Why Hospital Pharmacists Have Failed to Manage Antimalarial Drugs Stock-Outs in Pakistan? A Qualitative Insight

Abstract

Purpose. This study aimed to explore the perceptions of hospital pharmacists towards drug management and reasons underlying stock-outs of antimalarial drugs in Pakistan. Methods. A qualitative study was designed to explore the perceptions of hospital pharmacists regarding drug management and irrational use of antimalarial drugs in two major cities of Pakistan, namely, Islamabad (national capital) and Rawalpindi (twin city). Semistructured interviews were conducted with 16 hospital pharmacists using indepth interview guides at a place and time convenient for the respondents. Interviews, which were audiotaped and transcribed verbatim, were evaluated by thematic content analysis and by other authors' analysis. Results. Most of the respondents were of the view that financial constraints, inappropriate drug management, and inadequate funding were the factors contributing toward the problem of antimalarial drug stock-outs in healthcare facilities of Pakistan. The pharmacists anticipated that prescribing by nonproprietary names, training of health professionals, accepted role of hospital pharmacist in drug management, implementation of essential drug list and standard treatment guidelines for malaria in the healthcare system can minimize the problem of drug stock outs in healthcare system of Pakistan. Conclusion. The current study showed that all the respondents in the two cities agreed that hospital pharmacist has failed to play an effective role in efficient management of anti-malarial drugs stock-outs.

Drug Shortage: Causes, Impact, and Mitigation Strategies

“…The shortage of antimalarial drugs was seen in many low and middle-income countries. Acute shortage of antimalarial drugs (Artemether (P01BE02)/Lumefantrine (P01BF01) was found in Kenya, Sub-Saharan Africa, and Uganda due to the delayed procurement process which led to an increased mortality rate (Malik et al, 2013). Shortage of Chloroquine and Sulphadoxine/ Pyrimethamine (Fansidar) was also found in the public and private sector of Pakistan, creating a gap in effective malaria control (Malik et al, 2013).…”

“…Acute shortage of antimalarial drugs (Artemether (P01BE02)/Lumefantrine (P01BF01) was found in Kenya, Sub-Saharan Africa, and Uganda due to the delayed procurement process which led to an increased mortality rate (Malik et al, 2013). Shortage of Chloroquine and Sulphadoxine/ Pyrimethamine (Fansidar) was also found in the public and private sector of Pakistan, creating a gap in effective malaria control (Malik et al, 2013). Shortage of Chloroquine (P01BA01) and Hydroxychloroquine (P01BA02) was found during the COVID-19 pandemic in many countries due to increased demand (Mazer-Amirshahi et al, 2020).…”

“…In low-income countries, literature cited medicines used for TB, Malaria, and HIV due to the increased incidence of these diseases and the unavailability of essential drugs rather than drug shortages or stock-out. Table 1 shows the medicines affected by shortages in different countries (Elbagir et al, 1995;Kangwana et al, 2009;Tren et al, 2009;Ballinger, 2010;Ventola, 2011;Griffith et al, 2012;Liang and Mackey, 2012;Malik et al, 2013;Quilty, 2014;Ricci et al, 2016;Donohue and Angus, 2017;Gross et al, 2017;Hsueh et al, 2017;Meloni et al, 2017;Tan et al, 2017;Vail et al, 2017;Banerjee et al, 2018;Dave et al, 2018;Gundlapalli et al, 2018;Holcombe et al, 2018;Said et al, 2018;Benge and Burka, 2019;Visage et al, 2019;Yellapu et al, 2019;Benhabib et al, 2020;Choo and Rajkumar, 2020;Clark et al, 2020;Honda et al, 2020;Siow et al, 2020;Sun et al, 2020;Mclaughlin et al, 2017;Dave et al, 2018).…”

“…The causes of drug shortages are multifactorial. For example, manufacturing problems, financial pressures, shortage of raw materials, and just in time inventory are found as essential causes of medicine shortages in developed countries of the EU, United States, Saudi Arabia, and developing countries like Pakistan, Fiji (Malik et al, 2013;Hedman, 2016;Zu'bi and Abdallah, 2016;Schwartzberg et al, 2017;Walker et al, 2017;Jenzer et al, 2019). According to the UUDIS, the quality delays and capacity issues were most dominant in the United States, in 2012 followed by quality manufacturing issues and discontinuation (Figure 3) (Dill and Ahn, 2014), whereas a more significant percentage of reasons was unknown, in 2020, followed by business issues and supply/ demand issues (Figure 4) (Pharmacists, 2020).…”

“…It can be classified into manufacturing problems, unavailability of raw materials, business reasons (economic reasons like low-profit margin, low market size, cost raise of raw materials, capacity constraints), and logistic problems (supply chain issues) (Dill and Ahn, 2014;Bogaert et al, 2015;Organization, 2015;Alsheikh et al, 2016;Fox and Tyler, 2017;Walker et al, 2017;Alruthia et al, 2018;Fox and McLaughlin, 2018;Pharmacists, 2018;Videau et al, 2019b;Phuong et al, 2019). In high-income countries, these causes have been controlled to some extent, but in the low and middle-income countries, financial burden affects manufacturing quality and capability, medicines availability, affordability, and drug supply chain quantification (Malik et al, 2013;Walker et al, 2017).…”