Factors contributing to human and veterinary medicine shortages in developing countries: perspectives of suppliers and regulators in Namibia.

Background: Medicine shortages remain a pervasive global public health challenge, particularly affecting import-dependent countries with limited local manufacturing capacity. Namibia's reliance on pharmaceutical imports makes it vulnerable to supply chain disruptions across human and veterinary health sectors.

Aim: This study explores availability and factors contributing to medicine shortages in Namibia from the perspectives of regulators and pharmaceutical suppliers.

Methods: An exploratory qualitative study was conducted between August and October 2024. In-depth semi-structured interviews were carried out with 11 key stakeholders in the pharmaceutical sector involved in procurement, distribution, and regulation across public and private sectors, including animal health. Thematic analysis was employed.

Results: Five themes emerged: persistent shortages affecting both sectors with pronounced public sector challenges, particularly for chronic disease treatments (antihypertensives, insulin, anti-tuberculosis medicines, antiretrovirals); general supply chain constraints including limited local manufacturing, small market size, and global active ingredient shortages; public sector barriers including absence of formal procurement contracts and manual systems; regulatory bottlenecks encompassing processing delays and capacity constraints; and veterinary sector vulnerabilities despite economic importance.

Conclusions: Stakeholders identified medicine shortages as resulting from interconnected systemic challenges encompassing procurement, regulatory, infrastructural, and market-based constraints. Key patterns emerged: Namibia's regional reclassification appears to have increased supply vulnerabilities; absence of formal procurement contracts has led to reliance on emergency mechanisms; and regulatory capacity limitations may compound supply challenges. These interconnected factors suggest the need for coordinated multi-domain interventions, though further research is needed to quantify these relationships. Findings may inform policy considerations for improving medicine security in similar resource-constrained settings.