Table 2 Perceptions on barriers to effective supply chain management of psychotropic drugs

Producers, promoters and distributors

• There is market competition. Need to spend money for bonuses and incentives. There is not much profit in psychotropic drugs but there are more hassles in its production, import and record keeping.

• The drugs imported by one agent cannot be imported by another agent despite high market demand for that drug.

• There is substitution of drugs by retailers due to higher bonuses and incentives by other companies.

• Nepal is dependent on India for raw materials which is a challenge for independent manufacturing of psychotropic drugs in Nepal.

Policy makers and government actors

• The drugs are prescribed in brand names with the hidden motives for incentives.

• The storekeepers at district level have limited knowledge on drugs as they do not have medical background.

• The inappropriate use or misuse of psychotropic drugs could increase if prescription authority is provided to primary health care workers without proper training and supervision.

• The supervision and monitoring of psychotropic drugs at the district level is minimal so there are chances of misuse.

Service providers

• Old generation psychotropic drugs listed in government’s free drug list have lots of side effects compared to the new generation drugs available on the market.

• Some patients overdose on the drugs while others refuse to take psychotropic drugs due to side effects.

• There are limited health workers in the district who can effectively diagnose and prescribe psychotropic drugs. Many medical officers do not feel confident in prescribing psychotropic drugs.

• Patients are sometimes used by drug addicts to get the psychotropic drugs.

Service users and family members

• Psychotropic drugs are effective but they have lots of side effects.

• Due to stigma it is difficult for patients and family members to share that they are using psychotropic drugs.

• Psychotropic drugs are not available at the community level, therefore, patients have to travel far distances to buy the drugs.

• Doctors focus more on medication even for cases that could be managed by counselling and other social support interventions.