{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T03:20:01Z","timestamp":1793157601715,"version":"4.5.0"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T00:00:00Z","timestamp":1714608000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Health Logistics Management Center, Ministry of Social Development, Bagmati Province"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>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 \u201cProcurement of essential medicines\u201d. 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.<\/jats:p>","DOI":"10.1371\/journal.pgph.0003128","type":"journal-article","created":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T17:29:10Z","timestamp":1714670950000},"page":"e0003128","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":24,"title":["Procurement process and shortages of essential medicines in public health facilities: A qualitative study from Nepal"],"prefix":"10.1371","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3838-319X","authenticated-orcid":true,"given":"Basant","family":"Adhikari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamal","family":"Ranabhat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pratik","family":"Khanal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manju","family":"Poudel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujan Babu","family":"Marahatta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saval","family":"Khanal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vibhu","family":"Paudyal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9174-7120","authenticated-orcid":true,"given":"Sunil","family":"Shrestha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,5,2]]},"reference":[{"issue":"2","key":"pgph.0003128.ref001","doi-asserted-by":"crossref","first-page":"142","DOI":"10.4161\/23288604.2014.968005","article-title":"Health Product Supply Chains in Developing Countries: Diagnosis of the Root Causes of Underperformance and an Agenda for Reform.","volume":"1","author":"P. Yadav","year":"2015","journal-title":"Health Syst Reform."},{"issue":"2","key":"pgph.0003128.ref002","doi-asserted-by":"crossref","first-page":"e0191778","DOI":"10.1371\/journal.pone.0191778","article-title":"Medicine procurement in hospital pharmacies of Nepal: A qualitative study based on the Basel Statements.","volume":"13","author":"M Shrestha","year":"2018","journal-title":"PLoS One"},{"issue":"1","key":"pgph.0003128.ref003","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1186\/s12960-022-00755-8","article-title":"Stock-outs of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs): a systematic literature review of the extent, reasons, and consequences.","volume":"20","author":"A Olaniran","year":"2022","journal-title":"Human Resources for Health"},{"issue":"9","key":"pgph.0003128.ref004","doi-asserted-by":"crossref","first-page":"e0274776","DOI":"10.1371\/journal.pone.0274776","article-title":"Availability and stock-out duration of essential medicines in Shegaw Motta general hospital and Motta Health Centre, North West Ethiopia.","volume":"17","author":"BB Tefera","year":"2022","journal-title":"PLoS One"},{"issue":"1","key":"pgph.0003128.ref005","first-page":"010406","article-title":"Barriers and facilitators to the quality use of essential medicines for maternal health in low-resource countries: An Ishikawa framework.","volume":"5","author":"DN Tran","year":"2015","journal-title":"J Glob Health"},{"key":"pgph.0003128.ref006","doi-asserted-by":"crossref","first-page":"104078","DOI":"10.1016\/j.drugpo.2023.104078","article-title":"Barriers to accessing internationally controlled essential medicines in sub-saharan Africa: A scoping review.","volume":"118","author":"GI Ooms","year":"2023","journal-title":"Int J Drug Policy."},{"issue":"5","key":"pgph.0003128.ref007","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1016\/j.kint.2022.07.029","article-title":"Barriers to accessing essential medicines for kidney disease in low-and lower middle\u2013income countries","volume":"102","author":"A Francis","year":"2022","journal-title":"Kidney Int"},{"issue":"6","key":"pgph.0003128.ref008","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1016\/j.jsps.2023.04.019","article-title":"Local causes of essential medicines shortages from the perspective of supply chain professionals in Saudi Arabia.","volume":"31","author":"Y AlRuthia","year":"2023","journal-title":"Saudi Pharm J"},{"issue":"1","key":"pgph.0003128.ref009","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s12889-021-12361-9","article-title":"Medicines and vaccines supply chains challenges in Nigeria: a scoping review.","volume":"22","author":"VO Olutuase","year":"2022","journal-title":"BMC Public Health"},{"key":"pgph.0003128.ref010","article-title":"Strategic issues in pharmaceutical supply chains: a review.","author":"RK Singh","year":"2016","journal-title":"International Journal of Pharmaceutical and Healthcare Marketing"},{"issue":"1","key":"pgph.0003128.ref011","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1186\/s12913-019-4087-0","article-title":"Availability of essential medicines and pharmaceutical inventory management practice at health centers of Adama town, Ethiopia.","volume":"19","author":"AT Kefale","year":"2019","journal-title":"BMC Health Services Research"},{"issue":"1","key":"pgph.0003128.ref012","doi-asserted-by":"crossref","first-page":"21582440221149717","DOI":"10.1177\/21582440221149717","article-title":"Inventory Management and Pharmaceutical Supply Chain Performance of Hospital Pharmacies in Bahrain: A Structural Equation Modeling Approach.","volume":"13","author":"S George","year":"2023","journal-title":"SAGE Open."},{"key":"pgph.0003128.ref013","doi-asserted-by":"crossref","first-page":"106051","DOI":"10.1016\/j.cie.2019.106051","article-title":"Modelling and analysis of inventory management systems in healthcare: A review and reflections.","volume":"137","author":"E Saha","year":"2019","journal-title":"Computers & Industrial Engineering."},{"issue":"2","key":"pgph.0003128.ref014","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1080\/20476965.2018.1496875","article-title":"Inventory management of surgical supplies and sterile instruments in hospitals: a literature review.","volume":"8","author":"E Ahmadi","year":"2019","journal-title":"Health Syst (Basingstoke)."},{"issue":"4","key":"pgph.0003128.ref015","doi-asserted-by":"crossref","first-page":"195","DOI":"10.15171\/ijhpm.2018.121","article-title":"Implementing Federalism in the Health System of Nepal: Opportunities and Challenges.","volume":"8","author":"R Thapa","year":"2019","journal-title":"Int J Health Policy Manag."},{"key":"pgph.0003128.ref016","unstructured":"DoHS. Annual Report FY 2077\/78 (2020\/21) 2022 [cited 2022 October 24]. Available from: https:\/\/dohs.gov.np\/category\/annual-report\/."},{"issue":"2","key":"pgph.0003128.ref017","doi-asserted-by":"crossref","first-page":"212","DOI":"10.4103\/2321-4848.196212","article-title":"Hospital pharmacy services in teaching hospitals in Nepal: challenges and the way forward.","volume":"4","author":"PR Shankar","year":"2016","journal-title":"Archives of Medicine and Health Sciences"},{"key":"pgph.0003128.ref018","article-title":"Availability, Price, and Affordability of Essential Medicines to Manage Noncommunicable Diseases: A National Survey From Nepal.","volume":"56","author":"S Khanal","year":"2019","journal-title":"INQUIRY: The Journal of Health Care Organization, Provision, and Financing."},{"key":"pgph.0003128.ref019","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s40545-020-0203-0","article-title":"Price variation among different brands of anticancer medicines available in hospital pharmacies of Nepal.","volume":"13","author":"S Shrestha","year":"2020","journal-title":"J Pharm Policy Pract."},{"issue":"10067","key":"pgph.0003128.ref020","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/S0140-6736(16)31599-9","article-title":"Essential medicines for universal health coverage","volume":"389","author":"VJ Wirtz","year":"2017","journal-title":"Lancet"},{"issue":"2","key":"pgph.0003128.ref021","doi-asserted-by":"crossref","first-page":"e000243","DOI":"10.1136\/bmjgh-2016-000243","article-title":"Do changes to supply chains and procurement processes yield cost savings and improve availability of pharmaceuticals, vaccines or health products? A systematic review of evidence from low-income and middle-income countries","volume":"2","author":"G Seidman","year":"2017","journal-title":"BMJ Glob Health"},{"issue":"5","key":"pgph.0003128.ref022","doi-asserted-by":"crossref","first-page":"e0156026","DOI":"10.1371\/journal.pone.0156026","article-title":"The Impact of Inventory Management on Stock-Outs of Essential Drugs in Sub-Saharan Africa: Secondary Analysis of a Field Experiment in Zambia.","volume":"11","author":"N-HZ Leung","year":"2016","journal-title":"PLOS ONE."},{"issue":"6","key":"pgph.0003128.ref023","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1111\/poms.12662","article-title":"National drug stockout risks and the global fund disbursement process for procurement","volume":"26","author":"J Gallien","year":"2017","journal-title":"Production and Operations Management"},{"issue":"9","key":"pgph.0003128.ref024","doi-asserted-by":"crossref","first-page":"e027028","DOI":"10.1136\/bmjopen-2018-027028","article-title":"Medicines shortages in Pakistan: a qualitative study to explore current situation, reasons and possible solutions to overcome the barriers","volume":"9","author":"M Atif","year":"2019","journal-title":"BMJ Open"},{"issue":"10","key":"pgph.0003128.ref025","doi-asserted-by":"crossref","first-page":"e0165183","DOI":"10.1371\/journal.pone.0165183","article-title":"Current situation, determinants, and solutions to drug shortages in Shaanxi Province, China: a qualitative study.","volume":"11","author":"C Yang","year":"2016","journal-title":"PloS one."},{"issue":"3","key":"pgph.0003128.ref026","doi-asserted-by":"crossref","first-page":"e0119322","DOI":"10.1371\/journal.pone.0119322","article-title":"Insights into European drug shortages: a survey of hospital pharmacists.","volume":"10","author":"K Pauwels","year":"2015","journal-title":"PloS one."},{"key":"pgph.0003128.ref027","volume-title":"An overview of findings from 26 assessment reports","author":"World Health Organization","year":"2010"},{"key":"pgph.0003128.ref028","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40545-020-00208-4","article-title":"Tackling the blind spot of poor-quality medicines in universal health coverage.","volume":"13","author":"E Orubu","year":"2020","journal-title":"J Pharm Policy Pract"},{"issue":"10","key":"pgph.0003128.ref029","doi-asserted-by":"crossref","first-page":"e1001327","DOI":"10.1371\/journal.pmed.1001327","article-title":"Strengthening medical product regulation in low-and middle-income countries","volume":"9","author":"C Preston","year":"2012","journal-title":"PLoS Med"},{"key":"pgph.0003128.ref030","unstructured":"Silve B. Health logistics is a profession: improving the performance of health in developing countries, Field Actions Science Reports [Online], Vol. 1 | 2008, Online since 22 January 2009, connection on 04 April 2024. Available in http:\/\/journals.openedition.org\/factsreports\/109"},{"issue":"10","key":"pgph.0003128.ref031","first-page":"101","article-title":"Barriers to access: availability and affordability of essential drugs in a retail outlet of a public health center in south western Ethiopia","volume":"3","author":"Z Abiye","year":"2013","journal-title":"Journal of Applied Pharmaceutical Science"},{"issue":"10","key":"pgph.0003128.ref032","first-page":"63","article-title":"Factors influencing frequent stock-outs of essential medicines in public health facilities in Kisii County, Kenya.","volume":"18","author":"MW Fredrick","year":"2016","journal-title":"IOSR J Business Manag"},{"issue":"1","key":"pgph.0003128.ref033","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1186\/s12913-020-05080-1","article-title":"Medicine shortages and challenges with the procurement process among public sector hospitals in South Africa; findings and implications.","volume":"20","author":"C Modisakeng","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"pgph.0003128.ref034","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1186\/s12889-015-2525-4","article-title":"What influences availability of medicines for the community management of childhood illnesses in central Uganda? Implications for scaling up the integrated community case management programme.","volume":"15","author":"J Bagonza","year":"2015","journal-title":"BMC Public Health"},{"issue":"5","key":"pgph.0003128.ref035","doi-asserted-by":"crossref","first-page":"737","DOI":"10.4269\/ajtmh.2009.80.737","article-title":"Malaria drug shortages in Kenya: a major failure to provide access to effective treatment","volume":"80","author":"BB Kangwana","year":"2009","journal-title":"Am J Trop Med Hyg"},{"key":"pgph.0003128.ref036","author":"U-OO Abu","year":"2020","journal-title":"Availability of Essential Medicines in Malawi\u2019s Public Health Facilities: Enablers and Barriers: The University of North Carolina at Chapel Hill"},{"key":"pgph.0003128.ref037","doi-asserted-by":"crossref","unstructured":"ChePa N, Jasin NM, Bakar NAA, editors. How change management can prevent the failure of information systems implementation among Malaysian government hospitals? AIP Conference Proceedings; 2017: AIP Publishing LLC.","DOI":"10.1063\/1.5005370"},{"issue":"18","key":"pgph.0003128.ref038","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.2146\/sp130001","article-title":"ASHP guidelines: minimum standard for pharmacies in hospitals.","volume":"70","author":"TS Brenner","year":"2013","journal-title":"Am J Health Syst Pharm"},{"issue":"2017","key":"pgph.0003128.ref039","first-page":"20130306","article-title":"Shelf life modelling for first-expired-first-out warehouse management.","volume":"372","author":"ML Hertog","year":"2014","journal-title":"Philos Trans A Math Phys Eng Sci"},{"issue":"8","key":"pgph.0003128.ref040","doi-asserted-by":"crossref","first-page":"11157","DOI":"10.1007\/s10668-020-01115-z","article-title":"Maintaining efficient logistics and supply chain management operations during and after coronavirus (COVID-19) pandemic: learning from the past experiences.","volume":"23","author":"U Illahi","year":"2021","journal-title":"Environ Dev Sustain."},{"issue":"7","key":"pgph.0003128.ref041","doi-asserted-by":"crossref","first-page":"e0232966","DOI":"10.1371\/journal.pone.0232966","article-title":"Importance of medicine quality in achieving universal health coverage.","volume":"15","author":"S Ozawa","year":"2020","journal-title":"PLoS One."}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0003128","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T17:29:34Z","timestamp":1714670974000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0003128"}},"subtitle":[],"editor":[{"given":"Julia","family":"Robinson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,5,2]]},"references-count":41,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0003128","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,2]]}}}