care provider doesn’t have the education on what to do.” “Awareness of the public on how to report the resulted medical effect.”	“Do not know clearly the reporting process.”
Fears of repercussions: personal safety and reputational risks	Risks to personal security	“Threaten to reporters.” “No trust for privacy after reporting the matter.”	“I’m afraid of because of reporting this, the hospital could get into trouble and lose employment.” “The reporter’s security guarantee.” “As an informant, there are considerations that need to be taken regarding the reporting of the drug, in the sense that the reporter is not suspected of more than his role so that legal protection is needed for the reporter.”
	Reputational risks	Not applicable	“When an incident occurs due to substandard or counterfeit drugs in my hospital, then it is reported, it will affect the public perception of my hospital even though the cause is unknown, so it is not reported.” “Barrier/paradigm that hospitals become fake drug carriers.”