Introduction and Objectives

Medicine shortages have become a complex global problem. There is limited data to quantify the full extent of the burden of medicines stock outs, but as stock outs increase, country health systems incur extra costs in managing them as well as the problems that arise in patient care. Clinical outcomes for patients may be adversely affected because of non-treatment, under-treatment and possible medication error from attempts to substitute missing medicines. (Hedman, 2015)

The Philippines has been facing an increasing incidence of medicine shortages over the past decade, specifically for vaccines in our national immunization program (i.e., pentavalent vaccines, rabies vaccines) and supply failures of several lifesaving medicines across our public hospitals (e.g., first line cancer drugs, dialysates, drug for end stage renal disease, old antibiotics). The reasons for medicines shortages are diverse, requiring urgent attention by the government as they lead to adverse patient outcomes.

The recently enacted Universal Health Care Law ensures that all Filipinos are guaranteed equitable access to quality and affordable health care goods and services, and protected against financial risk. Thus, the Philippines recognizes the importance of an efficient supply chain with good information systems to track and monitor the movement of products and predict shortages. As a result, the country is currently establishing a notification system for reporting products in short supply to better understand the issues and design preemptive strategies in coordination with our Food and Drug Administration (FDA), drug manufacturers, patient and healthcare providers.

This study aimed to analyze the causes and frequency of drug shortages and stockouts in the Philippines through key informant interviews with stakeholders in the drug management system in the country. The following are the specific objectives:

• To identify drugs frequently out of stock or in shortage in health facilities
• identify the most common causes of drug shortages in the Philippines at each level of pharmaceutical supply chain;
• To recognize the existing strategies of stakeholders in addressing drug shortages in the country and assess its impact;
• To formulate policy recommendations or solutions which FDA, DOH, industry and healthcare providers can take to prevent and address drug shortages.

Methods

The study used mixed methods using purposive sampling to answer the objectives of the study. It incorporated quantitative data (medicines affected by stockouts and shortages, and frequency), and qualitative data (Semi structured interviews were used to extract insights on the causes of stockouts and management strategies). 

The content of the qualitative tool was based on the World Health Organization’s Questionnaire for the Rapid Assessment of Medicines Procurement and Supply Management Systems and Management Sciences for Health’s Assessment Guide on Distribution. These two tools were combined to cover the different factors affecting stock outs and shortages under the entire drug management and distribution cycles. The KII transcripts were processed using MAXQDA, a computer assisted qualitative data analysis software.

Results and Discussion

The data limitations and poor cooperation of some stakeholders cannot provide substantial data to measure the magnitude of stockouts and shortages and to see the trends in the past three years. However, the data collection showed selected provinces in Luzon reporting stockouts of Pneumococcal Polyvalent Vaccine (PPV 23), Influenza Polyvalent Vaccine (Flu) and Human Papillomavirus Vaccine (HPV) in 2020. It also showed similar findings of the drug availability surveys conducted in 2016 and 2019 reporting anti hypertensives and anti-diabetic drugs as fast moving medicines with frequent stockouts. 

The respondents echo the findings of the previous studies by attributing the causes of drug shortages and stockouts to any form of disruption to the supply chain processes. However, the extent of shortage and stockout is more measurable and anticipated in private facilities than in public facilities. This is because of the data driven and IT enabled supply chain system of the private sector. 

Conclusion and Recommendations

The causes of drug shortage and stockouts are generally attributed to a disruption at any point in the supply chain process. In the private sector, they are generally capable of anticipating drug shortages and stockouts. Future shortages are managed by stock build-up informed by an IT enabled supply chain flow, data sharing, and collaborative planning across different supply chain levels. On the other hand, the public sector supply chain is most of the time only reactive to drug shortages and stockouts. This is because of several resource limitations such as human resources, fragmented IT systems and processes and warehouse and logistics capacity. 

To manage the impact of supply chain disruptions to service delivery, manufacturers and distributors practice equitable reallocation of drugs and medicine informed by their data systems.  The public sector resorts to alternative procurement modalities such as shopping, emergency purchases and extensive coordination for stock reallocation.

  At the facility level, the limited storage capacity of hospitals, private retail facilities, and RHUs requires thorough forecasting and procurement planning to ensure timely replenishment of stocks. Drug shortages and stockouts also have policy dimensions. These include the regulatory requirements and the procurement law. There is a need to improve the regulatory processes to expedite market entry of drugs and medicines within acceptable shelf life requirements. The public sector also needs an improved procurement system for drugs and medicines together with adequate and predictable financing mechanisms. 

In line with the full implementation of the UHC Law, the following policy recommendations can be recommended:

• Create a macro-level oversight for the DOH supply chain
• Create a harmonized DOH SCMS Strategic Plan
• Ensure Predictable funding flow and sufficient financial requirements.
• Build the capacity of LGUs under UHC
• Review and monitor the existing supply chain-related policies
• Improve regulatory capacity