Table 2.

Summary of the types of connections identified between different actor groups and illustrative examples of the resultant COI based on the data

Groups involved	Type of connection	Examples
Policy actors and pharmaceutical industry	Financial (overt)	Some government officials and professional associations with influence over policy decisions might either (co)own, manage or receive benefits from companies that manufacture or distribute pharmaceutical products (Cambodia and Pakistan).
	Financial (covert)	Some government officials and community leaders reported to receive benefits from pharmaceutical companies (Cambodia and Pakistan).
	Political	US or UK-owned pharmaceutical companies can have their embassies lobby domestic politicians to prioritise policies that protect their pharmaceutical product sales (Pakistan).
	Social and familial	Some government officials might socialise with pharmaceutical company owners or executives in non-professional settings, leading to friendships and sometimes familial relations (eg, marriages) (Cambodia, Pakistan and Indonesia).
Policy actors and healthcare providers	Financial (overt)	Some government officials and members of professional association might own clinics, pharmacies or other type of health facilities (Cambodia and Pakistan). Certain healthcare providers might apply pressure for favourable prescribing guidelines on the professional associations that they support financially (Cambodia and Pakistan).
	Financial (covert)	Some government officials and members of professional associations reported to receive benefits from private healthcare providers (licensed or unlicensed) (Cambodia and Pakistan).
	Political	Some local government officials, who might have relationships with authorities at the national level, may use this relationship to protect local healthcare providers from federal, regulatory investigations (Cambodia and Pakistan). Some local government leaders struggle to crack down on informal practices because of the disruption it would cause to population access to healthcare, which they realise is critical for public support (Cambodia, Indonesia and Pakistan).
	Social and familial	Some government employees have family members who might own licensed or unlicensed private healthcare facilities and they can use this relationship to favour healthcare providers that they are related to (Cambodia). Government officials and healthcare providers they are regulating might be alumni of the same institution, or the provider might be the former teacher of the official (Indonesia). Government officials may receive medical care from private healthcare providers, and some might build a social relationship from these encounters (Pakistan).
Healthcare providers and pharmaceutical companies	Financial	Some pharmaceutical company owners or employees might (co)own a clinic, pharmacy or other type of health facility (Cambodia and Pakistan). Pharmaceutical companies often offer a range of benefits to licensed or unlicensed healthcare providers (Cambodia, Indonesia and Pakistan).
	Social	Pharmaceutical companies might arrange social events, often with a professional development angle, to build friendships with healthcare providers (Cambodia and Pakistan).
Licensed healthcare providers and other licensed healthcare providers	Financial	Some doctors prescribe to increase sales from specific pharmacies in exchange for kickbacks or because they own these pharmacies (Cambodia, Indonesia and Pakistan). Certain pharmacies sell antibiotics to midwives knowing this is outside of their usual treatment protocols (Indonesia). Large pharmacies sometimes act as wholesalers and sell medicines to other pharmacies, instead of only selling to patients with prescriptions in line with rules (Cambodia and Indonesia).
Licensed healthcare providers and unlicensed healthcare providers	Financial	Licensed providers may hire untrained people (including family members) to run their clinic or pharmacy while they are working elsewhere (Cambodia, Indonesia and Pakistan). Some doctors own unlicensed practices, such as drug shops, or purchase their medicines supplies from unlicensed drug sellers (Cambodia and Pakistan). Some licensed providers rent their license to unlicensed providers to allow them to open clinics or drug shops (Cambodia and Pakistan).
	Familial	Family members of licensed providers might own and manage unlicensed practices without having the required training, owing to the knowledge and support of the licensed provider (Cambodia and Pakistan).