IDEAS home Printed from https://ideas.repec.org/a/plo/pgph00/0003128.html
   My bibliography  Save this article

Procurement process and shortages of essential medicines in public health facilities: A qualitative study from Nepal

Author

Listed:
  • Basant Adhikari
  • Kamal Ranabhat
  • Pratik Khanal
  • Manju Poudel
  • Sujan Babu Marahatta
  • Saval Khanal
  • Vibhu Paudyal
  • Sunil Shrestha

Abstract

Ensuring access to essential medicines remains a formidable challenge in Nepal. The specific reasons for the shortage of essential medicines within Nepal have not been extensively investigated. This study addresses challenges associated with access to essential medicines, procurement process difficulties, and functionality of inventory management systems at different levels of public health facilities. Fifty-nine semi-structured in-depth interviews were conducted with health managers and service providers at provincial and local levels in six randomly selected districts of Bagmati province, Nepal. Interviews were audiotaped and transcribed verbatim, and the results were analyzed using the inductive approach and were later mapped within the four domains of “Procurement of essential medicines”. The major barriers for the effective management of essential medicines included delays in the procurement process, primarily locally, leading to frequent stock-out of essential drugs, particularly at the health post level. Additionally, challenges arise from storage problems, mainly due to insufficient storage space and the need to manage additional comorbidities related to COVID-19. Other identified challenges encompass the absence of training on logistics management information systems, a lack of information technology resources in primary health facilities, inadequate qualified human resources to operate the IT system, and insufficient power backup. Moreover, unrealistic demand estimation from the service points, inadequate transportation costs, and manual inventory management systems further contributed to the complex landscape of challenges. This study identified procurement delays as the primary cause of essential medicine shortages in Bagmati Province, Nepal. We recommend implementing comprehensive procurement guidelines, collaborative training, and dedicated budgets to address this issue. Improving the procurement and inventory management process in low-resource settings requires a well-trained workforce, suitable storage spaces, and enhanced coordinated administrative tiers within health facilities at different levels to ensure the year-round availability of essential medicines in these settings.

Suggested Citation

  • Basant Adhikari & Kamal Ranabhat & Pratik Khanal & Manju Poudel & Sujan Babu Marahatta & Saval Khanal & Vibhu Paudyal & Sunil Shrestha, 2024. "Procurement process and shortages of essential medicines in public health facilities: A qualitative study from Nepal," PLOS Global Public Health, Public Library of Science, vol. 4(5), pages 1-17, May.
    • Handle: RePEc:plo:pgph00:0003128
    DOI: 10.1371/journal.pgph.0003128
    as

    Download full text from publisher

    File URL: https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0003128
    Download Restriction: no
    File URL: https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0003128&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pgph.0003128?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Shaju George & Safaa Elrashid, 2023. "Inventory Management and Pharmaceutical Supply Chain Performance of Hospital Pharmacies in Bahrain: A Structural Equation Modeling Approach," SAGE Open, , vol. 13(1), pages 21582440221, January.
    2. Gemma Berenguer & Pinar Keskinocak & J. George Shanthikumar & Jayashankar M. Swaminathan & Luk Van Wassenhove & Jérémie Gallien & Iva Rashkova & Rifat Atun & Prashant Yadav, 2017. "National Drug Stockout Risks and the Global Fund Disbursement Process for Procurement," Production and Operations Management, Production and Operations Management Society, vol. 26(6), pages 997-1014, June.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. De Boeck, Kim & Decouttere, Catherine & Jónasson, Jónas Oddur & Vandaele, Nico, 2022. "Vaccine supply chains in resource-limited settings: Mitigating the impact of rainy season disruptions," European Journal of Operational Research, Elsevier, vol. 301(1), pages 300-317.
    2. Isaac Iyinoluwa Olufadewa & Miracle Ayomikun Adesina & Ruth Ifeoluwa Oladele & Moyinoluwa Joshua Oladoye & Nnenne Florence‐Ayambem Eke, 2021. "Global fund: Analyzing 10 Years of bridging health inequalities," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(2), pages 282-287, March.
    3. Jónas Oddur Jónasson & Kamalini Ramdas & Alp Sungu, 2022. "Social impact operations at the global base of the pyramid," Production and Operations Management, Production and Operations Management Society, vol. 31(12), pages 4364-4378, December.
    4. Raed Al-Husain, 2023. "Unveiling the Dynamics of Organizational Characteristics in Disaster Management: Insights from Kuwait," Sustainability, MDPI, vol. 15(17), pages 1-32, August.
    5. Sarang Deo & Sameer Mehta & Charles J. Corbett, 2022. "Optimal Scale‐Up of HIV Treatment Programs in Resource‐Limited Settings Under Supply Uncertainty," Production and Operations Management, Production and Operations Management Society, vol. 31(3), pages 883-905, March.
    6. Nahim Bin Zahur & Lucy Xiaolu Wang, 2024. "Procurement Institutions and Essential Drug Supply in Low and Middle-Income Countries," Working Paper 1519, Economics Department, Queen's University.
    7. Jérémie Gallien & Ngai‐Hang Z. Leung & Prashant Yadav, 2021. "Inventory Policies for Pharmaceutical Distribution in Zambia: Improving Availability and Access Equity," Production and Operations Management, Production and Operations Management Society, vol. 30(12), pages 4501-4521, December.
    8. Feng Qiu, 2024. "Exploring the Linkage Between Self-Construal and Student Learning Process with Moderation of Demotivation and Disengagement Drawing on TRA," SAGE Open, , vol. 14(2), pages 21582440241, May.
    9. Harwin De Vries & Lisa E. Swinkels & Luk N. Van Wassenhove, 2021. "Site Visit Frequency Policies for Mobile Family Planning Services," Production and Operations Management, Production and Operations Management Society, vol. 30(12), pages 4522-4540, December.
    10. Burak Kazaz & Scott Webster & Prashant Yadav, 2023. "Increasing the supply of health products in underserved regions," Production and Operations Management, Production and Operations Management Society, vol. 32(12), pages 4212-4228, December.
    11. Retsef Levi & Georgia Perakis & Gonzalo Romero, 2019. "Near-Optimality of Uniform Copayments for Subsidies and Taxes Allocation Problems," Operations Research, INFORMS, vol. 67(2), pages 548-561, March.
    12. Jónas Oddur Jónasson & Sarang Deo & Jérémie Gallien, 2017. "Improving HIV Early Infant Diagnosis Supply Chains in Sub-Saharan Africa: Models and Application to Mozambique," Operations Research, INFORMS, vol. 65(6), pages 1479-1493, December.
    13. Gemma Berenguer & Zuo-Jun (Max) Shen, 2020. "OM Forum—Challenges and Strategies in Managing Nonprofit Operations: An Operations Management Perspective," Manufacturing & Service Operations Management, INFORMS, vol. 22(5), pages 888-905, September.
    14. Amir Karimi & Anant Mishra & Karthik V. Natarajan & Kingshuk K. Sinha, 2021. "Managing Commodity Stock‐outs in Public Health Supply Chains in Developing Countries: An Empirical Analysis," Production and Operations Management, Production and Operations Management Society, vol. 30(9), pages 3116-3142, September.
    15. Xiaoshuai Fan & Ying‐Ju Chen & Christopher S. Tang, 2023. "Allocating scarce resources in the presence of private information and heterogeneous favoritism," Production and Operations Management, Production and Operations Management Society, vol. 32(7), pages 2068-2086, July.
    16. Thein Hlaing & Tun Win Lat, 2024. "Drug supply management at first-level public health facilities: Case of Pyay District, Myanmar," PLOS Global Public Health, Public Library of Science, vol. 4(9), pages 1-32, September.
    17. Nur Sunar & Jayashankar M. Swaminathan, 2022. "Socially relevant and inclusive operations management," Production and Operations Management, Production and Operations Management Society, vol. 31(12), pages 4379-4392, December.
    18. Mili Mehrotra & Karthik V. Natarajan, 2020. "Value of Combining Patient and Provider Incentives in Humanitarian Health Care Service Programs," Production and Operations Management, Production and Operations Management Society, vol. 29(3), pages 571-594, March.
    19. Ho‐Yin Mak & Tinglong Dai & Christopher S. Tang, 2022. "Managing two‐dose COVID‐19 vaccine rollouts with limited supply: Operations strategies for distributing time‐sensitive resources," Production and Operations Management, Production and Operations Management Society, vol. 31(12), pages 4424-4442, December.
    20. Johannes Jakubik & Stefan Feuerriegel, 2022. "Data‐driven allocation of development aid toward sustainable development goals: Evidence from HIV/AIDS," Production and Operations Management, Production and Operations Management Society, vol. 31(6), pages 2739-2756, June.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pgph00:0003128. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: globalpubhealth (email available below). General contact details of provider: https://journals.plos.org/globalpublichealth .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.