Improving Supply Chain for Essential Drugs in Low-Income Countries: Results from a Large Scale Randomized Experiment in Zambia

Vledder, Monique; Friedman, Jed; Sjöblom, Mirja; Brown, Thomas C.; Yadav, Prashant

doi:10.1080/23288604.2019.1596050

Cited by 57 publications

(65 citation statements)

References 30 publications

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“…Historically, infrastructure for the procurement, storage, and distribution of medical supplies has been underfinanced, and international vertical programmes for specific diseases (such as malaria and HIV) have fuelled parallel and fragmented supply chains, contributing to shortages and waste 10. Supply chains in many low and middle income countries rely on “push systems,” whereby centralised agencies distribute medicines and supplies top-down, rather than more responsive “pull systems,” in which facilities determine need based on actual consumption 11. Meanwhile, production too often remains concentrated among a few international companies,9 leaving countries vulnerable to price swings and disruptions.…”

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confidence: 99%

Structural inequities in the global supply of personal protective equipment

Garber

Ajiko

Gualtero-Trujillo

et al. 2020

BMJ

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confidence: 99%

Structural inequities in the global supply of personal protective equipment

Garber

Ajiko

Gualtero-Trujillo

et al. 2020

BMJ

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“…The study found that training costs for the district personnel were higher compared with other costs such as staff recruitment, salaries and transport. 9 Though costly, such training and mentorship programmes have been found to improve staff skills as well as the overall quality of service delivery. 43 With the Jazia PVS, a step-down cascading approach was used for training of staff at various levels, to control costs.…”

Section: Discussionmentioning

confidence: 99%

Cost and cost drivers associated with setting-up a prime vendor system to complement the national medicines supply chain in Tanzania

et al. 2020

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IntroductionEconomic analysis of supply chain management interventions to improve the availability of healthcare commodities at healthcare facilities is important in generating evidence for decision-makers. The current study assesses the cost and cost drivers for setting-up a public-private partnership programme in Tanzania in which all public healthcare facility orders for complementary medicines are pooled at the district level, and then purchased from one contracted supplier, the prime vendor (referred to as ‘Jazia Prime Vendor System’ (Jazia PVS)).MethodsFinancial and economic costs of Jazia PVS were collected retrospectively and using the ingredients approach. The financial costs were spread over the implementation period of January 2014–July 2019. In addition, we estimated the financial rollout costs of Jazia PVS to the other 23 regions in the country over 2 years (2018–2019). A multivariate sensitivity analysis was conducted on the estimates.ResultsJazia PVS start-up and recurrent financial costs amounted to US$2 170 989.74 and US$709 302.32, respectively. The main cost drivers were costs for short-term experts, training of staff and healthcare workers and the Jazia PVS technical and board management activities. The start-up financial cost per facility was US$2819.47 and cost per capita was US$0.37.ConclusionIn conclusion, the study provides useful information on the cost and cost drivers for setting-up a complementary pharmaceutical supply system to complement an existing system in low-income settings. Despite the substantial costs incurred in the initial investment and operations of the Jazia PVS, the new framework is effective in achieving the desired purpose of improving availability of healthcare commodities.

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“…(31) A recent randomized trial in Zambia examined the effect of three supply chain structures on the frequency and duration of stockouts of essential medicines. (32) The three arms were: Zambia's existing system, a twotier system where product is centrally stored as lay away inventory and district stores were used as a cross-docking point without lay away inventory, and a three-tier system with storage of product centrally, at the district stores, and at hospitals. Essential medicine stockouts were markedly less frequent in the two-tier arm compared to Zambia's existing system.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Local Supply Chains and Stock Management Practices for Trauma Care Resources in Ghana: A Comparative Small Sample Cross-Sectional Study 

Boakye

Gyedu

Stewart

et al. 2020

Preprint

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Background: Injuries are a major public health problem globally. With sound planning and organization, essential trauma care can be reliably provided with relatively low-cost equipment and supplies. However, availability of these resources requires an effective and efficient supply chain and good stock management practices. Therefore, this study aimed to assess trauma care resource-related supply management structures and processes at health facilities in Ghana. By doing so, the findings may allow us to identify specific structures and processes that could be improved to facilitate higher quality and more timely care. Methods: Ten hospitals were purposively selected using results from a previously performed national trauma care capacity assessment of hospitals of all levels in Ghana. Five hospitals with low resource availability and 5 hospitals with high resource availability were assessed using the United States Agency for International Development (USAID) Logistics Indicators Assessment Tool and stock ledger review. Data were described and stock management practices were correlated with resource availability. Results: There were differences in stock management practices between low and high resource availability hospitals, including frequency of reporting and audit, number of stock-outs on day of assessment (median 9 vs 2 stock-outs, range 3 – 57 vs 0 – 9 stock-outs, respectively; p=0.05), duration of stock-outs (median 171 vs 8 days, range 51 – 1,268 vs 0 – 182 days, respectively; p=0.02), and fewer of up-to-date stock cards (24 vs 31 up-to-date stock cards, respectively; p=0.07). Stock-outs were common even among low-cost, essential resources (e.g., nasal cannulas and oxygen masks, endotracheal tubes, syringes, sutures, sterile gloves). Increased adherence to stock management guidelines and higher percentage of up-to-date stock cards were correlated with higher trauma resource availability scores. However, the variance in trauma resource availability scores was poorly explained by these individual factors or when analyzed in a multivariate regression model (r2=0.72; p value for each covariate between 0.17 – 0.34). Conclusions: Good supply chain and stock management practices are correlated with high trauma care resource availability. The findings from this study demonstrate several opportunities to improve stock management practices, particularly at low resource availability hospitals.

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Improving Supply Chain for Essential Drugs in Low-Income Countries: Results from a Large Scale Randomized Experiment in Zambia

Cited by 57 publications

References 30 publications

Structural inequities in the global supply of personal protective equipment

Structural inequities in the global supply of personal protective equipment

Cost and cost drivers associated with setting-up a prime vendor system to complement the national medicines supply chain in Tanzania

Assessment of Local Supply Chains and Stock Management Practices for Trauma Care Resources in Ghana: A Comparative Small Sample Cross-Sectional Study

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Improving Supply Chain for Essential Drugs in Low-Income Countries: Results from a Large Scale Randomized Experiment in Zambia

Cited by 57 publications

References 30 publications

Structural inequities in the global supply of personal protective equipment

Structural inequities in the global supply of personal protective equipment

Cost and cost drivers associated with setting-up a prime vendor system to complement the national medicines supply chain in Tanzania

Assessment of Local Supply Chains and Stock Management Practices for Trauma Care Resources in Ghana: A Comparative Small Sample Cross-Sectional Study&nbsp;

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Assessment of Local Supply Chains and Stock Management Practices for Trauma Care Resources in Ghana: A Comparative Small Sample Cross-Sectional Study