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This article is motivated by the gap between the growing demand and available supply of high-quality, cost-effective, and timely health care, a problem faced not only by developing and underdeveloped countries but also by developed countries. The significance of this problem is heightened when the economy is in recession. In an attempt to address the problem, in this article, first, we conceptualize care as a bundle of goods, services, and experiences-including diet and exercise, drugs, devices, invasive procedures, new biologics, travel and lodging, and payment and reimbursement. We then adopt a macro, end-to-end, supply chain-centric view of the health care sector to link the development of care with the delivery of care. This macro, supply chain-centric view sheds light on the interdependencies between key industries from the upstream to the downstream of the health care supply chain. We propose a framework, the 3A-framework, that is founded on three constructs-affordability, access, and awareness-to inform the design of supply chain for the health care sector. We present an illustrative example of the framework toward designing the supply chain for implantable device-based care for cardiovascular diseases in developing countries. Specifically, the framework provides a lens for identifying an integrated system of continuous improvement and innovation initiatives relevant to bridging the gap between the demand and supply for high-quality, cost-effective, and timely care. Finally, we delineate directions of future research that are anchored in and follow from the developments documented in the article.

The efforts of not‐for‐profit organizations (NPOs) toward enabling health care delivery in underserved communities across the globe are well‐acknowledged. To date, little is known about the workings and sustenance of NPO‐enabled long‐term health care delivery in underserved communities, and even less about NPO‐enabled surgical care delivery. Further, health care delivery in underserved communities is a context that is often characterized by primitive and poor record keeping, data scarcity and poor data quality. Therefore, conducting research on health care delivery in such contexts is particularly challenging. The central question motivating this study is: How can international NPOs enable the long‐term delivery of surgical care in underserved communities? To overcome the data challenges, we use multi‐method triangulation as the research design to conduct this study. Specifically, we adopt a grounded theory approach with small sample statistical analysis for empirical validation. We triangulate insights from qualitative and quantitative data analyses to develop and validate an integrative framework for an international NPO‐enabled long‐term surgical care delivery in underserved communities. The setting for this study is Children's HeartLink, an international medical non‐profit organization based in the United States, which partners with health care delivery organizations in developing countries to enable the diagnosis and treatment of children with congenital heart disease (CHD). The focus of this study is the Children HeartLink's partnership with the First Hospital of Lanzhou University (FHLU) located in the underserved and impoverished Gansu province of China. In Gansu province, the CHD incidence rate is six times China's average. The time‐period of this study is 11 years, 1998–2008. The key contribution of this study is the integrative framework for an international NPO‐enabled long‐term surgical care delivery in underserved communities. The framework demonstrates how an international NPO's efforts related to affordability, provider awareness, and physical access are interdependent, and how the efforts interact and impact the surgical care delivery outcome. Contrary to conventional wisdom, the framework provides new and nuanced insights such as the following: (i) an international NPO's efforts related to affordability (e.g., funding) or provider awareness (e.g., knowledge transfer) alone has limited direct impact on long‐term surgical care outcome; (ii) instead of having a direct impact on the volume of surgeries, an international NPO's effort related to affordability moderates (positively interacts with) the positive association between its efforts related to provider awareness and physical access to surgical care delivery infrastructure, thus impacting the volume of surgeries; and (iii) an international NPO's efforts related to provider awareness and physical access are complementary for long‐term surgical care delivery – i.e., the effort related to provider awareness moderates by way of strengthening the po...

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