Humanitarian health project supply chain costs

Supply chain management in times of crisis: a systematic review

Complexities of crises force supply chains managers to formulate crisis-induced strategies, which contrast with the conventional strategies that give precedence to competitive priorities. Recent crises, such as the coronavirus outbreaks, large-scale product recalls, and financial crises, underscore the increasing regularity and severity of crises with imperatives for introspective and retrospective socio-economic insights on the contexts, priorities, and themes of supply chain management in times of crisis. The purpose of this article is to review the literature on supply chain management in times of crisis, systematically coalescing the related body of scholarly work; outlining current methods applied by researchers; capturing strategic priorities and themes of complexities in research studies; and highlighting potentials for future studies. Using a systematic review of 250 journal articles published between 1996 and 2021, the review finds four dimensions for restorative priorities that reflect operations strategy during crisis: (i) critical supplies with essential services, (ii) timely response with recovery, (iii) safety with security, and (iv) traceability with transparency. The review also finds that operational complexities during crises originate from network configurations and business cycle complexities, optimal selections and provisioning system complexes, and complex learning processes and demand predictions. Insights from the review aid in the proposal of build-to-cycle, organic capabilities, and operational mindfulness framings for supply chain management in times of crisis. The article concludes by recommending future research studies on supply chain upgrades, diagnosis, solidarity, mapping, temporariness, and thresholds, as well as optimal selection problems on linking crisis systems investments with liabilities and on linking crisis network allotments with cross-functionalities.

A Framework for Assessing Import Costs of Medical Supplies and Results for a Tuberculosis Program in Karakalpakstan, Uzbekistan

Background. Import of medical supplies is common, but limited knowledge about import costs and their structure introduces uncertainty to budget planning, cost management, and cost-effectiveness analysis of health programs. We aimed to estimate the import costs of a tuberculosis (TB) program in Uzbekistan, including the import costs of specific imported items.Methods. We developed a framework that applies costing and cost accounting to import costs. First, transport costs, customs-related costs, cargo weight, unit weights, and quantities ordered were gathered for a major shipment of medical supplies from the Médecins Sans Frontières (MSF) Procurement Unit in Amsterdam, the Netherlands, to a TB program in Karakalpakstan, Uzbekistan, in 2016. Second, air freight, land freight, and customs clearance cost totals were estimated. Third, total import costs were allocated to different cargos (standard, cool, and frozen), items (e.g., TB drugs), and units (e.g., one tablet) based on imported weight and quantity. Data sources were order invoices, waybills, the local MSF logistics department, and an MSF standard product list.Results. The shipment contained 1.8 million units of 85 medical items of standard, cool, and frozen cargo. The average import cost for the TB program was 9.0% of the shipment value. Import cost varied substantially between cargos (8.9-28% of the cargo value) and items (interquartile range 4.5-35% of the item value). The largest portion of the total import cost was caused by transport (82-99% of the cargo import cost) and allocated based on imported weight. Ten (14%) of the 69 items imported as standard cargo were associated with 85% of the standard cargo import cost. Standard cargo items could be grouped based on contributing to import costs predominantly through unit weight (e.g., fluids), imported quantity (e.g., tablets), or the combination of unit weight and imported quantity (e.g., items in powder form).Conclusion. The cost of importing medical supplies to a TB program in Karakalpakstan, Uzbekistan, was sizable, variable, and driven by a subset of imported items. The framework used to measure and account import costs can be adapted to other health programs.

Elusive quality: the challenges and ethical dilemmas faced by international non-governmental organisations in sourcing quality assured medical products

Although medical products that are of sound quality are fundamental to the delivery of healthcare, so too is their availability, affordability, accessibility and acceptability. However, achieving all of these aims consistently and simultaneously may be unfeasible due to a host of barriers—no matter the country. If uncertainty, constraints and conflicting priorities also threaten their delivery, not only does the situation becomes yet more challenging, the morally just course of action becomes yet more opaque. While global health organisations, supply chains and projects are heterogenous, international non-governmental organisations (iNGOs) responding to humanitarian crises or delivering development assistance in low-income and middle-income countries are undoubtedly prone to this issue. In a novel framing of the problem of substandard and falsified medicines, this article explores some ethical dilemmas that, directly or indirectly, could result in the quality of medical products in iNGO health projects to be compromised. Drawing on a broad literature base and years of experience as a senior humanitarian pharmacist, the author reflects on the barriers, culture and system that contributes to the existence and persistence of substandard and falsified medical products in global assistance projects. The paper offers an in-depth examination of pressures that may arise in four key areas (capacity, supply chain, bureaucracy and quality assurance) and postulates on the myriad ways in which this may alter the attitudes, behaviours and decision-making of iNGOs in a manner that disincentivises the prioritisation of medical product quality. This paper does not seek to excoriate the aid sector, but rather to lend a new perspective: that such predicaments are overlooked, real-world ethical dilemmas in urgent need of greater openness, research, debate and guidance, for the benefit of moral decision-making and patient care.

Commodity security frameworks for health planning

Building functional logistics systems and a healthy supplier base within low- and middle-income countries (LMICs) are key ways of providing steady, predictable supplies of health commodities for unpredictable demands for healthcare and health. Efforts to provide secure supplies of health commodities, whenever and wherever they are needed, however cannot ignore questions of whether there exists an external supportive environment in LMICs. Health planners must focus not just on capacities internal to logistics systems but also on external capacities. Internal and external capacities must be considered together and not in isolation. For this reason, a capacity-oriented commodity security framework, applicable to all therapeutic categories, is presented to help health planners in LMICs identify and evaluate the interrelated root causes of unreliable supplies in their respective countries.

Modeling the enablers of humanitarian supply chain management: a hybrid group decision-making approach

Purpose

This paper intends to explore and appraise the humanitarian supply chain management enablers (HSCMEs) for efficient and effective humanitarian operations. This research aims to analyze the interaction of enablers for humanitarian supply chain management (HSCM) using a proposed hybrid framework consists of fuzzy Delphi (FD), interpretive structural modeling (ISM)–matriced impacts croises multiplication appliquee a un classement (MICMAC) and revised Simos approach.

Design/methodology/approach

This research is deliberate to identify 28 HSCMEs through a literature review and experts' opinions; out of which 20 HSCMEs are selected using FD. ISM is applied to know contextual relationship among the selected HSCMEs for developing a hierarchical model. The MICMAC analysis classifies the HSCMEs based on driving power and dependence power to validate the developed hierarchical ISM structure. The revised Simos technique is used to prioritize the HSCMEs to access its relative significance in humanitarian operations.

Findings

The finding of the analysis suggests that government policy and leadership support obtained the highest priority, having high driving power and low dependence power is significantly strategic and emerged as the leading driver for the HSCM implementation.

Research limitations/implications

ISM model presents an insight into interrelationship among HSCMEs, but this cannot quantify the impact of each HSCMEs.

Practical implications

Disaster relief aid agencies and stakeholders may focus on the enablers having high driving power and higher weight in designing and executing an effective and efficient humanitarian supply chain and to improve their activities and strategies of HSCM.

Social implications

This research helps humanitarian logisticians and humanitarian organizations to make better decisions to improve their operational performance in pre and postdisaster phases.

Originality/value

This paper explores the application of proposed hybrid framework to analyze the HSCMEs that can be considered as the original contribution.