Pharmaceutical Wastage in Public Health Facilities of Ethiopia: Determinants, Consequences, and Solutions

Abstract

Background: Pharmaceutical wastage presents a significant challenge to health systems in developing countries, including Ethiopia; however, evidence regarding its magnitude and drivers remains limited. This study aimed to examine the extent of pharmaceutical wastage in public health facilities in Northwest Ethiopia, identify its key determinants and consequences, and explore feasible solutions to minimize losses and improve pharmaceutical efficiency. Unlike previous single-method studies, this research integrates financial quantification with a qualitative exploration of systemic issues, thereby providing a comprehensive evidence base to inform policy and supply chain reforms. Methods: An explanatory-sequential mixed-methods design was employed in 17 public health facilities. A cross-sectional survey of 121 health professionals, selected through stratified random sampling, quantified wastage and perceptions using self-administered questionnaires. Descriptive statistics (MS Excel 2016, Statistical Package for the Social Sciences [SPSS] v26) were applied. In-depth interviews with purposively selected key informants provided qualitative insights, thematically analyzed using QDA Miner Lite v2.0.9. Results: The total value of wasted pharmaceuticals was ETB 12,201,119.21 (approximately $235,089.00), calculated using the average 2022 exchange rate of $1 = 51.9 ETB, resulting in an overall wastage rate of 4.0%. A decline was observed from 4.72% in 2012 to 2.96% in the 2014 Ethiopian fiscal year. Expired products accounted for nearly 98% of the wastage value. Health professionals identified lack of accountability, receipt of near-expiry products, and absence of inter-facility transfer mechanisms as major causes. Key informants further highlighted facility, supplier, and system-level weaknesses as contributing factors. Conclusion: Although wastage rates showed a declining trend, levels remain above the national standard, with expiration the leading cause. Strengthening accountability, introducing electronic inventory systems, and enabling redistribution of near-expired products between facilities are essential to minimize losses and improve efficiency in resource-limited health systems.