Life in the buffer zone: Social relations and surplus health workers in Uganda’s medicines retail sector

Despite their critical role, medicine sellers are often excluded from health systems and policy research. In this paper, we ask ‘what happens to the conceptualisations of a health system when medicine sellers and their practices are foregrounded in research?’ We respond by arguing these sellers sit uncomfortably in the mechanical logic in which health systems are imagined as bounded institutions, tightly integrated and made up of intertwined and interconnected spaces, through which policies, ideas, capital and commodities flow. They challenge the functionalist holism running through complex adaptive systems (CAS) approach. Drawing on ethnographic research from Uganda (2018–2019), we propose that health systems are better understood as social fields in which unequally positioned social agents (the health worker, managers, patients, carers, citizens, politicians) compete and cooperate over the same limited resources.