Abstract
While measuring, monitoring, and improving supply chain management (SCM) for antiretrovirals (ARVs) is understood at many levels of health systems, a gap remains in the identification and measurement of facility-level practices and behaviors that affect SCM. This study identifies practices and behaviors that are associated with SCM of ARVs at the hospital level and proposes new indicators for measurement. We performed an in-depth literature review to identify facility-level practices and behaviors and existing indicators that are associated with SCM. We used the United States Agency for International Development's 2013 National Supply Chain Assessment Toolkit to define 7 supply chain function areas to frame the study. Qualitative, semistructured key informant and focus group interviews were conducted in hospitals with health professionals from Cameroon, Namibia, and Swaziland to understand facility-level practices and behaviors. Using the results from 54 key informant and focus group interviews from 12 hospitals, we identified 30 practices and behaviors that may affect ARV SCM at the facility level. The following practice areas were particularly associated with SCM: order verification, actions taken when ARV stock is received, changes in prescription and dispensing due to ARV stock-out, actions to ensure patient adherence, and communication with other affiliated facilities and higher-level SCM. We subsequently developed measurable indicators for future research. This study characterizes facility-level practices and behaviors that can affect ARV SCM. It also identifies gaps in their measurement. While this study uses ARVs as a tracer medicine to understand gaps in practices at the facility level, many of the findings are more broadly applicable to other medicines in an integrated setting. This study provides real-world evidence and the groundwork for further research to characterize the link between 30 facility-level practices and behaviors and ARV SCM at the facility and central levels.
Highlights
While measuring, monitoring, and improving supply chain management (SCM) for antiretrovirals (ARVs) is understood at many levels of health systems, a gap remains in the identification and measurement of facility-level practices and behaviors that affect SCM
We reviewed official reports published by nonprofit organizations, development agencies, and their implementing partners, in particular, United States Agency for International Development (USAID), Management Sciences for Health (MSH), John Snow Inc., and the World Health Organization.[5,6,8,9,23,24,25]
To identify existing facility-level SCM indicators, we reviewed indicators related to product selection, forecasting and supply planning, procurement, warehousing and inventory management, transportation, dispensing, waste management, laboratory issuing, information management, infrastructure, human resources, demand factors, behaviors and practices, and perceptions related to HIV/AIDS treatment.[5,8,17,24,26,27]
Summary
While measuring, monitoring, and improving supply chain management (SCM) for antiretrovirals (ARVs) is understood at many levels of health systems, a gap remains in the identification and measurement of facility-level practices and behaviors that affect SCM. Effective and efficient communication between central, regional, and local health facility levels as well as quantification, secure transport, and quality assurance of medical products are all required parts of a functional supply chain.[4,5,6,7] much is understood about how to measure, monitor, and improve ARV SCM at the central and regional levels of a health system, less has been done to identify and measure facilitylevel practices and behaviors that can affect SCM.[5,6,8,9,10,11,12] In this article, we define facility-level SCM as activities related to managing and ordering inventory and monitoring the performance of facilities at the point of service delivery carried out by health care providers, managers, and administrators involved in prescribing and dispensing.[7] These facilities may include public and private hospitals and health facilities, clinics, pharmacies, drug stores, and other outlets. Behaviors are defined as the leadership or management styles as well as the quality of relationships and communication between health care workers and managers at the facility level and those working in higher-level SCM management positions
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