Aligning health supply chain maturity with technology transfer in low-and-middle-income countries

Background: Technological advancement has been very rapid in low-and-middle-income countries (LMICs), facilitating economic growth and removing structural challenges. However, there is still much to be achieved as the developing world is in the phase of adapting existing technologies, rather than pursuing innovations and creating new technology. In this context, many of the LMICs still lack social infrastructures like power and maintenance culture to help sustain the consistent and efficient use of these technologies. Technology affects public health supply chains (PHSC) mainly through automation, connectivity for last-mile delivery, and the level of innovation. Technologies like Logistic Management Information System (LMIS), RFID (radio-frequency identification), mobile phone technology, blockchain, etc have the potential to make existing PHSC more robust. Purpose: This study aims to conceptually elucidate the constraints of the introduction of technology in PHSC of LMICs. Some of these countries do not recognize the absorptive capacity that must be in place to enable the diffusion of technology. In the absence of such capacity, major challenges can arise in a country after the technology transfer takes place. Therefore, to overcome this gap in the literature, we attempt to understand the role of technology transfer in PHSC of LMICs and focus on identifying the appropriate supply chain maturity stage that technology should be introduced to improve healthcare outcomes. Methodology: We attempt to understand the appropriate stage for introducing technology in PHSC through the review of existing literature on broader themes. We searched the Google Scholar and Science Direct databases for studies that focussed on the right maturity stage of PHSCs for the transfer of technology. The review includes forty-seven studies encompassing four studies on healthcare supply chains, seven on economic development, ten on technology transfers, six on innovation, five on how different models of technology transfer impact regional growth, and fifteen on the evolution and importance of maturity models in improving supply chain performance. Our detailed review supported our use of the Frontier Markets Supply Chain Maturity Model (MM), as proposed by the Bill and Melinda Gates Foundation, for further analysis, since it is based on the identification of the weakest links in LMIC supply chains and it is widely used in their context. Finding: The frontier market maturity model is a reference framework that identifies dynamically shifting bottlenecks and helps supply chain teams know where to focus their improvement efforts for the maximum impact on supply chain performance. Our study elucidates how technology can be best used depending on the maturity stage of the health supply chains in LMICs. We identified leadership, collaboration, local capacity building, etc as some of the “key determinants for success” to enhance a country’s absorptive capacity to strengthen the PHSC through technology. When the maturity model stages were mapped with the key determinants, we found that countries can use the technology differently depending on their capacity. At the canvas stage, the LMICs can absorb the technology and can optimally utilize it at the bronze stage. LMICs can exploit the imported technology at the silver stage leading to better integration at the gold stage. Finally, in the graduated stage, LMICs are more adept at realizing the full potential of technology and harnessing it for context-driven solutions. Conclusion: An important consideration is that technology should be relevant to the country’s capabilities and factor endowments. The introduction of technology does not necessarily bring immediate benefits. The benefits will depend on countless factors that vary across countries. If an LMIC uses technology for its development, it will have from the beginning human and capital resources for the new technologies, avoiding the problem of all the developed countries that must channelize more time and effort presently to reskill their workforces that have been trained on old technologies. The study underlines that key drivers like participation, benchmarking, developing capacity, and allocating financial resources judiciously will help in creating an enabling environment for better use of technology

Interventions to improve access to medicine in developing countries: mapping WHO’s building blocks and supply chain functions

Access to medicine remains poor and inequitable in many low- and middle-income countries (LMICs). This is a complex and multi-dimensional issue calling for holistic solutions. Studies in this area focus on singular disciplines, highlighting one or two main issues; this paper seeks to consider this issue from a multi-disciplinary perspective. It first enumerates the supply chain bottlenecks which lead to poor access to medicine. Since access is dependent on a host of factors, it is critical to understand each of these in the context of LMICs. Secondly, the paper proposes interventions to improve access by focusing on availability, affordability, quality and obtainability of medicine. These interventions are categorised into broader areas of focus to help stakeholders understand their role and responsibilities across the supply chain functions. Finally, the paper establishes a rationale for each intervention, matching it to a WHO Building Block and the corresponding supply chain management function. The resulting map will allow stakeholders to envision policies that will contribute to comprehensive solutions that strengthen the public health supply chains in LMIC

Developing a sustainability index for public health supply chains

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 analyze 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

Human capital and economic growth - challenges and prospects for the Nigerian economy

Despite its recent policy reorientation towards capital accumulation as a means of boosting economic activity, Nigeria still faces low productivity, poor infrastructure, and underdeveloped human capital. In this paper, we review the challenges to Nigeria’s development and explore the impact of human capital on economic growth over the period 2011 to 2017. To that purpose, Granger Causality Tests has been adopted to establish the causal dimension between human capital and economic growth. While we provide some tentative evidence on the contribution of human capital to economic growth, we also highlight key strategic questions that, when addressed, could provide some solutions to the existing pressing issues

Understanding a constellation of eight COVID-19 disease prevention behaviours using the COM-B model and the theoretical domains framework: a qualitative study using the behaviour change wheel.

Background The use of behavioural science and behaviour change within local authorities and public health has supported healthful change; as evidenced by its importance and contribution to reducing harm during the COVID-19 pandemic. It can provide valuable information to enable the creation of evidence-based intervention strategies, co-created with the people they are aimed at, in an effective and efficient manner. Aim This study aimed to use the COM-B model to understand the Capability, Opportunity and Motivation of performing a constellation of eight COVID-19 disease prevention behaviours related to the slogans of ‘Hands, Face, Space, Fresh Air’; ‘Find, Isolate, Test, (FIT), and Vaccinate’ in those employed in workplaces identified as high risk for transmission of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) to support intervention development. Methods This qualitative study recruited twenty-three participants (16 female, 7 male), who were interviewed from three environments (schools, care homes, warehouses) across three local authorities. Semi-structured interviews were analysed using thematic analysis. Findings Ten core themes were identified inductively; (1) knowledge and skills, (2) regulating the behaviour, (3) willingness to act, (4) necessity and concerns, (5) emotional impact, (6) conducive environment, (7) societal influence, (8) no longer united against COVID-19, (9) credible leadership, and (10) inconsistent adherence to COVID-19 prevention behaviours. Themes were then deductively mapped to the COM-B model of behaviour change and the theoretical domains framework and a logic model using the behaviour change wheel (BCW) was produced to inform intervention design. Conclusion This study offers a novel approach to analysis that has included eight behaviours within a single thematic analysis and COM-B diagnosis. This will enable local authorities to direct limited resources to overarching priorities. Of key importance, was the need for supportive and credible leadership, alongside developing interventions collaboratively with the target audience. COVID-19 has had an emotional toll on those interviewed, however, promoting the value of disease prevention behaviours, over and above their costs, can facilitate behaviour. Developing knowledge and skills, through education, training, marketing and modelling can further facilitate behaviour. This supports guidance produced by the British Psychological Society COVID-19 behavioural science and disease prevention taskforce

Understanding a constellation of eight COVID-19 disease prevention behaviours using the COM-B model and the theoretical domains framework: a qualitative study using the behaviour change wheel

Background: The use of behavioural science and behaviour change within local authorities and public health has supported healthful change; as evidenced by its importance and contribution to reducing harm during the COVID-19 pandemic. It can provide valuable information to enable the creation of evidence-based intervention strategies, co-created with the people they are aimed at, in an effective and efficient manner. Aim: This study aimed to use the COM-B model to understand the Capability, Opportunity and Motivation of performing a constellation of eight COVID-19 disease prevention behaviours related to the slogans of ‘Hands, Face, Space, Fresh Air’; ‘Find, Isolate, Test, (FIT), and Vaccinate’ in those employed in workplaces identified as high risk for transmission of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) to support intervention development. Methods: This qualitative study recruited twenty-three participants (16 female, 7 male), who were interviewed from three environments (schools, care homes, warehouses) across three local authorities. Semi-structured interviews were analysed using thematic analysis. Findings: Ten core themes were identified inductively; (1) knowledge and skills, (2) regulating the behaviour, (3) willingness to act, (4) necessity and concerns, (5) emotional impact, (6) conducive environment, (7) societal influence, (8) no longer united against COVID-19, (9) credible leadership, and (10) inconsistent adherence to COVID-19 prevention behaviours. Themes were then deductively mapped to the COM-B model of behaviour change and the theoretical domains framework and a logic model using the behaviour change wheel (BCW) was produced to inform intervention design. Conclusion: This study offers a novel approach to analysis that has included eight behaviours within a single thematic analysis and COM-B diagnosis. This will enable local authorities to direct limited resources to overarching priorities. Of key importance, was the need for supportive and credible leadership, alongside developing interventions collaboratively with the target audience. COVID-19 has had an emotional toll on those interviewed, however, promoting the value of disease prevention behaviours, over and above their costs, can facilitate behaviour. Developing knowledge and skills, through education, training, marketing and modelling can further facilitate behaviour. This supports guidance produced by the British Psychological Society COVID-19 behavioural science and disease prevention taskforce