Mapping Portfolio Management Models and Clinical Risk Stratification in Public Health Pharmaceutical Supply Chains: A Scoping Review

Background: Public health pharmaceutical supply chains in low- and middle-income (LMIC) settings routinely report stockout rates between 25% and 60% at primary care and last-mile levels. Commercial supply chains manage supply risk and financial exposure through purchasing portfolio models such as the Kraljic Matrix. At the same time, health systems separately use clinical criticality tools such as VED (Vital, Essential, Desirable) and ABC-VED matrix analysis. These two literatures have developed largely in parallel. Objective: To map how purchasing portfolio models (Kraljic and its adaptations) and clinical risk stratification tools (VED/ABC-VED) have each been applied in public health and hospital pharmaceutical procurement, and to identify the extent to which they have been formally integrated. Methods: This scoping review follows JBI methodology and is reported in line with PRISMA-ScR. Evidence was drawn from a purposive corpus of purchasing-portfolio literature compiled by the review team, supplemented by a targeted search for VED/ABC-VED studies (PubMed/PMC, single-reviewer, non-exhaustive). Fifteen studies met the review's focus criteria and are synthesised below. Results: Eight studies applied Kraljic or adapted portfolio models to hospital or public procurement (Portugal, Brazil, Netherlands, Jordan, humanitarian and public-value contexts); Four studies applied ABC-VED or ABC-VEN matrix analysis to drug inventories (India ×2, Ethiopia, Rwanda), consistently finding a small subset of high-cost/high-criticality items driving most expenditure and risk. Only one identified study (a Jordanian oncology pharmacy case) combined supply-risk portfolio logic with direct clinical input; no study in the corpus empirically tested a fully integrated Kraljic-VED matrix in a public health setting. Conclusion: The Kraljic and VED/ABC-VED literatures are individually mature but rarely combined. We propose an Integrated Public Health Kraljic-VED Matrix (IPH-KVM) as a conceptual synthesis to guide future empirical testing, and identify four operational barriers to its adoption.