Main causes of medicine stock-outs in mauritania: a qualitative study

The number of medicine stock-outs (MSOs) is increasing globally. In Mauritania, they are recurring, although, to our knowledge, no study has yet been conducted to determine the causes. Therefore, this qualitative study aims to identify the main local or national causes of stock-outs to provide a common understanding and guide policy-makers towards corrective actions. The study was carried out in five health districts and at the regional and central levels. The samples were purposive. Two focus groups and twenty semi-structured individual interviews were held with 38 participants, including health professionals, managers from the Central Purchasing Office for Essential Medicines and Consumables (CAMEC), the Pharmacy and Laboratory Department (DPL) and the Ministry of Health (MoH). All interviews were recorded and transcribed. A thematic content analysis was carried out. Our findings indicate the national causes of MSOs at three healthcare system levels (operational, regional, and central). They were grouped into five categories: insufficient human resource capacity (number of staff, training, retention), communication and coordination problems between stakeholders, logistical constraints (transport, storage), financial constraints, inadequate forecasting of needs, and complex procurement procedures. These causes of MSOs are interconnected, and many could be addressed locally through solutions initiated and led by the Mauritanian authorities. To address MSOs sustainably, we suggest and discuss some possible actions, including reforms to improve CAMEC’s governance and accountability and, more broadly, to strengthen the various pillars of the local health and pharmaceutical system. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The project received ethical approval from the Institutional Review Board of the Institute of Tropical Medicine of Antwerp in Belgium (Ref. No. 1640/22). In the absence of an ethical committee in Mauritania, approval was obtained from the Ministry of Health of Mauritania (Ref N ° 000208/2022). All participants gave their approval and signed the informed consent. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The raw data from this study are interview transcripts, which contain potentially identifiable and sensitive information about participants. We are unable to share this data publicly due to restrictions imposed by the Institutional Review Board of the Antwerp Institute of Tropical Medicine, as participants have not consented to their data being shared outside the study team. Relevant de-identified extracts from the transcripts are included in the article. Requests for further information can be sent to the Institutional Review Board of the Antwerp Institute of Tropical Medicine at irb{at}itg.be. * AMC : average monthly consumption AI-PASS : project Institutional Support for the Health Sector Support Program CAMEC : ( Centrale d’Achat des Médicaments Essentiels et Consommables): Central Purchasing Office for Essential Medicines and Consumables DPL : Pharmacy and Laboratory Department MoH : Ministry of Health MSOs : medicine stock-outs NEML : national Essential Medicines List HDI : Human Development Index INRUD : International Network for Rational Use of Drugs RHD : Regional Health Directorates RLSs : resource-limited settings SARA : Services, Availability and Readiness Assessment UHC : Universal Health Coverage WHO : World Health Organization