Drug counterfeiting has serious public health and safety implications; it is estimated that up to 15 % of drugs sold worldwide are counterfeit, with the percentage reaching up to 50 % in parts of Africa and Asia.

We examined a range of systems-level interventions to combat or prevent drug counterfeiting and found some evidence on their efficiency, reliability, ability to detect counterfeit drugs, cost-effectiveness, acceptability, and/or implementation considerations.

Contextual factors are critical in shaping health system decisions, and policymakers need to take these into consideration to ensure effective implementation and, ultimately, the success of systems-level interventions to combat or prevent drug counterfeiting.