Enabling health supply chains for improved well-being

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-bein

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

The Effect of Rural-to-Urban Migration on Obesity and Diabetes in India: A Cross-Sectional Study

Shah Ebrahim and colleagues examine the distribution of obesity, diabetes, and other cardiovascular risk factors among urban migrant factory workers in India, together with their rural siblings. The investigators identify patterns of change of cardiovascular risk factors associated with urban migration

A cross-sectional investigation of regional patterns of diet and cardio-metabolic risk in India

<p>Abstract</p> <p>Background</p> <p>The role of diet in India's rapidly progressing chronic disease epidemic is unclear; moreover, diet may vary considerably across North-South regions.</p> <p>Methods</p> <p>The India Health Study was a multicenter study of men and women aged 35-69, who provided diet, lifestyle, and medical histories, as well as blood pressure, fasting blood, urine, and anthropometric measurements. In each region (Delhi, n = 824; Mumbai, n = 743; Trivandrum, n = 2,247), we identified two dietary patterns with factor analysis. In multiple logistic regression models adjusted for age, gender, education, income, marital status, religion, physical activity, tobacco, alcohol, and total energy intake, we investigated associations between regional dietary patterns and abdominal adiposity, hypertension, diabetes, and dyslipidemia.</p> <p>Results</p> <p>Across the regions, more than 80% of the participants met the criteria for abdominal adiposity and 10 to 28% of participants were considered diabetic. In Delhi, the "fruit and dairy" dietary pattern was positively associated with abdominal adiposity [highest versus lowest tertile, multivariate-adjusted OR and 95% CI: 2.32 (1.03-5.23); P_trend= 0.008] and hypertension [2.20 (1.47-3.31); P_trend< 0.0001]. In Trivandrum, the "pulses and rice" pattern was inversely related to diabetes [0.70 (0.51-0.95); P_trend= 0.03] and the "snacks and sweets" pattern was positively associated with abdominal adiposity [2.05 (1.34-3.14); P_trend= 0.03]. In Mumbai, the "fruit and vegetable" pattern was inversely associated with hypertension [0.63 (0.40-0.99); P_trend= 0.05] and the "snack and meat" pattern appeared to be positively associated with abdominal adiposity.</p> <p>Conclusions</p> <p>Cardio-metabolic risk factors were highly prevalent in this population. Across all regions, we found little evidence of a Westernized diet; however, dietary patterns characterized by animal products, fried snacks, or sweets appeared to be positively associated with abdominal adiposity. Conversely, more traditional diets in the Southern regions were inversely related to diabetes and hypertension. Continued investigation of diet, as well as other environmental and biological factors, will be needed to better understand the risk profile in this population and potential means of prevention.</p

Effective Demand Forecasting in Health Supply Chains: Emerging Trend, Enablers, and Blockers

Health supply chains aim to improve access to healthcare, and this can be attained only when health commodities appropriate to the health needs of the global population are developed, manufactured, and made available when and where needed. The weak links in the health supply chains are hindering the access of essential healthcare resulting in inefficient use of scarce resources and loss of lives. A chain is only as strong as its weakest link, and demand forecasting is one of the weakest links of health supply chains. Also, many of the existing bottlenecks in supply chains and health systems impede the accurate forecasting of demand, and without the ability to forecast demand with certainty, the stakeholders cannot plan and make commitments for the future. Forecasts are an important feeder for budgeting and logistics planning. Under this backdrop, the study examines how improved forecasting can lead to better short-term and long-term access to health commodities and outlines market-related risks. It explores further how incentives are misaligned creating an uneven distribution of risks, leading to the inability to match demand and supply. For this purpose, a systematic literature review was performed, analyzing 71 articles from a descriptive and content approach. Findings indicate the emerging trends in global health and the consequences of inaccurate demand forecasting for health supply chains. The content analysis identifies key factors that can pose a varying degree of risks for the health supply chain stakeholders. The study highlights how the key factors emerge as enablers and blockers, depending on the impact on the overall health supply chains. The study also provides recommendations for actions for reducing these risks. Consequently, limitations of this work are presented, and opportunities are identified for future lines of research. Finally, the conclusion confirms that by adopting a combination of approaches, stakeholders can ensure better information sharing, identify avenues of diversifying risks, and understand the implications

Lakshmy Subramanian's Quick Files

The Quick Files feature was discontinued and it’s files were migrated into this Project on March 11, 2022. The file URL’s will still resolve properly, and the Quick Files logs are available in the Project’s Recent Activity

Financial inclusion and well-being- is it demand-following or supply-leading

A two-way association can be established between financial inclusion and well-being. On the one hand, financial inclusion promotes well-being (supply-leading hypothesis), while an increase in well-being facilitates the generation of demand for financial products and services (demand-following hypothesis). This study attempts to objectively assess the significance of the demand-following and supply-leading hypotheses in the context of different-income economies to fill such gaps in the existing literature. It aims to investigate the evolving nature of financial inclusion and well-being (only physical dimensions) and establish an empirical relationship between the two. The canonical correlation technique is used to provide empirical evidence, and the supply-leading hypothesis holds for high-income counties. However, the demand-following approach is more effective than the supply-leading approach in middle-income and low-income countries. As the demand-following hypothesis is gaining momentum, policy efforts to raise the demand for financial products and services through financial literacy is vital, as are collaboration and investments to improve quality of life