en Pharmaceutical Supply Inefficiency in Developing Countries: A Study Framework Based on an Integrated AHP Model پژوهشي Original Article <div dir="ltr" style="text-align: justify;"><span style="font-size:12px;"><span style="font-family:Tahoma;"><span style="line-height:115%">Inefficiencies in pharmaceutical supply in developing countries rarely arise from a single factor; rather, they reflect interactions among financial constraints, market structure, production capacity, import dependence, and regulatory conditions. Beyond the physical availability of medicines, these factors may affect affordability, quality, equitable patient access, and supply chain resilience. This study aimed to develop an integrated multicriteria framework for identifying and prioritizing the factors contributing to pharmaceutical supply inefficiencies in the health systems of developing countries. An expert-informed decision-making model was developed using the analytic hierarchy process (AHP). In this study, the term &ldquo;case study framework&rdquo; refers to a structured analytical model representing common conditions affecting pharmaceutical supply systems in developing countries, rather than an empirical assessment of the pharmaceutical system of a specific country. The hierarchical model comprised four main criteria - cost, quality, access, and availability of alternatives - and eight contributing factors: market concentration, insurance coverage, profitability, production capacity, import dependence, trade tariffs, information transparency, and access to raw materials. A panel of 15 experts with professional experience in pharmaceutical policymaking, pharmaceutical manufacturing and industrial management, supply chains, distribution networks, procurement, insurance, pharmaceutical economics, and pharmaceutical research participated in the pairwise comparison process. Eligibility required at least 10 years of relevant academic, managerial, operational, or policymaking experience. Expert judgments were collected through structured pairwise comparisons using Saaty&rsquo;s nine-point scale and aggregated using the geometric mean. Local and global priority weights were calculated using AHP software, version 9.28. A consistency ratio below 0.10 was considered acceptable. Sensitivity analysis was performed by varying the weights of the main criteria to assess the stability of factor rankings under different policy scenarios. In the optimized model, insurance coverage ranked first, with a global priority weight of (19.6), followed by market concentration or monopoly, with a weight of (18.7), and profitability, with a weight of (11.8). Insurance coverage had the highest priority under the cost criterion, whereas market concentration was the most influential factor under the quality criterion. In the access-focused scenario, the weights of insurance coverage (weight: 16) and market concentration (weight: 17.5) converged. These two factors remained among the top two priorities across all sensitivity analysis scenarios, indicating that the overall ranking pattern was relatively stable despite changes in criterion weights. The findings suggest that pharmaceutical supply inefficiencies in the health systems of developing countries cannot be explained solely by insufficient production capacity or the physical unavailability of medicines. Financial protection for patients and market structure were the most influential components of the proposed framework, although their relative importance varied across policy scenarios. Achieving sustainable access to medicines therefore requires coordinated interventions to strengthen insurance coverage, reduce excessive market concentration, diversify supply sources, support economically viable production, and improve supply chain transparency. Because the model relies on expert judgments and provides a general framework for developing countries, its findings should be interpreted in light of the composition of the expert panel and the institutional characteristics of each pharmaceutical system.</span></span></span></div> <div style="text-align: justify;"><span style="font-size:12px;"><span style="font-family:Tahoma;"><span style="line-height:115%">Inefficiencies in pharmaceutical supply in developing countries rarely arise from a single factor; rather, they reflect interactions among financial constraints, market structure, production capacity, import dependence, and regulatory conditions. Beyond the physical availability of medicines, these factors may affect affordability, quality, equitable patient access, and supply chain resilience. This study aimed to develop an integrated multicriteria framework for identifying and prioritizing the factors contributing to pharmaceutical supply inefficiencies in the health systems of developing countries. An expert-informed decision-making model was developed using the analytic hierarchy process (AHP). In this study, the term &ldquo;case study framework&rdquo; refers to a structured analytical model representing common conditions affecting pharmaceutical supply systems in developing countries, rather than an empirical assessment of the pharmaceutical system of a specific country. The hierarchical model comprised four main criteria - cost, quality, access, and availability of alternatives - and eight contributing factors: market concentration, insurance coverage, profitability, production capacity, import dependence, trade tariffs, information transparency, and access to raw materials. A panel of 15 experts with professional experience in pharmaceutical policymaking, pharmaceutical manufacturing and industrial management, supply chains, distribution networks, procurement, insurance, pharmaceutical economics, and pharmaceutical research participated in the pairwise comparison process. Eligibility required at least 10 years of relevant academic, managerial, operational, or policymaking experience. Expert judgments were collected through structured pairwise comparisons using Saaty&rsquo;s nine-point scale and aggregated using the geometric mean. Local and global priority weights were calculated using AHP software, version 9.28. A consistency ratio below 0.10 was considered acceptable. Sensitivity analysis was performed by varying the weights of the main criteria to assess the stability of factor rankings under different policy scenarios. In the optimized model, insurance coverage ranked first, with a global priority weight of (19.6), followed by market concentration or monopoly, with a weight of (18.7), and profitability, with a weight of (11.8). Insurance coverage had the highest priority under the cost criterion, whereas market concentration was the most influential factor under the quality criterion. In the access-focused scenario, the weights of insurance coverage (weight: 16) and market concentration (weight: 17.5) converged. These two factors remained among the top two priorities across all sensitivity analysis scenarios, indicating that the overall ranking pattern was relatively stable despite changes in criterion weights. The findings suggest that pharmaceutical supply inefficiencies in the health systems of developing countries cannot be explained solely by insufficient production capacity or the physical unavailability of medicines. Financial protection for patients and market structure were the most influential components of the proposed framework, although their relative importance varied across policy scenarios. Achieving sustainable access to medicines therefore requires coordinated interventions to strengthen insurance coverage, reduce excessive market concentration, diversify supply sources, support economically viable production, and improve supply chain transparency. Because the model relies on expert judgments and provides a general framework for developing countries, its findings should be interpreted in light of the composition of the expert panel and the institutional characteristics of each pharmaceutical system.Inefficiencies in pharmaceutical supply in developing countries rarely arise from a single factor; rather, they reflect interactions among financial constraints, market structure, production capacity, import dependence, and regulatory conditions. Beyond the physical availability of medicines, these factors may affect affordability, quality, equitable patient access, and supply chain resilience. This study aimed to develop an integrated multicriteria framework for identifying and prioritizing the factors contributing to pharmaceutical supply inefficiencies in the health systems of developing countries. An expert-informed decision-making model was developed using the analytic hierarchy process (AHP). In this study, the term &ldquo;case study framework&rdquo; refers to a structured analytical model representing common conditions affecting pharmaceutical supply systems in developing countries, rather than an empirical assessment of the pharmaceutical system of a specific country. The hierarchical model comprised four main criteria - cost, quality, access, and availability of alternatives - and eight contributing factors: market concentration, insurance coverage, profitability, production capacity, import dependence, trade tariffs, information transparency, and access to raw materials. A panel of 15 experts with professional experience in pharmaceutical policymaking, pharmaceutical manufacturing and industrial management, supply chains, distribution networks, procurement, insurance, pharmaceutical economics, and pharmaceutical research participated in the pairwise comparison process. Eligibility required at least 10 years of relevant academic, managerial, operational, or policymaking experience. Expert judgments were collected through structured pairwise comparisons using Saaty&rsquo;s nine-point scale and aggregated using the geometric mean. Local and global priority weights were calculated using AHP software, version 9.28. A consistency ratio below 0.10 was considered acceptable. Sensitivity analysis was performed by varying the weights of the main criteria to assess the stability of factor rankings under different policy scenarios. In the optimized model, insurance coverage ranked first, with a global priority weight of (19.6), followed by market concentration or monopoly, with a weight of (18.7), and profitability, with a weight of (11.8). Insurance coverage had the highest priority under the cost criterion, whereas market concentration was the most influential factor under the quality criterion. In the access-focused scenario, the weights of insurance coverage (weight: 16) and market concentration (weight: 17.5) converged. These two factors remained among the top two priorities across all sensitivity analysis scenarios, indicating that the overall ranking pattern was relatively stable despite changes in criterion weights. The findings suggest that pharmaceutical supply inefficiencies in the health systems of developing countries cannot be explained solely by insufficient production capacity or the physical unavailability of medicines. Financial protection for patients and market structure were the most influential components of the proposed framework, although their relative importance varied across policy scenarios. Achieving sustainable access to medicines therefore requires coordinated interventions to strengthen insurance coverage, reduce excessive market concentration, diversify supply sources, support economically viable production, and improve supply chain transparency. Because the model relies on expert judgments and provides a general framework for developing countries, its findings should be interpreted in light of the composition of the expert panel and the institutional characteristics of each pharmaceutical system.</span></span></span><br> &nbsp;</div> <table class="MsoTableGrid" style="border-collapse:collapse; border:none"> <tbody> <tr> <td style="border-bottom: none; width: 174px; padding: 0cm 3px; height: 42px; border-top: 3px solid rgb(0, 112, 192); border-right: none; border-left: none; text-align: justify;"><span style="font-size:12px;"><span style="font-family:Tahoma;"><span style="line-height:115%"><b><span style="line-height:115%">Please cite</span></b></span><br> <span style="line-height:115%"><b><span style="line-height:115%">this article as:</span></b></span></span></span><span style="font-size:11pt"><span style="line-height:115%"><span style="text-autospace:none"><span style="font-family:Calibri,sans-serif">^{<span style="font-size:9.0pt"><span style="line-height:115%"><span style="font-family:&quot;MS Mincho&quot;"></span></span></span>}</span></span></span></span></td> <td style="border-bottom: none; width: 474px; padding: 0cm 3px; height: 42px; border-top: 3px solid rgb(0, 112, 192); border-right: none; border-left: none; text-align: justify;"></td> </tr> </tbody> </table> <div style="text-align: justify;"></div> <table class="MsoTableGrid" style="border-collapse:collapse; border:none"> <tbody> <tr> <td style="border-bottom: none; width: 474px; padding: 0cm 3px; height: 42px; border-top: 3px solid rgb(0, 112, 192); border-right: none; border-left: none; text-align: justify;"></td> </tr> </tbody> </table> <div style="text-align: justify;"></div> <table class="MsoTableGrid" style="border-collapse:collapse; border:none"> <tbody> <tr> <td style="border-bottom: none; width: 474px; padding: 0cm 3px; height: 42px; border-top: 3px solid rgb(0, 112, 192); border-right: none; border-left: none; text-align: justify;"><span style="font-size:12px;"><span style="font-family:Tahoma;"><span style="line-height:115%"><span style="line-height:115%">Mir Mohammadmakki SF. Pharmaceutical Supply Inefficiency in Developing Countries: A Study Framework Based on an Integrated AHP Model. Medical Law Journal. 2026; Special Issue: e6.</span></span><br> <span style="line-height:115%"><span style="line-height:115%">https://doi.org/10.22037/bhl.v6i6.53515.</span><span style="font-family:&quot;Times New Roman&quot;,serif"></span></span></span></span></td> </tr> </tbody> </table> <div style="text-align: justify;"></div> Pharmaceutical Supply Inefficiency, Developing Countries, Case Study Framework, Analytic Hierarchy Process, Access to, Medicines, Insurance Coverage, Market Concentration, Pharmaceutical Supply Chain, Universal Health Coverage Pharmaceutical Supply Inefficiency, Developing Countries, Case Study Framework, Analytic Hierarchy Process, Access to, Medicines, Insurance Coverage, Market Concentration, Pharmaceutical Supply Chain, Universal Health Coverage 82 103 http://ijmedicallaw.ir/browse.php?a_code=A-10-2586-1&slc_lang=en&sid=1 Seyed Fathollah Mir Mohammadmakki1 Mir Mohammadmakki1 Seyed Fathollah Mir Mohammadmakki sf_makki@yahoo.com Yes Department of Industrial Engineering & Management Systems, Amirkabir University of Technology, Tehran, Iran. Department of Industrial Engineering & Management Systems, Amirkabir University of Technology, Tehran, Iran.