In November 2024, the Fiji Pharmaceutical and Biomedical Services director mentioned that there were medical shortages in many health facilities.
This primarily comprises medicines that are used for non-communicable diseases (NCD).
There were over 200 healthcare services like hospitals, health centres and nursing stations that were affected.
When we look at it, this situation is not a recent one. But the situation is getting worse because more and more people in Fiji are now prone to long-term diseases.
When we look at statistics, 84% of all deaths are a part of NCDs in the country.
The prominent causes are diseases related to the heart (34%), diabetes (22%), cancer (9%) and diseases related to breathing issues (5%).
The problem is that these patients require medicines on a daily basis, and their treatment cannot be stopped.
If you analyse the past 20 years of research studies and reports, you will see that Fiji has faced a shortage of medical supplies for a long period.
Because of this, Indian API exporters, buyers and distributors need to analyse the shortage of APIs.
They need to know which supplies are in short supply and why the demand is not being met.
| What’s Next?: This information can help solve supply gaps related to medicine in this country. Now that the situation is analysed, let’s understand how the country’s NCD burden is creating continuous API demand. |
Fiji’s NCD Epidemic Creates Relentless API Demand That Supply Cannot Meet
Fiji’s healthcare burden is mainly driven by NCDs. This only shows that the country requires a constant supply of APIs.
Unlike emergency medicines, these treatments are needed every day for many years.
Such a shortage is hard to control as demand is never ceasing. A small supply discontinuity is detrimental to patients.
An NCD-Dominant Death Profile Requiring Uninterrupted API Supply
The majority of the diseases in Fiji require lifelong medications.
In the country, cardiovascular disease is a leading cause of NCD deaths at 34%.
Diabetes kills almost 22% of people. Daily medications that the patients with such conditions require include:
When the medicines are out of stock temporarily (which is for several weeks), the health of the patients can deteriorate.
Shortages at a monthly level can lead to severe complications, hospitalisation, or premature mortality of patients. This is underway in Fiji.
The most significant facts indicate that the problem is massive:
The need for APIs connected with NCDs is not short-lasting.
It is increasing year by year, with an increasing number of people developing diabetes and heart diseases.
| What’s Next?: Having learned about the overall healthcare burden, we can now consider the role of NCDs in fostering ongoing API demand. |
Zero Domestic Manufacturing- 100% Import Dependency
Fiji has no local production of any pharmaceutical APIs.
All the milligrams of metformin, atorvastatin, amoxicillin, and morphine consumed in the healthcare system in Fiji will have to be imported.
This renders the system very reliant on external provision.
Due to the same reason, the system has vulnerabilities to:
A fault of a single component of the import chain leads to the collapse of the entire supply chain.
This has occurred numerous times previously. Fiji does not have any domestic backup.
The alternative supply in the country is nonexistent. The nation has to wait until the next shipment.
| What’s Next?: With this picture of the disease burden, behind the medicine demand, at hand, now we can examine why the procurement system in Fiji continues to falter. |
Why Fiji’s Procurement System Keeps Failing to Prevent Shortages
There are three factual and substantiated reasons why medicine shortages continue to occur in Fiji.
These problems continue even though Fiji has a central procurement agency.
Every problem has been reported independently, and studies have been conducted.
| What’s Next?: Now that we know the problem with procurement, we will take a look at the first significant reason for constant shortages. |
Systemic Cause 1- Poor Quantification and Demand Forecasting
The most widespread one is poor demand forecasting:
Most of the Fiji healthcare facilities lack an appropriate mechanism to:
Due to this fact, the FPBS is not able to accurately determine its demand in relation to the amount of medicine that it should order.
The data relating to facility-level medicine can be incomplete or missing.
The international shipments can take up to, meaning that it is typically late when a shortage has been identified, and it is impossible to make a new order.
The issue was clearly described by a healthcare professional surveyed in the significant article published in 2017 PLOS ONE study.
It has carried out 48 interviews with 37 stakeholders, and poor quantification has been pointed out as one of the largest problems in the pharmaceutical chain of Fiji.
“There’s a big disconnect in the organisational side of the medications organisation; there does not seem to be a really good idea of predicting the changing need.
I’ve asked for records of what the previous amount of the drugs used is, and those records aren’t available.”
Each procurement cycle will rely on otherwise unchecked guesses and approximations without effective monitoring of medicine consumption at healthcare facilities.
In case of the falseness of those assumptions, there are shortages in medicine.
| Moving Forward: Now that we have told you why the demand for medicine in Fiji is so hard to maintain, we shall take a look at the reasons as to why the procurement system keeps failing to avert shortages. |
Systemic Cause 2- Supplier Quality Failures and Contract Terminations
Temporary discontinuation of suppliers has been experienced by FPBS following receipt of low-quality batches of medicine.
This is both to keep patients safe and to lead to medicine shortages.
In such cases, when a batch of NCD medicines is rejected and sent back, no immediate replacement is available.
Fiji has a tight procurement system. Emergency purchasing is slowed down by the Financial Management Act 2004 and the Procurement Regulation 2010.
Due to this fact, hospitals and clinics may run out of stock as the government launches a new tender process.
The FPBS Director explained this issue publicly in November 2024:
We may discover that the quality of medicines procured is not very good only after obtaining them, and we need to recall them.
These are medicines against non-communicable diseases (NCD), which produce an effect of shortage when demand is high indeed.
It is significant to check the quality of medicine.
However, all of the cancelled contracts may also result in a shortage of stocks in the absence of any back-up supplier.
| Moving Forward: Having talked about supplier quality failure, we will now move on to how procurement regulations delay the response to an emergency. |
Systemic Cause 3- A Rigid Regulatory Framework That Cannot Respond to Urgent Needs
The Fiji FPBS will need to adhere to the Procurement Regulation 2010 and the Financial Management Act 2004.
Such rules were established primarily to control and be accountable financially. They are not developed to manage healthcare supply.
Because of this system:
Consequently, shortages of medication so often persist for weeks or months after their onset.
This is not a case of Fiji only.
A survey was carried out in the South Pacific countries in the Lancet Regional Health – Western Pacific in December 2024.
It was discovered that in the region, low and middle-income countries (LMICs) rated an average availability of lowest-priced generic medicines in the public sector at 59.1%.
In developed nations, supply was 87.2%.
These shortages were associated with the study as:
Fiji is in this LMIC category, and its procurement system is susceptible to most of these structural issues in the Lancet survey.
Having described the causes of the shortages, we are going to consider which APIs are the most frequently affected ones.
Micro-summary (Sections 1-2): Fiji’s healthcare burden is mainly driven by NCDs, which cause 84% of deaths in the country.
These illnesses need continuous provision of APIs, and Fiji has no production of APIs in the country.
The greatest causes of death are cardiovascular disease and diabetes. By 2018, the rate of diabetes in Fiji was already exceeding the 2030 estimates by the WHO.
There is a continued shortage in medicine due to three significant system failures:
In November 2024, the FPBS Director publicly addressed these issues.
| What’s Next?: Having discussed the factors that have led to the shortage, we shall now discuss the most prevalent APIs. |
The Chronic Shortage Map- Which Essential APIs Are Most Critically Short in Fiji
No common report includes all the APIs that are experiencing deficits in Fiji. This is because FPBS does not release real-time stock data.
It derives the following shortage map based on:
Having got the general picture of the shortages in the supply picture, we can proceed to take a look at the APIs, which are under the greatest demand in terms of supply.
The Fiji API Shortage Map- 2024/2025
| API / Medicine Category | Specific APIs Affected | Shortage Severity | Primary Evidence Source |
|---|---|---|---|
| Antidiabetic APIs | Metformin HCl, Glibenclamide, Insulin (human) | CRITICAL- documented parliamentary crisis (2021); ongoing | NFP Fiji / Fiji Times; PLOS ONE 2017; PMC 2025 |
| Cardiovascular APIs | Atorvastatin, Amlodipine, Enalapril, Aspirin API | HIGH- cardiac centre “lacks regular supply of medication” | PLOS ONE 2017 (Interview 19); PMC PEN Study 2025 |
| Anti-infective APIs | Amoxicillin, Azithromycin, Co-trimoxazole | MODERATE-HIGH- communicable disease co-burden | PLOS ONE 2017; WHO EML Fiji survey |
| Morphine / Palliative APIs | Morphine Sulphate, Opioid analgesics | CRITICAL- documented complete stock-out (2021, 3 months) | NFP Fiji: “FPBS cannot import morphine for 3 months” |
| Oncology / Chemotherapy | Cytotoxic APIs (category) | HIGH- patients buying chemotherapy from private sector at FJD 800-900 | NFP Fiji / Fiji Times, 2021 |
| Respiratory APIs | Salbutamol, Ipratropium | MODERATE- chronic respiratory disease 5% of NCD deaths | Fiji NCD profile; WHO PEN Fiji |
Now that we’ve identified the main shortage categories, let’s examine the most critical shortage area in Fiji.
Priority 1: Antidiabetic APIs- The Most Documented and Persistent Shortage
Metformin is Fiji’s most demanded medicine. Diabetes affects more than 30% of the population.
This number had already crossed WHO’s 2030 estimate more than 10 years early. Because of this, demand for first-line antidiabetic APIs is extremely high and constant.
In 2021, Fiji’s parliament received a formal inquiry about shortages of metformin.
Patients said they were not taking medicines because they could not afford other treatment options.
Glibenclamide supply is also inconsistent. Human insulin has also faced limited availability in Pacific Island Countries, including Fiji.
The Access to Medicine Foundation’s 2025 report states that oral antidiabetic medicines, including metformin, face regular access gaps across Pacific Island Countries.
This problem is linked to the same forecasting and procurement failures explained in Section 2.
These shortages are not one-time events. They are part of a long-term structural problem.
Now that we’ve covered antidiabetic shortages, let’s examine cardiovascular medicine supply issues.
Priority 2: Cardiovascular APIs- The Silent Shortage
Cardiovascular disease (CVD) causes more deaths in Fiji than any other NCD category. It accounts for 34% of all NCD deaths.
However, peer-reviewed research showed that Fiji’s cardiac care centre lacked “a very good supply of stents” and “a regular supply of the medication required to keep them working” (PLOS ONE: Medicine Shortages in Fiji, 2017).
These are standard WHO Essential Medicines List (WHO-EML) medicines. Many Indian WHO-GMP certified manufacturers already produce them.
Now that we’ve covered cardiovascular shortages, let’s look at Fiji’s palliative care crisis.
Priority 3: Morphine and Palliative Care APIs- The Invisible Crisis
In 2021, FPBS could not import morphine for three months. FPBS is the only licensed authority allowed to import controlled drugs like morphine into Fiji.
Because of this shortage:
Morphine is a controlled substance, Schedule 1. It entails special importations and licenses.
This brings in another regulation hurdle and more complicated emergency procurement compared to traditional APIs.
This deficiency has immediate patient survival and pain control implications, yet it is given minimal attention by the public and the policy.
Now that we’ve identified Fiji’s most critical API shortages, let’s explore how Indian WHO-GMP suppliers can help close these gaps.
| Key Takeaway: Having determined which APIs we are out of and why, we will now investigate how WHO-GMP-certified Indian suppliers can fill these supply gaps. Now that we’ve identified Fiji’s most critical API shortages, let’s explore how Indian WHO-GMP suppliers can help close these gaps. |
How WHO-GMP Certified Indian API Suppliers Can Close Fiji’s Gaps
Every API category facing chronic shortages in Fiji matches India’s strong generic manufacturing capabilities.
This is not accidental. India is a major global supplier in the same therapeutic categories that drive Fiji’s healthcare demand.
Now that we understand the opportunity, let’s look at the specific API categories where India can help immediately.
Perfect API Category Alignment
The match between Fiji’s shortage profile and India’s production strengths is nearly 1:1.
| Fiji Shortage Category | Specific API | Indian Supply Position | Actiza Portfolio |
| Antidiabetic | Metformin HCl, Glibenclamide | WHO-PQ dominant; largest global generic producer | Available |
| Antidiabetic | Human Insulin (biosimilar) | WHO-PQ certified biosimilar insulin | Refer to specialist |
| Cardiovascular | Atorvastatin, Amlodipine | Top-3 global generic statin/CCB producer | Available |
| Cardiovascular | Enalapril, Ramipril | Established WHO-GMP export capability | Available |
| Anti-infective | Amoxicillin, Azithromycin | Dominant global generic antibiotic supplier | Available |
| Respiratory | Salbutamol (API) | Established Indian generic producer | Available |
The congruency match is quite high.
Already with the supply being aligned, we will now discuss how the suppliers of India can be eligible for the procurement system of Fiji.
Navigating Fiji’s Procurement Framework as an Indian Supplier
The exporters of APIs to Fiji have to be aware of the functioning of FPBS in order to access the market in Fiji.
The Commerce Commission List oversees the prices. It is also quite essential to have the WHO-GMP certification.
To become an approved supplier, there are four key processes:
Register as an approved FPBS foreign supplier with a valid WHO-GMP certificate for the target APIs.
Lodge batch-specific Certificates of Analysis (CoAs) according to the standards of BP or USP.
Give ICH Zone IVb stability (40°C/75% RH) in the tropical climate of Fiji.
Demonstration of Pacific logistical capability, such as the experience of shipping in Suva port and cold chain management of insulin and morphine API.
Having discussed the qualification of suppliers’ requirements, we will proceed to the most effective long-term procurement solution for Fiji.
The Dual-Source Recommendation for Fiji’s FPBS
The easiest remedy to the frequent medicine shortages encountered by Fiji is as follows: FPBS must have at least two qualified WHO-GMP certified suppliers in each of the Tier-1 API categories.
Right now, Fiji mostly uses single-source yearly tenders. This puts a vast jeopardy. Shipping delay is one quality issue or cancellation of a contract, and can easily result in a medicine shortage. It lacks a backup supplier.
This can be addressed by a dual-source procurement system, which has overlapping supply agreements.
There are already numerous WHO-GMP certified manufacturers in all major shortage API categories in India.
Fiji does not have any significant supply issues that could hinder the use of dual suppliers of essential NCD drugs.
Now we are going to consider the most frequent questions that buyers and suppliers have about the pharmaceutical market of Fiji.
Micro-summary (Sections 3-4): The API Shortage Map of Fiji illustrates six large shortage areas.
There is a shortage of antidiabetic medicine and morphine. Other high-priority shortage areas include cardiovascular and oncology APIs.
All these types of shortages correspond to the high WHO-GMP-manufacturing capabilities of India.
The suppliers must have:
Dual-source procurement is the most suitable long-term solution. This can be done instantly, on the strength of the large supplier network in India.
| What’s Next?: Since we have discussed the solutions, now it is time to discuss the most common questions. |
Frequently Asked Questions
Q1: Which medicines are most chronically short in Fiji’s public health system?
According to parliamentary records, research studies, and the statements of the FPBS Director, the most common short-acting medicines in Fiji are:
Antidiabetic APIs like metformin HCl, glibenclamide and human insulin.
Atorvastatin, amlodipine and enalapril are cardiovascular APIs.
Palliative morphine sulphate.
Oncology APIs and cytotoxic APIs.
These medicines are all included in Fiji’s 4th Edition Essential Medicines List. There are several Indian manufacturers already being manufactured on a WHO-GMP scale.
Q2: Why does Fiji keep experiencing medicine shortages despite having a centralised procurement agency (FPBS)?
The shortages can be attributed to three key structural causes:
Poor quantification- as the healthcare facilities are not able to develop correct medicine usage forecasts, FPBS is not able to estimate the correct volumes of orders.
Supplier quality failures- batches of low quality are rejected, although there is no rapid replacement mechanism.
Rigidity in regulation- Financial Management Act 2004 and Procurement Regulation 2010 delays emergency procurement.
Through these three issues, shortages are likely to go on for weeks and even months after they start.
Establishing a new agency is not the solution. The main solution is:
Dual-source procurement contracts
Improved facility-level tracking and predicting medicine.
Q3: How can Indian API suppliers qualify to supply Fiji’s FPBS?
To be able to work with FPBS, Indian API manufacturers are forced to:
Have a valid WHO-GMP certificate in the target API.
Issue Certificates of Analysis (CoAs), which are batch-specific, under BP or USP.
Submit ICH Zone IVb stability data (40°C / 75% RH) for tropical climate suitability.
Display Pacific logistics experience, such as Suva port freight experience.
Cold chain records also need to be taken on:
Insulin
Controlled drug APIs such as morphine
A majority of supplier engagement occurs in the annual FPBS tender process. Fiji does not tend to procure common NCD medicines through spot procurement unless in cases of emergencies.
Q4: Is metformin still in shortage in Fiji in 2025?
Reports indicate that a shortage of medicines still occurs in Fiji.
According to the 2025 report published by the Access to Medicine Foundation, Pacific Island nations such as Fiji continue to experience the periodic shortage of oral diabetes drugs like metformin.
The FPBS Director assured that, in the year 2024, shortages of the NCD medicines continue to exist. Issues related to the quality of products and termination of contracts with suppliers were the major causes of them.
The same faces that befall the parliamentary shortage discussions that took place in 2021 still exist.
Conclusion- Fiji’s API Shortage Is a Solvable Supply Chain Problem
The global strains in the supply of chronic medicines are not the cause of chronic medicine shortages in Fiji.
All APIs listed as critically or severely short in Fiji are currently manufactured in high volume on a large scale by WHO-GMP certified Indian manufacturers at relatively low costs.
Procurement rigidities, inadequate demand forecasting and the dependency on single sources are the causes of the shortage. These are systemic issues that require systemic solutions.
They can only be solved by obligating a dual-source annual supply contract to reliable Indian API exporters familiar with FPBS procurement practices, Pacific logistics and stability of the tropical climate.
The business opportunity is evident. The morbidity load of the disease is reported to be increasing. The supply compares well with the Indian manufacturing.
The only thing that it lacks is a formal and qualified supplier relationship, and that is why it is time in 2025 to create one.
