Investigating public sector shortages of psychotropic medicines in Western Cape, South Africa: a qualitative inquiry

Abstract

Despite the rising burden of mental health disorders in South Africa, significant gaps persist in mental health resources, governance, and service delivery. Pharmacological therapy is central to mental health treatment, yet psychotropic medicines are often inconsistently available in public healthcare facilities. Their shortage can lead to treatment interruptions, relapse, and increased hospitalisations. This study explores the challenges underlying these shortages, their impact on patient care, and healthcare facilities' strategies to manage them. This qualitative study used semi-structured interviews with ten stakeholders from various points along the mental health supply chain in the Western Cape, encompassing pharmacists, clinicians, nurses, procurement analysts, and pharmaceutical policy specialists. Guided by a health systems perspective and the Medical Supply Management framework, the study explored supply chain processes' structural and operational dynamics in the public health sector. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Findings revealed that psychotropic medicine shortages stem from manufacturer limitations, rising demand, insufficient budget allocations, unreliable procurement processes, and logistical constraints. Manufacturing-related challenges, particularly those linked to older psychotropic medicines, emerged as a distinct theme. These included limited global production, low commercial viability, and reduced manufacturer interest, which contributed to supply instability. Shortages disrupted the continuity of care and prompted facilities to adopt both short-term and long-term strategies, including stock rationing, sharing, and supplier engagement. Conclusion: Psychotropic medicine shortages call for improved supplier accountability, investment in local production, better supply chain communication, and increased mental health funding to protect patient care and support healthcare providers.