Health Supply Chain Research Articles

A Rapid Cost Modeling Tool for Evaluating and Improving Public Health Supply Chain Designs.

Effective and efficient health supply chains play a vital role in achieving health outcomes by ensuring supplies are available for people to access quality health services. However, supplying health commodities to service delivery points is complex and costly in many low- and middle-income countries. Thus, governments and partner organizations are often interested in understanding how to design their health supply chains more cost efficiently.Several modeling tools exist in the public and private market that can help assess supply chain efficiency and identify supply chain design improvements. These tools are generally capable of providing users with very precise cost estimates, but they often use proprietary software and require detailed data inputs. This can result in a somewhat lengthy and expensive analysis process, which may be prohibitive for many decision makers, especially in the early stages of a supply chain design process. For many use cases, such as advocacy, informing workshop and technical meetings, and narrowing down initial design options, decision makers may often be willing to trade some detail and accuracy in exchange for quicker and lower-cost analysis results. To our knowledge, there are no publicly available tools focused on generating quick, high-level estimates of the cost and efficiency of different supply chain designs.To address this gap, we designed and tested an Excel-based Rapid Supply Chain Modeling (RSCM) Tool. Our assessment indicated that, despite requiring significantly less data, the RSCM Tool can generate cost estimates that are similar to other common analysis and modeling methods. Furthermore, to better understand how the RSCM Tool aligns with real-world processes and decision-making timelines, we used it to inform an ongoing immunization supply chain redesign in Angola. For the use cases described above we believe that the RSCM Tool addresses an important need for quicker and less expensive ways to identify more cost-efficient supply chain designs.

Capacity for optimal performance of healthcare supply chain functions: competency, structural and resource gaps in the Northern Region of Ghana

PurposeThe study drew on capacity framework around the individual, organisational, health system and wider context to explore gaps in health supply chain (HSC) workers capacity and competency to perform supply chain (SC) functions and the lessons for workforce development.Design/methodology/approachA mixed-method study was conducted across the Northern Region of Ghana. Qualitative data were collected from in-depth interviews with 34 key SC managers at the regional, district and facility levels. A semi-structured questionnaire was administered through the RedCap mobile app to 233 core HSC workers and non-core workers (clinicians with additional responsibilities in SC). Data were managed and analysed inductively and deductively for themes.FindingsWeak knowledge and competency in SC functions attributed to poor training exposure and organisational support for capacity building, undermined the capacity to perform basic SC functions, especially by the non-core category. The policy and regulatory environment of the HSC marketplace were described as fluid and with complexity of demands. Both worker categories, therefore, requested functional, technical, managerial and customer care competencies to anticipate and manage complexities. Structural characteristics of the health system giving narrow decision space to HSC workers cascaded the capacity for innovation and initiative and promoted frustrations among mid-level managers. Infrastructural deficits and shortfalls in operational resources scaled back the capacity to efficiently manage inventory and ensure that commodities reach clients in good quality.Originality/valueFinding suggest that capacity building of HSC workers, strengthening of health institutions structural and resource capacity, and leveraging on technology will enable optimal performance of HSC functions.

BEST PRACTICES FOR DEMAND-DRIVEN SUPPLY CHAIN MANAGEMENT IN PUBLIC HEALTHCARE SECTOR: A SYSTEMATIC LITERATURE REVIEW

Healthcare supply chains ensure that there is a cost-effective availability of medicines at healthcare facilities. However, it appears that public healthcare supply chains in South Africa are experiencing significant challenges in the management and distribution of the right medicines, at the right time, and at the right cost. This has resulted in poor healthcare outcomes. Moreover, public health supply chains also face major challenges due to rising patient expectations and inefficiencies in supply chain operations. There is recent interest in increasing public health supply chain efficiency and improving patient services. To address these challenges and opportunities, other studies have suggested the transformation of healthcare supply chains from the current pure ‘push’ approach into a ‘pull’ approach, which is driven by actual customer demand (demand-driven supply chain management DDSCM). However, no guidelines exist to support the design of DDSCM in public healthcare supply chains. Therefore, through a systematic literature review, this study aims to distinguish the key success factors for the DDSCM approach from those of other industries, and subsequently develops a framework to guide the design of DDSCM for the public healthcare sector.

Enabling health supply chains for improved well-being

ABSTRACT Health supply chains are necessary for effective health service delivery as they not only provide appropriate health outputs but also have the potentials to create and deliver cost-effective outcomes in line with the economic, social, and cultural conditions of a country. There is a need, therefore, to investigate ways to create functionally appropriate enabling environments that will largely be dependent upon the economic developmental levels in which health supply chains are considered. Under this backdrop, the current study helps in identifying the key enablers for the health supply chains which when present will contribute towards strengthening the health coverage and improving overall well-being. The enabling environment of health supply chains will include the broad structure within which individuals and organisations function. The different enablers are grouped into four broad categories namely (i) people and processes, (ii) systems and data, (iii) investments, and (iv) policies. The study attempts to delineate an integrated model of health supply chain enablers and their role in improving overall well-being. The model is further investigated with Kenya as a case study to understand the impact of the enablers on quality of life and improved well-being.

A NEW MODEL FOR A DISTRICT HEALTH SYSTEM SUPPLY CHAIN

ABSTRACT
 Rationale: The theme of health today has been the most worrying in the world and in Brazil. Its context and management have generated academic, political and administrative discussions around the world. The main problem about health services offered in small towns is related to a deficient view and poor management conditions of public administrators about the agents that could contribute to community health care.
 Objective: This study was aimed at contributing to analyze the deficiencies and propose solutions for health services in the municipality, applying the theoretical model of the Supply Chain.
 Method: In this study, a new model for supply chain management was developed and proposed, based on contributions from the literature, seeking to offer improvements for the management of the municipality's health system.
 Result: This health supply chain model is much more complex, involves many community organizations, but is also better able to provide effective health services at low cost.
 Contributions: presentation of a new model capable of generating insights for new research and for executive applications.

COVID-19: Impact on Health Supply Chain and Lessons to Be Learnt

Before the imposition of the strict lockdowns and the spread of COVID-19, the disruptions in China caused a ripple effect on the global supply chains. Emphasis has been laid on minimisation of costs and timely delivery of essential products. In India, as the situation worsens due to the outbreak, we have seen disruptions in the logistics supply chain. There are several reasons attributed to the increase in demand and slowing of the supply. There are several workable solutions available to look into this situation. We should work towards promoting Indian markets and amend policies to help the local workforce lessen the interdependencies of imports on other countries. This will help in strengthening the logistics supply chain in India. This will create employment opportunities and increase the GDP growth.

Challenging times: ethics, nursing and the COVID-19 pandemic.

Globally nurses and midwives are working hard to detect cases of COVID‐19, to save lives or give comfort in the face of death, to educate themselves and the public about protective measures to stop the viral spread, while still caring for those not infected with the virus. In many countries nurses are working under virtual siege from this pandemic, with not enough resources or personal protective equipment, overwhelming numbers of patients, staff shortages, underprepared health systems and supply chain failures. Nurses and other health and emergency workers are suffering physical and emotional stress, and moral distress from conflicting professional values. They are faced with unpalatable and complex ethical issues in practice, with moral conflicts, high levels of acuity and patient deaths, and long working hours. A rising number of nurses are infected with SARS‐CoV‐2 or dying in the line of duty. Nurses need strong moral courage, stamina and resilience to work on the front lines of the pandemic, often while separated from their loved ones.

A novel COVID-19 based truck driver syndemic? Implications for public health, safety, and vital supply chains.

U.S. long‐haul truck drivers traverse great distances and interact with numerous individuals, rendering them vulnerable to acquiring and transmitting coronavirus disease 2019 (COVID‐19). Together, the unique co‐occurrence of pronounced health disparities and known COVID‐19 infection, morbidity, and mortality risks suggest the possibility of a novel COVID‐19 based truck driver syndemic due to advanced driver age and endemic health issues. In turn, COVID‐19 sequelae may perpetuate existing health disparities. The co‐occurrence of afflictions may also result in compromised safety performance. To curb the likelihood of a COVID‐19 based truck driver syndemic, several action stepsare needed. First, key COVID‐19 metrics need to be established for this population. Second, relationships between long‐haul trucker network attributes and COVID‐19 spread need to bedelineated. Third, mutually reinforcing interactions between endemic health disparities and COVID‐19 vulnerability need to be elucidated. Finally, grounded in the aforementioned steps, policies and interventions need to be identified and implemented.

Economic Shocks From the Novel COVID-19 Pandemic for Anesthesiologists and Their Practices.

Economic Shocks From the Novel COVID-19 Pandemic for Anesthesiologists and Their Practices.

Evaluating Constraints and Prospects in Public Health Supply Chain: The Case of the Ethiopian Pharmaceutical Supply Agency (EPSA)

Evaluating Constraints and Prospects in Public Health Supply Chain: The Case of the Ethiopian Pharmaceutical Supply Agency (EPSA)

Developing a sustainability index for public health supply chains

Abstract Researchers and practitioners alike have become increasingly aware and interested in the sustainability of supply chains. The majority of the research in this area includes the triple-bottom approach of sustainability understanding the economic, social, and environmental outcomes of supply chain functions. Several sustainability measures have been presented in the literature to recognize the sustainability of supply chains helping stakeholders in making strategic decisions. However, most of these studies analyse supply chains in developed nations and the research on sustainable supply chains in developing countries is scarce. The existing studies cover only the triple-bottom approach of sustainability in supply chains and there is a need to delve deeper into research to identify and quantify additional aspects of supply chain sustainability. Moreover, there is very little evidence of research on the sustainability of public health supply chains. Greater attempts in doing so will gain more comprehension of the emerging scope of sustainability practices in healthcare and help the various stakeholders improve their actions. Under this background, the main contribution of the paper is to devise a sustainability measure applicable to supply chains in public health. To this end, we develop a Supply Chain Sustainability Index which in addition to measuring the economic, social, and environmental footprints, also measures the stakeholder collaboration, health outcomes, and product/service and process quality initiatives. The index is comprised of a set of quantitative sub-indicators assessing multiple dimensions of sustainability across the supply chain participants concerning their role, location, capacity, etc. The sustainability index is modelled as a multi-dimensional vector and follows a hierarchal structure breaking down the different dimensions of sustainability to sets of sub-indicators and metrics. Although the current conceptual study does not provide any empirical evidence, it aims to propose this index to improve the evaluation and health coverage of public health supply chains. It will act as a foundation for further research and enable practical testing of the index in public health supply chains.

Blockchain in health supply chain management: State of art challenges and opportunities

Rising global costs and the fragmented nature of the healthcare supply chain creates several challenges. The healthcare industry needs efficient solutions that can streamline supply chain operations and processes in a cost- effective manner. Leading healthcare players are exploring blockchain technologies to achieve efficiencies and gain better control over their supply chains. In this paper, we present the current state of the subject and summarize the benefits and the challenges of the distributed organization and management of supply chains management. Focusing on healthcare, and we discuss the applicability of blockchains in the supply chain domain in the healthcare.

Factors contributing to medicines wastage in public health facilities of South West Shoa Zone, Oromia Regional State, Ethiopia: a qualitative study

BackgroundMedicines wastage is one of the challenges of health supply chain management in developing countries including Ethiopia. However, there is lack of objective evidence on the detailed underlying causes of medicines wastage. Therefore, the aim of this study is to explore factors contributing for medicines wastage in selected public health facilities of South West Shoa Zone, Oromia Regional State, Ethiopia.MethodsA qualitative study was conducted in 10 public health facilities (1 General hospital and 9 health centers). An in-depth interview with flexible probing techniques was employed to collect the data from 20 key informants from May 2, 2016 to May 27, 2016. A semi structured interview guide was prepared to explore key informants’ idea about current situation of contributing factors and efforts made to reduce medicines wastage in public health facilities. A thematic analysis was then used to analyze the data.ResultsAlmost all key informants felt that medicines wastage is increasing from time to time in their health facility due to supplier’s issuing of medicines without health facilities’ needs and request, failure to follow first expired first out principle in issuing medicines from stores to different dispensing units, lack of communication between supplier and health facilities, inadequate number of pharmacy personnel and weak monitoring system of supply chain in the health facilities. They also revealed budget constraint, stock out of medicines and congested store are of the major challenge that are compromising their service provision.ConclusionMedicine wastage is an ever-increasing problem in public health facilities of South West Shoa Zone. The problem is exacerbated due to absence of mechanisms to minimize the wastage. Health facilities, therefore, should place a mechanism to exchange medicines from overstocked facilities to under stocked ones; has to improve store management capacity by employing competent professionals, equipping the store with necessary technology and introducing a monitoring and evaluating health supply chain performance system in the health facilities.

Associations Between Practices and Behaviors at the Health Facility Level and Supply Chain Management for Antiretrovirals: Evidence from Cameroon, Namibia, and Swaziland.

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.

Making the Health System Work for Nutrition (P10-139-19)

ObjectivesThe many factors underlying malnutrition highlight the need for nutrition strategies that are comprehensive and multi-sectoral. Within a multi-sectoral approach, the health system is uniquely placed to deliver ten nutrition-specific interventions, which, if scaled up, could substantially reduce under-5 deaths in high-burden countries (Bhutta et al, 2013). This study aims to clarify the role of key health system components, illuminating opportunities for increased uptake of nutrition-specific interventions and potential bottlenecks and challenges for programs and policies. MethodsWe reviewed existing nutrition frameworks to develop a comprehensive logic model illustrating the causal pathways by which health system components influence household-level determinants of nutrition and individual-level health outcomes. Concurrently, we reviewed literature on health and nutrition interventions that have a proven, quantifiable impact on morbidity and mortality in low- and middle-income countries. We mapped data from the gathered literature onto the logic model, allowing us to identify key causal pathways for the delivery of nutrition-specific interventions, and highlighting areas where evidence is lacking. ResultsThere exists a large gap in the literature about how health system components influence the ability to delivery appropriate and high-quality nutrition care. Based on the nature of the intervention (i.e., supplement delivery, counselling, SAM/MAM management) several unique delivery pathways were identified and three common themes cut across all interventions: namely, the importance of a motivated and trained health workforce; reliable and efficient supply chains; and generating demand and increased care-seeking for nutrition interventions. Evidence from the broader health systems literature supports the importance of these three themes; however, this remains a research gap in the nutrition literature. ConclusionsThree core health system components - a health workforce, supply chain and demand generation - play a pivotal role in the delivery of nutrition interventions. A better understanding of these components in relation to nutrition, based on evidence, will help to improve the design and implementation of future nutrition programs. Funding SourcesGlobal Affairs Canada, under the project “Real Accountability: Data Analysis for Results”.

Integration of the UNICEF nutrition supply chain: a cost analysis in Kenya.

Integration of parallel health commodities supply chains into one national supply chain is becoming more common globally as national health systems are strengthened and organizations realize the potential for increased effectiveness and cost reduction from integration. UNICEF conducted a 10-week pilot to integrate its supply chain for nutrition commodities into the national Ministry of Health supply chain for medical commodities. This paper is a cost analysis of the integration process in two counties, comparing four scenarios of cost structures before, during and after integration. It found as a result of integration, within the two counties involved in the 10-week pilot period, 14% cost savings were obtained on transport, warehousing and staff costs, when compared with the pre-integration total cost structure, and 37% when extrapolated out to a year as initial capacity development (training) costs were spread over a longer period. When looking only at recurrent costs and not one-time investments in capacity development, cost savings increased to 42%. More of the costs post-integration were invested in capacity building activities to strengthen the Kenyan health system, as opposed to pre-integration when more costs went towards higher transportation costs. Besides the positive impact on costs and savings generation, integration increased the reliability of forecasting and reporting, improved communication and coordination across stakeholders, decreased stock-outs and strengthened the capacity of the health system. This article also includes lessons learned and challenges of the integration process, useful to other country programmes considering similar integration. Because of the potential for a positive impact on health systems strengthening, combined with decreased costs and enhanced accountability, this is an exciting change not only for scale-up domestically, but for donors and implementing organizations to consider more broadly in other countries.

The Effect of Employee Turnover on the Efficiency of Pharmaceutical Fund and Supply Agency (PFSA)

Background: Employee turnover is one of the major factors to affect organizational efficiency and considered as challenging issues and deep implications for public health supply chain, while a professional workforce is vital to ensure continuous availability of pharmaceuticals. Objective: To assess the effect of staff turnover on organizational (PFSA) efficiency. Methods: A cross-sectional descriptive study was conducted. Using sample size determination formula 96 respondents was obtained from 478 permanent employees of target population. Data obtained through structured questionnaires were analyzed using the version 20 SPSS. Descriptive statistics (mean, standard deviation, variance, and percentage) was computed and summary results was present using tables and graphs. Chi-square test was compute to see the association and proven the research hypothesis. Result: A total of 96 respondents were participated. The result showed that majority 90 (93.8%) of the respondents were responded PFSA has experience of employee turnover. A mean of 4.05, 4.00 of respondents agreed that lack of incentives and poor wages, low level of employee motivation, were the reasons of employee turnover respectively. Even though 50 (52.1%) of the respondents felt that the organization had not taken any measures to manage employee turnover, a mean of 3.55 and 3.41 respondents indicated that establishing of functional and effective human resource management system and create an open communication between employee and management respectively could decrease employee turnover and improve organization efficiency to a great extent, this supported by (X2= 10;97, df=4, p< 0.027) establishing effective human resource management system is the way of reducing staff turnover implies significant relationship between staff turnover and organizational effectiveness. A study showed that a significant association between staff turnover and organizational efficiency (X2= 20.49, df=4, p< 0.000).Conclusion: The study concluded that almost all the employees had an intimation to left the Agency due to poor incentives and wages, low level of employee motivation, lack of career development opportunities.

Value of inventory information in allocating a limited supply of influenza vaccine during a pandemic.

ObjectiveTo understand the value of information on vaccine inventory levels during an influenza pandemic, we propose a simulation study to compare vaccine allocation strategies using: (i) only population information (pro-rata, or population-based, PB), (ii) both population and vaccine inventory information (population and inventory-based, PIB).MethodsWe adapt an agent-based simulation model to predict the spread of the disease both geographically and temporally. We study PB and PIB when uptake rates vary geographically. The simulation study is done from 2015 to 2017, using population and commuting data from the state of Georgia from the United States census.FindingsCompared to PB under reasonable scenarios, PIB reduces the infection attack rate from 23.4% to 22.4%, decreases the amount of leftover inventory from 827 to 152 thousand, and maintains or increases the percentage of vaccinated population.ConclusionsOur results indicate the need for greater vaccine inventory visibility in public health supply chains, especially when supply is limited, and uptake rates vary geographically. Such visibility has a potential to decrease the number of infections, help identify locations with low uptake rates and to motivate public awareness efforts.

Building strong health supply chain systems: the visibility and analytics network approach to improving the Nigeria immunisation supply chain

BackgroundHealth supply chain managers are unable to effectively monitor the performance of the immunisation supply chain in Nigeria. As a result, they are unable to make effective, data-driven decisions. This...

One‐round provably secure yoking‐proof for RFID applications

SummaryThe yoking‐proof is the evidence that two or more RFID (Radio Frequency Identification) tags have been scanned simultaneously. Thanks to the IoT (Internet of Things), the yoking‐proof scheme becomes a very useful mechanism in many application areas such as health care and supply chain. However, the existing yoking‐proof schemes require two or more rounds of communication to generate the yoking‐proof. Following our idea presented in IEEE TrustCom 2017, we further investigate how to design the one‐round yoking‐proof scheme with efficiency advantage. Our contributions are threefold: (1) we propose a new timestamp‐based scheme for the RFID tag pair; (2) we prove the security and privacy of the proposed scheme under our models; (3) the proposed scheme is extended for the m > 2 RFID tags. In addition, the extended scheme still maintains one‐round of communication to generate the yoking‐proof.