Toward health system strengthening in low- and middle-income countries: insights from mathematical modeling of drug supply chains

Abdulrahman Jbaily,Marion Bouvier,Leila Kamareddine,Isabelle Feldhaus,Benjamin Bigelow,Mieraf Taddesse Tolla,Mizan Kiros,Stéphane Verguet

doi:10.1186/s12913-020-05549-z

Abdulrahman Jbaily, Marion Bouvier + Show 6 more

Open Access

https://doi.org/10.1186/s12913-020-05549-z

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Abstract

BackgroundGlobal health priority setting increasingly focuses on understanding the functioning of health systems and on how they can be strengthened. Beyond vertical programs, health systems research should examine system-wide delivery platforms (e.g. health facilities) and operational elements (e.g. supply chains) as primary units of study and evaluation.MethodsWe use dynamical system methods to develop a simple analytical model for the supply chain of a low-income country’s health system. In doing so, we emphasize the dynamic links that integrate the supply chain within other elements of the health system; and we examine how the evolution over time of such connections would affect drug delivery, following the implementation of selected interventions (e.g. enhancing road networks, expanding workforce). We also test feedback loops and forecasts to study the potential impact of setting up a digital system for tracking drug delivery to prevent drug stockout and expiration.ResultsNumerical simulations that capture a range of supply chain scenarios demonstrate the impact of different health system strengthening interventions on drug stock levels within health facilities. Our mathematical modeling also points to how implementing a digital drug tracking system could help anticipate and prevent drug stockout and expiration.ConclusionOur mathematical model of drug supply chain delivery represents an important component toward the development of comprehensive quantitative frameworks that aim at describing health systems as complex dynamical systems. Such models can help predict how investments in system-wide interventions, like strengthening drug supply chains in low-income settings, may improve population health outcomes.

Highlights

Global health priority setting increasingly focuses on understanding the functioning of health systems and on how they can be strengthened
Example of a drug supply chain system in a low-income country We study the evolution of drug quantity at the different levels of the supply chain of a country for a chosen time period
We observe that the stock level at the procurers increases on day 180, which is due to a shipment from the manufacturers that left on day 120 (Fig. 5a)

Summary

Introduction

Global health priority setting increasingly focuses on understanding the functioning of health systems and on how they can be strengthened. Essential medicines are drugs identified to satisfy the priority health needs of populations. They are selected based on the burden of disease, public health relevance, drug safety and efficacy, and the comparative cost and costeffectiveness across drugs [1]. Stockouts of essential medicines at the hospital and clinic levels are a widely acknowledged issue in resource-constrained settings that limit access and have significant negative impacts on morbidity, mortality, and disease burden [7,8,9]. Preventing drug stockouts and promoting greater access to essential medicines highly depends on well-functioning supply chains that can efficiently distribute drugs from manufacturers to health facilities to patients at the point of service delivery

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