Designing Public Health Supply Chains: Towards Improving Health Commodity Availability in Developing Countries

Abstract

In developing countries, significant resource constraints (e.g., funding and human resource limitations) hamper the effective delivery of health commodities from upstream suppliers to the last-mile, leading to supply chain failures such as “stock-outs.” For individuals who are deprived access to basic health commodities due to stock-outs, the consequences can be dire. For example, without reliable access to contraceptives, women may suffer unintended pregnancies, imposing economic and psychological burden, and unsafe abortions that often cause death. While the prevalence of health commodity stock-outs and the consequent repercussions for clients in developing countries are well-documented, there is a paucity of rigorous empirical research into the factors that drive such stock-outs. Focusing on this context, this dissertation aims to (i) empirically evaluate and uncover the factors that contribute to health commodity stock-outs in developing countries by leveraging field data collected from health facilities and using a combination of rigorous econometric and predictive modeling techniques; (ii) generate actionable insights that public health organizations, governments, and donors can use to mitigate the risk of stock-outs in developing countries. Toward addressing these objectives, the first dissertation study focuses on the effect of factors at the upstream level of the public health supply chain and explores the impact of the distribution model (i.e., pull vs. push) on the likelihood of stock-outs. At the downstream level, the second study investigates the role of practices that health facilities can use to mitigate the likelihood of stock-outs. The third dissertation study also focuses on the downstream level of the public health supply chain by examining how the provision of training to frontline healthcare providers can help reduce the likelihood of stock-outs. Taken together, the three dissertation studies serve as the first systematic attempt in the literature to conduct a rigorous empirical evaluation of the factors driving the stock-outs of health commodities in developing countries