TITLE:
Health Supply Chain Bottlenecks and Their Association with Medication Access and Prescribing Practices in Sub-Saharan Africa: A Narrative Review
AUTHORS:
Anthony B. Mwansa, Steward Mudenda
KEYWORDS:
Health Supply Chain, Medicine Stockouts, Medication Access, Prescription Fill Rate, Prescribing Practices, Antimicrobial Resistance, Antimicrobial Stewardship, Essential Medicines, Sub-Saharan Africa, WHO Prescribing Indicators
JOURNAL NAME:
Open Journal of Business and Management,
Vol.14 No.4,
July
9,
2026
ABSTRACT: Background: Health supply chain bottlenecks remain a major barrier to equitable access to essential medicines in low- and middle-income countries, particularly in Sub-Saharan Africa. Persistent stockouts, weak inventory systems, and last-mile distribution failures not only limit medication availability but are associated with altered prescribing practices, contributing to irrational medicine use and increased risk of antimicrobial resistance (AMR). This narrative review synthesizes available evidence on health supply chain bottlenecks and assesses their association with medication access and prescribing practices across Sub-Saharan Africa. Methods: A comprehensive literature search was conducted across Google Scholar, PubMed, and ScienceDirect, for studies published between January 2009 and May 2026. Studies were eligible if they addressed any one of the following domains: supply chain bottlenecks or inefficiencies; medication access outcomes (including prescription fill rates); or prescribing practices assessed using frameworks such as the World Health Organization (WHO) prescribing indicators. Studies were not required to address all three domains simultaneously. Following title and abstract screening of 218 unique records, 50 studies and reports were included in the final synthesis. Evidence was synthesized thematically across global, regional, and country-specific contexts. Results: Evidence consistently shows that supply chain bottlenecks, including procurement inefficiencies, poor demand forecasting, weak inventory management, and last-mile distribution failures are significantly associated with medication access and prescribing practices. Across Sub-Saharan Africa, essential medicine availability in public facilities is often below 50%, with stockout rates ranging from 40% to 60%. Antibiotic prescribing rates frequently exceed recommended thresholds (≤20% - 26.8%), reaching over 70% in some settings. These patterns reflect a compounding relationship between medicine shortages and irrational prescribing. Conclusion: Evidence suggests that health supply chain bottlenecks are strongly associated with medication access and prescribing practices in Sub-Saharan Africa. Addressing these challenges requires integrated interventions, including strengthening procurement and forecasting systems, expanding electronic logistics management information systems, improving last-mile distribution, and implementing antimicrobial stewardship programs. Strengthening supply chain systems is essential for improving rational medicine use and mitigating AMR in the region.