Cefazolin access and use in Ethiopia: A policy implication

Area of Science:

• Global Health
• Pharmaceutical Policy
• Health Systems Research

Background:

• Resource-limited healthcare systems face significant challenges with essential medicine shortages.
• Cefazolin is a critical antibiotic recommended for surgical antibiotic prophylaxis (SAP) in Ethiopia.

Purpose of the Study:

• To investigate the historical access and utilization of cefazolin within Ethiopia's healthcare system.
• To identify factors contributing to cefazolin shortages for potential policy interventions.

Main Methods:

• An exploratory qualitative study was conducted between July and August 2021.
• Data collection involved semi-structured interviews, observations, and document review across healthcare facilities and supply chain entities.
• Qualitative data were transcribed, coded, and analyzed thematically.

Main Results:

• Cefazolin, despite being on the Essential Medicine List (EML) and Standard Treatment Guideline (STG), has been historically unavailable in Ethiopian markets.
• The study identified a misalignment between national guidelines, government procurement processes, and actual drug availability at healthcare facilities.
• Cefazolin was removed from recent government procurement lists, contradicting its recommended status.

Conclusions:

• A persistent cefazolin shortage exists in Ethiopian healthcare settings, indicating a disconnect between policy and practice.
• Factors such as supply-demand issues, guideline-procurement misalignment, and inter-departmental communication breakdowns contribute to the shortage.
• Revising essential medicine lists or procurement without supply chain and prescribing practice reviews can lead to the removal of vital antimicrobials.