Medicines governance and systemic constraints: A qualitative study among healthcare professionals in South Africa

Abstract

Background: Medicine shortages and governance failures in low- and middle-income countries continue to hinder progress towards universal health coverage.
Aim: To explore healthcare professionals’ perceptions and experiences of medicines governance in South African healthcare facilities.
Setting: The study was conducted at the public healthcare sectors in Eastern Cape province, South Africa.
Methods: A qualitative exploratory cross-sectional design was used. Twenty healthcare professionals were purposively selected. Semi-structured interviews were conducted, audio–recorded, transcribed verbatim and thematically analysed using Braun and Clarke’s framework.
Results: Four major themes emerged: systemic governance constraints; pharmaceutical supply chain vulnerabilities; weak accountability mechanisms; and gaps in protocol implementation. Key determinants of medicine shortages included weak budget governance, supplier payment delays, limited pharmacy support staff and inconsistent implementation of standard treatment guidelines (STG) and limited functionality of Pharmacy and Therapeutics Committees (PTCs).
Conclusion: Medicine shortages result from systemic governance failures rather than isolated logistical issues. Strengthening pharmaceutical governance requires transparent budgeting, timely supplier payment systems, functional PTCs, and STG training to improve equitable access to essential medicines.
Contribution: This study deepens the understanding of pharmaceutical governance, revealing systemic, interrelated factors that collectively lead to the shortage of pharmaceuticals in South Africa. Unlike previous research that focused primarily on supply chain logistics, the study showed that stock-outs were rooted not simply in operational inefficiency, but also in structural governance weaknesses. This study presents practical insights to strengthen pharmaceutical governance and supports national efforts to achieve universal health coverage by identifying specific governance obstacles and proposing system-level reforms.