Table 4

Theme 2; reasons of medicine shortages

SubthemeCategories and subcategoriesQuotations
Manufacturer levelRaw material related issues included:
  • Raw material import hurdles.

  • Lack of resources of raw material.

  • High cost of raw material.

  • Raw material quota issue.

‘One of the reasons is the raw material import. Sometimes there is hurdle, like raw material is not cleared by customs or other processes due to which their supply chain is stopped which result in the discontinuation of the product.’ (Regulator 8)
‘There is genuine problem that raw material sources are very rare in the world or are finished. Only there are few raw material manufacturers and they also produce material in limited quantity that worldwide supply chain got affected.’ (Regulator 12)
‘The second factor is price, there are many products whose raw materials are very costly…when manufacturer failed to get appropriate price then he tries to avoid manufacturing that product in which his profit margin is very low.’ (Distributor 1)
‘There are some controlled substances that have quota for specific manufacturing and they could not get more than this. So sometimes due to raw material constraints, a gap is created between supply and demand.’ (Regulator 10)
Planning gap‘There are the major chances that companies do wrong forecasting of the market demand…there is some planning gap. Planning is not very efficient which leads to shortages.’ (Distributor 5)
Limited resources‘Manufacturers don’t have enough resources. In resources there could be human resources or material resources or machinery resources. So in this situation there is shortage.’ (Manufacturer 4)
Electricity crisis‘There are energy crises that is, earlier the energy was supplied to firms for 24 hours but now it is reduced very much; so, due to this their production is suffering very much.’ (Regulator 2)
Lack of qualified personnelMany personnel are not qualified in industries that lead to production hurdles … they should have qualified people, so that the probability of production breakdown became less.’ (Manufacturer 2)
Distribution levelIntermittent or inadequate supply from the manufacturer’s side‘Their main reason is that distributors are not receiving supply. Manufacturers are not sending stock according to their demand so this is the main reason…Wholesalers and distributors are bound that if they don’t get supply then obviously they could not provide to others. If manufacturer is not supplying according to his demand then he is helpless.’ (Regulator 8)
Biassed distribution monopoly‘Sometimes, when distributors are aware that any particular product is short in the market then they do not distribute equally…They forward it to specific people and in this way shortage becomes severe.’ (Distributor 4)
‘When the demand of the drug is more in any other area then distributors supply medicines of one area to other area where the price is high. So the main reason of shortage is the supply of medicines from one province to another province.’ (Regulator 10)
Healthcare institute levelPoor inventory management and procurement procedure included:
  • Poor demand prediction.

  • Poor procurement procedure.

  • Pilferage of medicines.

‘There is problem in their demand prediction. When they don’t purchase according to demand then there will be shortage in future.’ (Distributor 1)
‘The procurement planning in not proper that how much you have to procure medicine? When you have to start the procurement cycle to purchase timely and efficiently?’ (Regulator 10)
‘One reason of shortage in hospitals is the pilferage of medicines. It is a big reason due to which patients don’t get their medicines.’ (Regulator 2)
Budget constraints‘There are some problems related to their budget. In our government hospitals the average of the patients is very high but their budget is less accordingly…due to which shortage is created many times.’ (Regulator 10)
Supply issue‘There is issue from distributor’s side that they are not supplying properly in hospitals. They are not providing the quantity demanded by hospital, due to which shortage happens.’ (Pharmacist 1)
‘In government hospitals, medicine is purchased in large amount because there is consumption in bulk quantity. But if the company is not producing in bulk according the demand of the government and fail to timely fulfill the demand then this could lead to shortages.’ (Distributor 7)
Delayed quality control testing‘…if the sample became late from Drug Testing Laboratory (DTL) then there could be drug shortage in hospital because they don’t release the batch for the patient use unless they get the pass report from DTL…’ (Pharmacist 10)
Product attribute-related issuesProduct’s financial non-viability or low price‘Low price is the major factor responsible for shortages. If your product is not financially viable for manufacturing, than obviously no one in the world manufacture medicines in losses.’ (Manufacturer 2)
‘There are many reasons of shortage and one of them is low price of certain drugs and companies don’t get price increase so they don’t get monetary benefit that’s why such drugs are often short for example thyroxin and acetazolamide, and they have intermittent supply.’ (Regulator 8)
‘We have observed that most of the medicines have low market price but its manufacturing cost is high, due to this reason manufacturers don’t market such medicine. They have submitted their requisitions to raise the price but the price is not increased yet.’ (Regulator 9)
Small market size or low demand product‘Some of the products have low market demand. The doctors don’t prescribe in much quantity and the manufacturers don’t want to produce.’ (Regulator 5)
‘Normally orphan drugs became short in the country because they have small market size and their patients are very limited.’ (Regulator 6)