Optimizing Drug Procurement Using ABC-VEN: A Narrative Review and Conceptual Framework

Drug procurement represents a substantial component of healthcare expenditure, particularly in low- and middle-income countries (LMICs). While ABC-VEN analysis remains important for balancing economic and clinical priorities, existing literature lacks critical evaluation of its cross-country adaptability and methodological rigor. This study aims to synthesize international evidence on ABC-VEN application within healthcare facilities to identify structural knowledge gaps and comparative findings. A structured narrative review was conducted using literature from PubMed, Scopus, Taylor & Francis and Google Scholar. To improve reporting transparency, study selection was mapped using a PRISMA 2020 framework. Studies included were those that applied the ABC-VEN method in hospitals and primary healthcare centers. This review also proposes a conceptual framework to explain how ABC-VEN supports procurement decision-making across different healthcare settings. The method also facilitates the identification of wasteful spending and ensures more stringent monitoring of critical drug categories. The synthesis of 19 included studies showed that Category I expenditures consistently consumed 71.69% to 90% of pharmaceutical budgets. However, the review revealed substantial heterogeneity in methodological execution, lack of reviewer transparency, and an absence of formal quality appraisal across the existing literature. While the ABC-VEN matrix offers a valuable baseline for resource allocation, its operational effectiveness is highly dependent on institutional capacity and geographic context. This review provides a novel conceptual framework that transitions ABC-VEN from a static classification model into a dynamic decision-support mechanism, emphasizing the need for standardized implementation to achieve sustainable medicine availability.