Medicines and therapeutic pluralism in Maputo: exploring modalities of trust and the (un)certainties of everyday users

Abstract

The increased accessibility of medicines across the globe has expanded choice in therapeutic consumption. These changes give rise to increasing complexity and new uncertainties regarding the repertoire of therapeutic resources available for everyday users. This raises questions of how individuals evaluate different therapeutic resources and how they choose among such diversity in their daily lives. Using ongoing research in Maputo, Mozambique, in this article I explore how different modalities of trust influence decision-making processes concerning medicine use for minor ailments, particularly the role of trust in the management of perceived uncertainty and risk in a context of therapeutic pluralism. In this article, I draw on data from a study on pharmaceutical use in Maputo, Mozambique. The research included 8 months of ethnographic fieldwork in 2013 and 2014 plus seven focus group discussions with a total of 42 participants. I found that three main layers of trust framed individuals’ relations to medicine use: trust in medical systems, trust in health organisations and providers and trust in personal and socially shared experiences. Despite being strongly intertwined, these different layers played different roles in decision-making. The third layer, grounded on ‘lay’ bases of knowledge and experience, played a major role when individuals chose between the available repertoire of therapeutic resources for minor ailments.

Keywords:

• risk
• trust
• medicines
• therapeutic pluralism
• Maputo
• Mozambique

Acknowledgements

This research was supported by the Portuguese national funding agency for science, research and technology (FCT) under Grant SFRH/BD/78172/2011. I am grateful to Anita Hardon, Noémia Lopes and Trudie Gerrits for their insightful comments on earlier versions of this article. I am especially thankful to Patrick Brown for his challenging and highly constructive input, as well as to the reviewers for their comments and constructive feedback.

Disclosure statement

No potential conflict of interest was reported by the author.​​​

Additional information

Funding

This research was supported by the Portuguese national funding agency for science, research and technology (FCT) [grant number SFRH/BD/78172/2011].