Lived experiences of ethical dilemmas in pricing life-saving medicines among private-sector pharmacists in Zimbabwe

BACKGROUND: Access to affordable medicines is central to primary health care and universal health coverage. In Zimbabwe, the absence of national price regulation and heavy out-of-pocket expenditure place private-sector pharmacists at the centre of difficult decisions, as they balance professional duty with business survival. AIM: This study aimed to explore the ethical dilemmas faced by pharmacists in Zimbabwe's private sector when pricing life-saving medicines and the coping mechanisms and support systems they employ. SETTING: The study was conducted in private community pharmacies located in Harare and Bulawayo, Zimbabwe's two largest urban pharmaceutical markets. METHODS: A qualitative interpretive phenomenological design was used. Semi-structured interviews were conducted with 12 pharmacists (6 Harare, 6 Bulawayo) who were purposively sampled from independent and chain pharmacies. Interviews were recorded, transcribed verbatim, and thematically analysed using Braun and Clarke's six-phase framework. NVivo supported coding. RESULTS: Pharmacists described moral distress when patients could not afford medicines, particularly insulin and antihypertensives. Informal coping strategies included silent discounts, partial dispensing, referrals, and credit sales. Harare participants emphasised currency volatility and chain-store policies, whereas Bulawayo pharmacists highlighted community solidarity. All called for systemic support through ethical pricing guidelines, subsidy mechanisms, and professional forums. CONCLUSION: Ethical dilemmas in pricing are pervasive. Coping strategies provide temporary relief but are unsustainable and may compromise care. Systemic reforms are required to balance affordability with sustainable pharmacy practice.Contribution: This study highlights the moral dimension of medicine pricing in Zimbabwe and provides evidence to guide ethical frameworks, regulatory reforms, and professional support for equitable access to medicines.