Drug shortages in Latin America: A cross-sectional survey on impact and mitigation in pharmacy and procurement.

Introduction: Drug shortages in Latin America represent a widespread and persistent challenge, with a high proportion of hospitals reporting frequent supply disruptions that affect treatment continuity and quality of care. Methodology: A cross-sectional study was conducted using a structured survey applied in 144 hospitals across eight Latin American countries between January and April 2025. A non-probabilistic snowball sampling strategy was used to recruit pharmaceutical professionals and personnel responsible for drug procurement. The questionnaire was developed by the research team and reviewed by a panel of hospital pharmacists to ensure content validity. Data were collected anonymously and are based on self-reported perceptions from professionals representing their institutions. Descriptive analyses and exploratory chi-square tests were performed. Results: 75.0% of the responses came from South America, 20.8% from Mexico and 4.2% from Costa Rica. 75.7% of hospitals reported shortages as a serious problem, with a daily frequency in 30.6% and weekly frequency in 27.8% of cases. The most affected categories were antimicrobial, cardiovascular and oncological. Among the most relevant causes were inefficient procurement processes (84.3% in Argentina; 66.7% in Uruguay and Costa Rica), high prices, supply chain disruptions and global shortages of active ingredients. 53.7% of the hospitals had contingency plans, the presence of which was significantly associated with a lower frequency of shortages (p=0.025). The most commonly used strategies were therapeutic substitution (85-90%), inter-institutional collaboration, and the development of alternative formulations (95.5% in Colombia and 75% in Brazil). Conclusions: Shortage of drugs in the region are a multifactorial phenomenon with a relevant clinical and organizational impact. The implementation of contingency plans and inter-institutional cooperation strategies is associated with improved response capacity, understood as a reduced frequency and better management of shortage events. These findings highlight the need to strengthen contingency planning and promote coordinated regional policies based on the observed variability in causes and mitigation strategies.