Navigating the Generosity of Medicines (Gen-MED): characterizing the complex relationships of medication donations in Japan through stakeholder and social network analysis.

Background: Anthropogenic and natural hazards increase reliance on donated medicines. However, inappropriate donations (e.g., expired, unlabeled, or poorly matched to local needs) remain common and create negative impacts on disaster-affected communities. In Japan, the coordination mechanisms and roles among stakeholders remain insufficiently characterized. This study aimed to identify and characterize stakeholders involved in the donated medicine cycle in Japan and to examine their relationships. In addition, this study also obtained stakeholder opinions on our proposed collaborative initiative, to build transparency within the donated medicine systems and increase the proportion of donated medicines that meet the health needs of disaster affected populations while complying with the World Health Organization (WHO) guidelines. Method: This study applied stakeholder analysis combined with social network analysis to examine the existing collaboration network within the Japanese donated medicine system. The analysis followed three phases: stakeholder identification, stakeholder categorization, and analysis of stakeholder relationships. Between June and August 2025, an online questionnaire was distributed to 18 stakeholders asking for their attributes, interests, desire for involvement, concerns, and the level of collaboration they had with other stakeholders. Data analysis combined descriptive quantitative analysis and social network analysis. Results: The analysis identified 18 stakeholders across nine groups, of which 15 organizations responded and participated in the study. Eight stakeholders were considered critical to the proposed initiative. These belonged to seven groups including pharmacy professional bodies, national and regional government, humanitarian organizations, pharmaceutical companies, regional hospitals, and the national pharmaceutical manufacturers association. A collaboration network existed between 17 stakeholders. National-level stakeholders emerged as the most strategically positioned for controlling the flow of information and resources within the Japanese donated medicine system. Two of the eight critical stakeholders were pharmacy professional bodies, highlighting their important role in Japanese donated medicine system. Conclusion: This study revealed collaboration patterns and highlighted contextual insights required for the successful implementation of the proposed initiative. These insights provide practical guidance for building transparency, and better alignment of donated medicines with local health needs.