Discovery at Carlson·21 Keeping Rural Health Clinics in Developing Countries from Running Out

The paper is based on analysis of data collected over multiple years at public health clinics in developing countries where stock-outs have been a problem for numerous health commodities, including antimalarials, HIV medications, and contraceptives.
As Sinha notes, “the vast majority of developing countries’ healthcare delivery happens through these public health clinics,” and many of these clinics are located in impoverished areas. Over the past 10 to 15 years, rural communities have become more aware of the clinics in their area and all the services that these facilities can provide. But with demand for these clinics’ services rising, “it doesn’t seem as if public health supply chains have progressed in concert,” Mishra says. “You don’t have a commensurate investment in infrastructure.” As a result, “the stock-out problem is becoming more prominent.” 

In this paper, the researchers chose to focus on contraceptives. “They are one of the most typical global health commodities out there,” Natarajan says. And if people can’t get access to them, he adds, “there could be economic, social, and psychological consequences because of unwanted pregnancies.”
Contraceptives are available in many forms, which reflects, to an extent, the variety of healthcare commodities available worldwide.

“This is not to say that you have an accurate representation of the entire global health world,” Natarajan admits. “But at least there is variation within the contraceptive set.” In addition, health ministries in developing countries “are often pushing for offering more varieties of contraceptives to the public,” he says. “So you’re providing more choices, you’re expanding access. But what we find is that there is a downside of this. The more choices you offer, the higher the likelihood of stock-outs of each contraceptive type.”

Clinics located in urban areas can significantly reduce the chance of stock-outs by daily updating of inventory records via logistics management information systems (LMIS). However, in rural facilities, the paper’s research reveals, daily updating can work only when used in conjunction with an electronic LMIS. Where access to funding is limited, Mishra notes, “you’re probably going to get more bang for your buck investing in electronic LMIS for rural facilities.” With warehouses close by, urban facilities are less likely to require electronic LMIS.
Rural clinics “focus their efforts on providing care, not inventory management,” Sinha says. In order for daily inventory updating to work, governments and non-government organizations that support rural health clinics in developing countries, will need to train clinic staff in how to use digital LMIS technology. That would go a long way to preventing stock-outs. And that, in turn, would reduce the danger that people will be unable to get the healthcare products and services that often are desperately needed.

 

 

        供应链是复杂的。对于发展中国家的公共卫生系统而言，这种复杂性会严重影响居民的福祉。试想，如果一个医院的抗逆转录病毒药物（HIV病毒常用药物，译者注）、抗疟疾药物或其他必需药品缺货了，这会导致什么后果呢？

        医疗系统的“缺货”问题，正是Productionand Operations Management (《生产与运营管理》)杂志即将发表的一篇论文的研究主题。AmirKarimi是2020届卡尔森学院博士毕业生，目前在德克萨斯大学圣安东尼奥商学院任教。他与卡尔森学院供应链和运营系的论文委员会成员一起撰写了这篇论文，包括助理教授Karthik Natarajan、副教授AnantMishra和教授Kingshuk(KK) Sinha。

        该论文分析了发展中国家公立卫生系统的多年数据。这些国家一直面临着多种医用产品缺货的问题，包括抗疟疾药物、艾滋病药物和避孕药具。

        Sinha教授表示，“在发展中国家，公立医院承担了绝大部分的医疗工作。”并且，许多公立医院位于贫困地区。在过去的10到15年里，农村地区的居民对本地的医院及其服务更了解了，对医院的需求也因此上升。但是，“农村地区医疗系统的供应链并没有同步提升。基础设施没有得到相应的投资，因此药品缺货的问题越来越突出。”Mishra表示。

        该论文选择避孕药具作为研究对象。Natarajan说：“这是最典型的世界通用的医用商品。”如果无法获得避孕药具，“会带来因为意外怀孕而导致的经济、社会和心理方面的后果。”

        避孕药具的形式繁多，这在一定程度上反映了全球医用商品的多样性。

        Natarajan承认，“通过这个研究方向，并不能完整而准确地反映全球卫生体系的情况，但至少说明在避孕药具方面还存在一定问题。”他还表示，发展中国家的卫生部门“致力于推动更多种类的避孕药具。虽然选项更多了，可使用范围扩大了，但我们也发现了一个弊端：选项越多，每种避孕药具缺货的可能性就越大。”

        城市中的医院可以通过物流管理信息系统（LMIS）每天更新库存，从而大幅降低缺货的风险。但是本次研究发现，在农村地区，必须使用LMIS系统才能使日常库存管理发挥作用。Mishra指出，在资金有限的情况下，“投资农村地区的LMIS系统，回报更高。”城市中的医疗设施临近仓库，对LIMIS系统的依赖性较低。

        农村地区的医疗机构“主要关注医疗服务的开展，而不是库存管理”，Sinha表示。为了使日常库存跟踪工作发挥作用，支持发展中国家农村卫生系统的政府和非政府组织需要开展培训，让卫生系统工作人员学会使用LMIS系统。这将大大降低药品缺货的可能性，从而减少居民无法获得日常急需医疗产品和服务的风险。