Factors influencing pharmaceutical supply chain integration in the public health system of Sierra Leone

Background: Access to essential medicines is a cornerstone of public health, yet in many health systems, poorly coordinated supply chains lead to stockouts and losses. Recent policy reforms and partnerships have created momentum for pharmaceutical supply chain integration in Sierra Leone, yet systemic barriers remain. This study explored the facilitators and barriers to pharmaceutical supply chain integration in Sierra Leone. 

Methods: A qualitative study was conducted using in-depth, semi-structured interviews with sixteen purposively selected key informants. Participants were drawn from six districts in Sierra Leone and included national supply chain leads, program pharmacists, district pharmacists, and development partners, representing diverse perspectives across policy, implementation, and technical support. Data were analysed deductively through thematic content analysis guided by the Socio‑Technical Systems (STS) framework, which structured interpretation across five constructs: technical facilitators, technical barriers, social facilitators, social barriers, and socio‑technical interactions. Data collection and analysis proceeded iteratively until thematic saturation was reached, with NVivo software used to support coding and data management. 

Results: Digital platforms, alongside supportive policy frameworks and strong partnerships, emerged as key facilitators, improving data visibility, accountability, and coordination. Capacity-building and collaborative networks further enhanced integration. However, systemic barriers persist, including limited storage capacity, fragmented procurement, seasonal distribution challenges, financing gaps, workforce attrition, and heavy donor dependence. Socio-technical interactions revealed that mistrust over data ownership, policy inconsistency, and reliance on partners often undermined progress in integration. 

Conclusion: While digital innovations and policy initiatives have advanced pharmaceutical supply chain integration in Sierra Leone, sustainability remains constrained by infrastructural, financial, and workforce limitations. Building a resilient and self‑reliant system requires a balanced approach that addresses both technical and social dimensions. Policy action should prioritise strengthening domestic financing, harmonising procurement systems, and investing in human resource capacity alongside technological upgrades. These measures are critical for building a resilient, self‑reliant, and integrated pharmaceutical supply chain that ensures equitable access to medicines.