Medicine shortages in Fiji: A qualitative exploration of stakeholders’ views

Abstract

ObjectivesMedicine access is a human right; yet, concerningly, there are international instances of shortages. Quantitative data has allowed WHO to propose global solutions; however, individualised understanding of specific regions is still required to work towards national solutions. Fiji has an established issue with medication supply and the aim of this study was to use qualitative methods to gain a fuller understanding of this context.MethodsSemi-structured interviews were used to gain the perspective of key stakeholders involved in the Fijian medicine supply chain in regards to causes, impacts and possible solutions of medicine shortages. Thematic analysis was used to analyse the interview data.ResultsIn total, 48 stakeholders participated and the information was synthesised into three main themes, causes, impacts and solutions and the sub-themes including; political, system and patient causes, adverse health effects on patients, professional dissatisfaction, monetary loss and loss of faith in the health system, workarounds, operation improvements, government intervention and education and training.ConclusionsThe situation in Fiji is not dissimilar to other instances of shortages around the world and hence international solutions like that proposed by WHO are feasible; however, they must be modified to be uniquely Fijian to work in this context.

Medicine shortages and challenges with the procurement process among public sector hospitals in South Africa; findings and implications

“…Over the years, the shortage of medicines has been a challenge to the effective delivery of quality healthcare services worldwide including South Africa [1][2][3][4][5][6][7][8][9][10], with shortages of even essential medicines becoming a global problem irrespective of the economic status of countries [11][12][13]. More than half of the world's population do not have access to essential services [14], exacerbated by medicine shortages.…”

“…In Europe, a recent survey among hospital pharmacists showed there had been a significant increase in medicine shortages across Europe with 91.8% hospital pharmacists in 2018 experiencing shortages compared to 86.2% in 2014, with 35% experiencing them on a daily basis and 38% on a weekly basis [17], which is a concern. There are also considerable shortages in other continents and countries including other low and middle income countries (LMICs) across South America and wider [5,6,8,9].…”

“…Some of the contributing factors to the shortage of medicines include manufacturing and quality problems, production delays, lack of manufacturing capacity, shortage of raw materials, political instability, and profitability issues [5,6,8,9,18]. Other factors include long lead times, delays in awarding tenders, absence of national contracts on the regional code lists of medicines, the failure of suppliers to meet demand, and the failure to pay suppliers [2,19,20].…”

How coping can hide larger systems problems: the routine immunisation supply chain in Bihar, India

“…This could have substantial implications as anecdotal evidence suggests that coping is going on frequently throughout many different health systems worldwide. This includes stories of healthcare personnel spending non-working hours completing their work,1 taking on tasks for which they are untrained or unprepared,3 and circumventing protocols to administer medications during shortages 32…”

Patient-related factors associated with poor glycaemic control among patients with type 2 diabetes mellitus

“…Studies conducted in Fiji have shown that shortages of medications, medical consumables and basic medical equipment affect healthcare providers, patients and quality of healthcare delivery. 36,37 In ignoring patient-related factors, healthcare providers may tend to limit their focus to clinically-oriented issues and may miss many opportunities for effective intervention to achieve good glycaemic control.…”