Purpose: The study examined how health facility administrators, pharmacy managers, and supply chain officers navigate medicine procurement and inventory management within existing policy frameworks; identified administrative barriers perpetuating stockouts despite national policies; and explored coping strategies developed to manage medicine shortages in Accra's primary health centers.

Methodology/Design: The study employed a qualitative case study design grounded in interpretivism. Semi-structured interviews were conducted with 25 participants including administrators (n=3), pharmacy managers (n=5), supply chain officers (n=5), and frontline clinicians (n=12) from three public primary health centers in the Greater Accra Region. Data were analyzed using thematic analysis. Trustworthiness was ensured through credibility, transferability, dependability, and confirmability strategies.

Findings: Three main findings emerged. First, restricted procurement flexibility, reliance on informal communication, and inconsistent inventory practices characterized procurement navigation. Second, delayed NHIS reimbursements, restricted emergency procurement, inadequate storage, and poor communication were key barriers. Third, coping strategies included patient referral to private pharmacies, rationing, borrowing between facilities, and informal stockpiles.

Implications: Policies including the Framework Agreement system require urgent reform to incorporate local flexibility. NHIS reimbursement delays must be addressed to restore supplier confidence.

Originality/Value: This study provides novel qualitative evidence on administrative mechanisms of stockouts in Accra's urban primary health centers, applying Street Level Bureaucracy and Implementation Science theories.