Improving Supply Chain for Essential Drugs in Low-Income Countries

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dc.creatorVledder, Monique
dc.creatorFriedman, Jed
dc.creatorSjöblom, Mirja
dc.creatorBrown, Thomas
dc.creatorYadav, Prashant
dc.date2019-07-12T20:44:39Z
dc.date2019-07-12T20:44:39Z
dc.date2019-03-20
dc.date.accessioned2026-07-01T00:38:27Z
dc.descriptionDespite increased investments in procurement of essential medicines, their availability at health facilities remains extremely low in many low- and middle-income countries. The lack of a well-functioning supply chain for essential medicines is often the cause of this poor availability. Using a randomized trial conducted in 439 health facilities and 24 districts in Zambia, this study helps understand the optimal supply chain structure for essential medicines distribution in the public sector in low-income countries. It shows that a more direct distribution system where clinics order and receive medicines supply directly from the central agency through a cross-docking arrangement significantly reduces the duration and frequency of stockouts compared to a traditional three-level drug distribution system. As an example, the frequency of stockouts for first line pediatric malaria medicines reduced from 47.9% to 13.3% and the number of days of stockout in a quarter reduced from 27 days to 5 days. The direct flow of demand and order information from health facilities to the central supply agency reduces the problem of diffuse accountability that exists in multi-tiered distribution systems. It also shifts the locus of decision making for complex supply chain functions such as scarce stock allocation and adjustment of health facility order quantities to levels in the system where staff competency is aligned with what the function needs. Even when supply chain system redesign such as the one evaluated in this paper are demonstrated to be technically robust using rigorous evidence, they often require navigating a complex political economy within the overall health system and its actors.
dc.formatapplication/pdf
dc.identifierHealth Systems and Reform
dc.identifier2328-8604
dc.identifierhttps://hdl.handle.net/10986/32086
dc.identifier10.1596/32086
dc.identifier.urihttp://hdl.handle.net/123456789/408042
dc.publisherTaylor and Francis
dc.rightsCC BY-NC-ND 3.0 IGO
dc.rightshttp://creativecommons.org/licenses/by-nc-nd/3.0/igo
dc.rightsWorld Bank
dc.subjectHEALTH SYSTEM REFORM
dc.subjectHEALTH SYSTEM MANAGEMENT
dc.subjectLOGISTICS
dc.subjectPHARMACEUTICALS
dc.subjectSUPPLY CHAIN
dc.subjectSTOCKOUT
dc.subjectESSENTIAL MEDICINES
dc.titleImproving Supply Chain for Essential Drugs in Low-Income Countries
dc.titleResults from a Large Scale Randomized Experiment in Zambia
dc.typeJournal Article
dc.typeArticle de journal
dc.typeArtículo de revista

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