Supply Chain Performance and Drug Stockout Management at State Specialist Hospitals in Borno State, North East Nigeria

Drug stockouts in specialist hospitals represent a critical failure of the pharmaceutical supply chain, leading to treatment interruptions, patient harm, and increased disease burden, particularly in conflict-affected regions such as Borno State. This study assessed supply chain performance and the management of drug stockouts at state specialist hospitals in Borno, North East Nigeria. A cross-sectional institutional assessment was conducted at four specialist hospitals, combining structured interviews with 20 pharmacy and procurement officers, retrospective review of 12 months of inventory records, and focus group discussions with pharmacy technicians involved in stock management. Supply chain performance was evaluated across six indicators: order cycle time, stockout rate, fill rate, inventory turnover, waste rate, and emergency procurement frequency. Average stockout rate was 19.4 percent across the four hospitals, with antimalarials, antihypertensives, and insulin most frequently out of stock. Emergency procurement, typically at premium prices, accounted for 27 percent of total drug expenditure. Inventory turnover was below optimal thresholds in all facilities. Quantification errors, delayed funding releases, and supplier unreliability were the most cited stockout causes. The study proposes a responsive supply chain model incorporating pharmacist-led quantification, automated reorder point systems, and buffer stock policies for critical medicines. Regional pooled procurement among Borno State specialist hospitals is recommended to improve supplier negotiating leverage. Keywords: pharmaceutical supply chain, drug stockout, specialist hospitals, Borno State, pharmacy management