Systemic challenges in the supply and distribution of medicines in conflict-affected areas of Mali: a qualitative study

Abstract

Background: The conflicts that have been ongoing for over a decade in different Sahel countries, including Mali, have a negative impact on the supply and distribution of medicines. Objective: This study aims to identify and analyze the key contextual challenges affecting the supply and distribution of medicines in conflict-affected areas in Mali. Methods: This study adopts a qualitative study design. First, we conducted 28 interviews with key stakeholders in the pharmaceutical sector in the Mopti and Bamako areas. Such key stakeholders included health professionals, community association members, health authorities, and humanitarian stakeholders. Second, we conducted a thematic analysis, using NVivo software for retrieving and coding the qualitative data. Results: The key contextual factors affecting the supply and distribution of medicines in the study area have been organized under four interlinked themes: (1) insecurity and instability, disrupting transport routes and supply chains; (2) systemic and market dysfunctions, generating price instability and recurrent shortages; (3) technical and infrastructural weaknesses, compromising adequate storage conditions; and (4) insufficient coordination and collaboration among the different stakeholders, which further destabilizes the already fragile pharmaceutical supply system. Together, these factors have considerably weakened the pharmaceutical supply chain’s capacity to ensure continuous and equitable access to quality-assured medicines. Conclusion: Insecurity, market disruptions, weak infrastructure, and insufficient coordination severely undermine the supply and distribution of essential medicines in the conflict-affected areas of Mali. Restoring equitable access requires a strong coordination across public, private, and humanitarian actors, sustained investment in logistics and information systems, and the strengthening of regulatory oversight during and after the conflict.