Adhikari Basant, Ranabhat Kamal, Khanal Pratik, Poudel Manju, Marahatta Sujan Babu, Khanal Saval, Paudyal Vibhu, Shrestha Sunil
Ministry of Health, Bagmati Province, Hetauda, Nepal.
Nepal Public Health Association, Lalitpur, Nepal.
PLOS Glob Public Health. 2024 May 2;4(5):e0003128. doi: 10.1371/journal.pgph.0003128. eCollection 2024.
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.
在尼泊尔，确保基本药物的可及性仍然是一项艰巨的挑战。尼泊尔国内基本药物短缺的具体原因尚未得到广泛调查。本研究探讨了与基本药物可及性、采购流程困难以及不同层级公共卫生设施库存管理系统功能相关的挑战。在尼泊尔巴格马蒂省随机选取的六个区，对省和地方层面的卫生管理人员及服务提供者进行了59次半结构化深度访谈。访谈进行了录音并逐字转录，并采用归纳法对结果进行分析，随后将结果映射到“基本药物采购”的四个领域内。有效管理基本药物的主要障碍包括采购流程延误，主要是在地方层面，导致基本药物经常缺货，尤其是在卫生所层面。此外，还存在储存问题带来的挑战，主要原因是存储空间不足以及需要应对与新冠疫情相关的其他合并症。其他已识别的挑战包括缺乏物流管理信息系统培训、基层卫生设施缺乏信息技术资源、操作信息技术系统的合格人力资源不足以及电力备份不足。此外，服务点的需求估计不切实际、运输成本不足以及手工库存管理系统进一步加剧了这一复杂的挑战局面。本研究确定采购延误是尼泊尔巴格马蒂省基本药物短缺的主要原因。我们建议实施全面的采购指南、开展协作培训并划拨专项预算来解决这一问题。在资源匮乏地区改善采购和库存管理流程需要训练有素的工作人员、合适的存储空间，以及不同层级卫生设施内加强协调的行政层级，以确保这些地区全年都能获得基本药物。
