The ways that health system strengthening can improve supply chain management

There are multiple frameworks and approaches to health systems strengthening (HSS) that constantly change the way these models are defined conceptually, organised, used and funded. Regardless of the framework, all acknowledge supply chains as fundamental elements of a health system.

Historically, health supply chain management (SCM) has been considered a straightforward input to service delivery. The question is: Can an HSS approach improve SCM?

When applying a systems perspective to tasks and processes, one is able to recognise that supply chains and their management are systems within a broader one and, as such, are integrated and dynamic structures composed of people, resources and public and private institutions mandated to improve, maintain or restore health. These interconnected components affect each other, so strengthening one part (supply chain) alone does not ensure the functioning of the whole (health system). Weaknesses at any level of the system become constraints for equitable access and universal coverage.

A health systems approach to SCM will look for programmatic and operational linkages among the sub-systems, and between them and an external broader HSS framework. At this moment, this has not happened mainly because actions have been partial, short-term and dissociated. Assessment instruments and plans have not been integrated into a common vision and, for the most part, are seen as separate processes aimed at producing results in parts of the puzzle. This includes a weak integration of SCM with service delivery, demand creation and overall routine functions of the health system.

When we apply health system strengthening approaches to supply chain management, there are benefits beyond just the supply chain, including the following:

• At the subnational level of the health system, strengthening the capacity of staff involved in managing supply chains makes the health system more effective and efficient, and can increase community trust in and utilisation of health services. This then can lead to improvements in other health program measures and outcomes.
• Recognising that people are central to a functioning supply chain, an HSS approach will put a greater emphasis on health workforce capacity development within SCM programs (not just focusing on filling the supply gaps, but recognising the need to put as much emphasis on supporting the people involved in the supply chain.)
• In addition to the potential of integrating SCM with other health programs, applying a systems lens to SCM gives the opportunity to look at other sectors – for example, would there be ways to work with the education sector in supplying remote areas with both health and education commodities? This could improve sustainability and resilience of the supply chain.
• Focusing on strengthening health systems within supply chain management can lead to greater investment by the private sector and development assistance agencies.

The global community has developed calls to action, visions and international strategies for SC improvements as a pillar for strengthening health systems. New funding opportunities to support the development of countries’ supply chain systems are available. Yet, the success of these endeavours will rely on breaking the perception that SCM works in isolation.

There are some general principles that can be useful to support the process of aligning SCM and HSS perspectives:

• Capacity of people and institutions: The stronger the capacity of the workforce and national institutions, the stronger the systems-building process. Most SCM assessment tools are not designed to include an in-depth assessment of human resources. However, consistently, this is a key constraint in most if not all bottleneck analyses. Appropriate attention to the supply chain workforce, their motivation, training opportunities, career paths and continuous education will be key in the strengthening and sustaining of supply chains.
• Expanded partnerships: Partnership building within and across sectors is key and ensures active contribution from all parts. Some SCM tools and processes (e.g., Effective Vaccine Management) measure performance and plans across the health system from national to facility levels. This holistic appreciation of the different actors, institutions and governance structures provides opportunities to make evident and identify solutions for systemic gaps.
• Integrative planning: An HSS perspective of SCM tools makes it possible to address systemic issues that do not come out with technical assessments alone.
• Equity focus: Introducing an equity perspective to SCM ensures that the vulnerabilities of the weakest links of the supply chain can be addressed to increase capacity of the whole system. This comprehensive vision permits reiterative processes that are necessary for promoting long-term change.

What are the barriers to integrative planning in your setting? Take a moment to reflect on this before moving on to the next step.

References

World Health Organization & UNICEF, 2016, Achieving immunization targets with the comprehensive effective vaccine management (EVM) framework: WHO/UNICEF joint statement (No. WHO/IVB/16.09), World Health Organization.