Availability of essential medicines
Availability of essential medicines has massive impact on the quality of health care and patient satisfactions. Unavailability of EM may poses patients loss confidence on the health care facility as a result; in order to make sure that their treatment is uninterrupted, patients may also have to pay extra costs [18]. The finding of this study showed that the average availability of essential medicines (n = 12) in IDP camps were found to be 77.3%. The finding of the current study is inline with a study conducted at a national level in Ethiopia, Malawi, and Seri Lanka, 70%, 56%, and 71% of essential medicines were available at the day of visit respectively in public health facilities [19]. This may be due to; both IDP camps and public health facilities in these regions may face limited budgets, affecting their ability to procure and maintain adequate stocks of essential medicines. Furthermore, In many low-resource settings, IDP camps and public health systems depend heavily on international aid and donations for medical supplies. Fluctuations in donor funding and external support can impact the availability and consistency of medicine supplies in these settings. Data obtained from the key informants revealed that the implementation of adaptive management system such as shifting system, and establishing an immediate warning system to detect the shortages may also contribute to this agreement. While the availability of essential medicines in the current study aligns with findings from national and international studies, this alone does not ensure the medicines are appropriate for the health needs of IDP populations. Identifying local disease threats is crucial to guide the selection and quantity of medicines. In dynamic and high-risk settings like IDP camps, aligning supply with disease patterns is vital for preparedness and effective response. Future efforts should integrate disease surveillance to improve medicine relevance and impact.
This finding is considerably below the World Health Organization (WHO) recommendation that EMs should be available at a rate of 100%. It also fails to meet the minimum threshold of 80% availability stipulated by the WHO for public facilities [17]. The finding of the current study was also lower than a study conducted in public health facilities in Gondar Ethiopia, which was 91% [20]. This may be due to the fact that, IDP camps are often located in areas affected by conflict or displacement crises, where supply chains are frequently disrupted. Transportation challenges, security risks, and infrastructure issues can make it harder to deliver medicines reliably to camps compared to established public health facilities in more stable locations. Furthermore, Public health facilities may receive more consistent funding and resources from the government or non-governmental organizations. IDP camps, on the other hand, often rely on temporary or emergency aid, which may not be as stable or adequate to maintain a regular supply of essential medicines. Humanitarian organizations often have also to prioritize among numerous needs, leading to limited budgets for medicine. In addition to this, proper storage facilities for medicines may be lacking in IDP camps, leading to rapid depletion of supplies or spoilage of medications. Public health facilities in places are more likely to have dedicated infrastructure to store and manage medicines effectively. Even when medicines are delivered to IDP camps, distribution to all individuals in need can be challenging due to overcrowding, safety concerns, and logistical barriers within the camp [21]. According to experts from the key informants limited resources, poor infrastructure, and arbitrary store rooms are among the major challenges impacting availability of EM at the level of IDP camps.
However, the availability of essential medicines (EMs) in IDP camps is higher than that reported in a systematic review examining the availability of EMs for children in Ethiopia and Guatemala, which found that availability in both public and private facilities was below 50% [19, 22]. This discrepancy may be attributed to several factors, targeted interventions aimed at enhancing access to EMs in humanitarian settings, and increased funding and support for health services in IDP camps. Additionally, the focused nature of health interventions in these camps may prioritize essential medicines more effectively than in broader public health systems.
From the identified EM the availability index of ampicillin, was low. The low availability index of ampicillin in IDP camp could be due to high demand for antibiotics: IDP camps often have crowded living conditions that increase the risk of infections. This can lead to a higher-than-anticipated demand for antibiotics like ampicillin, resulting in faster depletion of stocks. The present study also found that all (100%) OPD clinics in IDP camps faced stock out for certain EMs in the six months prior to the survey. This finding is supported by a study conducted in Dessie public health facilities, which revealed that 88.9% of health facility was faced stock out [23]. The 100% stock-out rate of certain essential medicines (EMs) in OPD clinics within IDP camps over the six months prior to the survey could be due: IDP camps often experience sudden population increases due to new displacements, leading to unexpectedly high demand for medicines. Such surges are difficult to forecast and can rapidly exhaust existing supplies. Moreover, OPD clinics in IDP camps may operate separately from the public health supply chain. Without strong integration or coordination with local health systems, it becomes challenging to ensure regular and reliable access to essential medicines.
The finding from the current study suggest that significant efforts are being made to supply IDP camps with essential medicines, despite the challenges posed by displacement, logistical issues, and resource constraints. It reflects a positive outcome of targeted interventions by humanitarian organizations, local authorities, and international donors to support the health needs of displaced populations. In addition to this, the fairly high availability of essential medicines in IDP camps can help reduce health disparities between displaced populations and local communities. Maintaining sustainable availability could promote health equity, ensuring that vulnerable populations in camps have access to similar standards of care as those in stable communities. Although the availability rate is fairly high, there is still a gap from the WHO recommendation of 100% of essential medicines should be available. This gap suggests a need for continuous improvement in supply chain management, particularly for medicines with more frequent stock-outs and interventions might emphasize on sustainable availability of EMs at these levels because provision of healthcare service for IDPs primarily relies on OPD clinics located in IDP camps.
Inventory management practices
The availability and application of various logistic forms varies among the various OPD clinics within the IDP camps. The availability of IFRR report formats are 100% in OPD clinics. However, the availability of blank IFRRs is high. This finding is in line with previous conducted study at national level in Ethiopia [24]. Only 27.3% and 54.5% of the SDPs report stock on hand and loss and adjustment data respectively. The low utilization of IFRRs in IDP camps could be attributed to: healthcare workers in IDP camps often face high patient loads and limited resources, which can lead to prioritizing immediate patient care over administrative tasks like completing IFRRs. This pressure may result in forms being neglected or underutilized. Furthermore, if resupply processes are unpredictable and there is a lack of follow-through on reported needs, and feedback on the data submitted via IFRRs, staff may feel that filling out IFRRs is futile. This can create a sense of disillusionment with the system and lead to lower utilization. According to the KI, humanitarian settings, particularly in IDP camps, inventory management practices often receive less emphasis due to various challenges and competing priorities.
Only four (36.4%) of the SDPs have send reports during the one month period prior to the study. The finding of the current study is lower than similar study conducted in public health facilities of Dessie in which, 67% of health facilities includes stock on hand and loss and adjustment data in the report and 56% of the health facilities sent the report in the last month [23]. The low reporting rate among OPD clinics in IDP camps over the one month prior to the study could be due to overburdened healthcare staff, insufficient feedback on previously submitted reports, and resupply processes are erratic and there is no follow-up based on reports submitted. Furthermore, in conflict-affected regions, ongoing insecurity may disrupt the ability to collect and send reports, as healthcare workers might be focused on immediate survival and care rather than administrative tasks.
Inventory control cards were available in nearly half of the OPDs in IDP camps. However, the overall bin card updating practice on transaction was 0%, which is far less than studies conducted in Dessie (86%), Adama (66.67%), Jimma (83.33%), and Uganda public health facilities [25,26,27]. This huge variation could be attributed to: the inherently unstable environment in IDP camps can lead to disruptions in daily operations. Frequent changes in staffing or challenges due to the humanitarian context may impede the consistent updating of records. Besides, in crises, there tends to be a focus on immediate health needs rather than long-term logistical practices. Staff may prioritize patient care over administrative duties, resulting in zero updates to bin cards. Lack of accountability and standard operating procedures in IDP camps may contribute to a complete absence of practices around inventory management.
In the present study, none of the IDP camps met the criteria for acceptable storage conditions. This contrasts sharply with findings from previous studies conducted at the national level in Ethiopia, as well as in the West Wollega and Jimma zones, where 55%, 73.91%, and 83.33% of health facilities, respectively, complied with the established criteria for acceptable storage conditions [24, 26, 28]. The absence of any IDP camps meeting the criteria for acceptable storage conditions in the present study, could be attributed to many IDP camps are set up in emergency situations, often in makeshift facilities that lack proper infrastructure. IDP camps frequently operate with limited financial and material resources; and priority may be given to immediate healthcare delivery, food, and shelter rather than long-term investments in logistics and storage infrastructure, which can affect the quality of storage facilities. Furthermore, budget constraints along with lack of coordination between humanitarian organizations and local health authorities may lead to inadequate oversight of storage conditions, and may prevent the implementation of necessary upgrades to meet acceptable storage standards. The qualitative finding that mentioned in sub-theme three also supported the results. The KI mention that: “Drugs are often stored in arbitrary locations, lacking proper rooms to ensure their safety”.
The low adherence to protocols such as periodic review of stock levels and the FEFO inventory control procedure for storing and dispensing medicines in IDP camps can be attributed to. This finding is also much lower than a study conducted at national level in Ethiopia and Adama, which revealed that more than 60% and 80% of the health facilities follow the principles of FEFO respectively [24, 26]. Low adherence to such protocols can be attributed to the high patient load and demands placed on healthcare workers in IDP camps can lead to burnout and stress. As a result, they may focus on patient care rather than on the review of stock levels or inventory management procedures. Furthermore, lack of accountability and supervision, perceived complexity of procedures, absence of standard operating procedures, and the nature of IDP camps may result in low adherence for such protocols.
The higher-level officials determined the OPD clinics resupply quantities. These findings are in contrary to previous study conducted in Adama town in which, all health centers determine their own resupply quantity using formula based on annual consumption [26]. The determination of resupply quantities OPD clinics within the IDP camps may be due to In the context of IDP camps, where situations can rapidly change due to new influxes of people or outbreaks of disease, higher-level officials may need to quickly adjust resupply strategies to respond to emerging needs effectively. Additionally, higher-level officials often coordinate with various stakeholders, including NGOs and international organizations, to ensure that resupply quantities align with broader humanitarian response strategies. While centralized determination of resupply quantities by higher-level officials can enhance consistency and efficiency, it is important to ensure that local healthcare providers are engaged in the process. Their insights and knowledge about specific needs at the IDP camps level are crucial for accurate assessments and effective resource allocation. This finding were also in agreement with the qualitative finding stated in sub-theme six: “IDP camps heavily reliance on push system”.
The current study suggests that adopting standardized inventory management practices and improving storage conditions could significantly enhance operations in IDP camps and help close existing gaps. Organizations are increasingly encouraged to implement innovative inventory management strategies that accelerate value creation, in response to growing competition and stakeholder pressures. In this demanding environment, the sustainability of organizations that do not embrace these best practices and strategies may be at risk. In the face of intense competition, proactively and innovatively investing in an effective inventory management practices should be a top priority for organizational leadership aiming for growth. Successful implementation requires active engagement and commitment from stakeholders at all levels. Therefore, a collaborative approach involving donors, national governments, and IDP camps is essential for establishing sustainable inventory management practice.
Challenges of essential medicines availability and inventory management practices
Consistent with previous research in Nigeria, South Africa, Mozambique, Kenya, Ethiopia, and other sub-Saharan African regions, the present study identified persistent challenges affecting healthcare delivery IDP camps. Key issues mirrored across studies include the lack of credible information and capacity in terms of human resource, infrastructural issue, poor inventory control practices, reliance on push system and budgetary limitations [11, 25, 29,30,31,32,33,34]. The consistency in these findings likely stems from several interrelated factors. Many countries in sub-Saharan Africa face systemic limitations in public health infrastructure and funding, which are often amplified in high-need settings like IDP camps. Additionally, similar socioeconomic and political contexts marked by limited resources, high population mobility, and frequent crises may contribute to persistent weaknesses in healthcare systems across the region. Furthermore, the widespread use of centralized, top-down approaches to supply chain and resource allocation can lead to mismatched local needs, perpetuating inefficiencies across different contexts [12]. Addressing these challenges will require coordinated, region-specific strategies that prioritize flexibility, sustainability, and community-based solutions.
Unlike previous studies on public health facilities, experts identify irrational drug use, uncertainty, lack of inter-agency collaboration, inadequate storage facilities, and insecurity as some of the foremost challenges in IDP camps. According to previous study; this may be due to the nature of humanitarian relief operation and the critical challenges stem from a mix of logistical, structural, and social factors unique to the IDP environment [4]. Addressing these issues requires a comprehensive approach that includes both short-term measures such as securing resources and long-term solutions, such as improved funding, regulatory oversight, and collaboration with security forces.
Limitation of the study
Firstly, the lack of specific studies on the availability of essential medicines and inventory management practices in IDP camps presents a significant challenge for this study. As we pointed out, much of the existing literature focuses on public and private health facilities, which are fundamentally different from the volatile and resource-constrained environments of IDP camps. However, in the absence of direct studies, drawing comparisons with public and private health facilities can still offer useful insights, even though the context differs. Secondly, qualitative data collection was hindered by participant refusal and organizational restrictions, particularly among donor agencies, limiting a fuller understanding of system-level barriers. These challenges are not uncommon in such environments, and they highlight the complex nature of conducting research in sensitive settings where confidentiality and privacy are major concerns. Lastly, the presence of unfilled and incomplete logistics record forms in the IDP camps posed a significant challenge for accurately assessing essential medicine availability, inventory management practices, and their alignment with the actual disease burden. These data gaps hindered the ability to conduct a comprehensive analysis. Consequently, the study primarily focused on point availability: the availability of medicines at a specific point in time rather than more dynamic indicators such as availability trends over time or detailed evaluations of inventory management performance.
Suggestion for future researches
To expand the generalizability of findings and deepen the understanding of essential medicine availability and inventory management practices in IDP camps, future studies should incorporate disease surveillance data to evaluate whether essential medicine supply aligns with the specific health needs of IDP populations. This will support more targeted and effective inventory management. Furthermore, future research should also consider alternative study designs and broader variables. A longitudinal study would provide valuable insights into how these challenges evolve over time, while the exploration of additional factors like the regulatory environment and technology usage could offer a more comprehensive view of the systemic and operational barriers to efficient inventory management. By investigating these broader challenges, future research can inform more targeted interventions, helping to improve the delivery of essential medical supplies in humanitarian settings.
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