Key stakeholders' views on the causes of medicine stock-outs in Mauritania: A qualitative study

The number of medicine stock-outs 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 explore the views of key stakeholders in the pharmaceutical sector to identify the main local or national causes of stock-outs. It will thus provide a common understanding and guide policy-makers towards corrective action. 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, the Pharmacy and Laboratory Department and the Ministry of Health. All interviews were recorded and transcribed. A thematic content analysis was carried out. Our findings indicate the national causes of medicine stock-outs 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 medicine stock-outs are interconnected, and many could be addressed locally through solutions initiated and led by the Mauritanian authorities. To address medicine stock-outs sustainably, we suggest and discuss some possible actions, including reforms to improve Central Purchasing Office for Essential Medicines and Consumables's governance and accountability and, more broadly, to strengthen the various pillars of the local health and pharmaceutical system.