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Supply chain management and health systems: a conversation

Human resourcing aspects also bring challenges to supply chain management. Some of these challenges are discussed by Dr Arletty Pinel in this video.
CLAUDIA VIVAS TORREALBA: Hello, Arletty. Welcome to this conversation on the role of supply chains management. It is a pleasure to have you talking to us from Panama.
ARLETTY PINEL: Thanks a lot, Claudia. It’s a pleasure to be here. Greetings from warm Panama.
CLAUDIA VIVAS TORREALBA: So tell us, why are supply chains important?
ARLETTY PINEL: Well, they’re important first of all because they save lives. They ensure that medicine, vaccines, all the health products reach the people regardless of where they are geographically, regardless of their income or about the city or gender. And they also enable health systems to provide the services that impact the health and lives of people across the life cycle. In a nutshell, if you don’t have products you won’t have programmes.
CLAUDIA VIVAS TORREALBA: Are supply chains the same as supply chains management?
ARLETTY PINEL: No. Supply chain management is the system that permits supply chains to actually perform. And its system is made of little parts. And in the case supply chain management, it involves the products, the transportation, the health systems, the information systems. All of those come together to be able to have the desired outcome. What is important are three things. First of all, that health systems require supplies and people in the systems that delivered the goods to the population. Also, public health supply chain and management involves national, district, and community levels. So it’s really across the whole health system. And to provide affordable quality care, a functional health system needs to have knowledge, resources, people, effective management, and an enabling environment.
CLAUDIA VIVAS TORREALBA: So can countries deal with supply chains management without considering the whole of the health system?
ARLETTY PINEL: It’s going to be very difficult. Because countries are facing unprecedented demands due to the increasing availability and complexity of the products and their requirements. And this exponential growth will continue. With all this influx of products and complexities, you find countries constantly trouble shooting. And if you’re constantly trouble shooting, that will drain the health workforce. It will burden management, increase the cause, cost the lives of problem implementation that resulting low performance, and ultimately affect the quality of care and the health of the populations. So you can have immediate solutions. But addressing supply chain management problems without a health system perspective, you’ll most like to generate new problems.
CLAUDIA VIVAS TORREALBA: So can technologies threaten supply chains management?
ARLETTY PINEL: Yes and no. New technologies for struggling supply chain management are being constantly introduced. But the problem is that most of the [INAUDIBLE] is used as pilots. So you’re having pilot-itis, things that are tested, but they don’t continue even if they work. So innovation in supply chain management is not just about bringing the new gadgets. It requires also new ways of planning, developing processes, sharing, and learning. Because technological solutions are enablers. They’re not magic bullets. And public health supply chain management are often vertical, prescriptive, they’ve been working like that for decades. Plus, in countries that have really weak systems, you also have broader contextual difficulties, such as educational deficiencies and lack of qualified workforce.
And because of that, if you introduce too much technology without a system to appropriately manage that introduction and to manage that innovation process, you have the potential of further burdening the system rather than helping it.
CLAUDIA VIVAS TORREALBA: So human resources are key.
ARLETTY PINEL: Yes. Because true innovation is driven by human and social capabilities. And human resource is for health of the Core20 health system, including supply chain management. So you have to take a look at placement, retention, motivation, and training. Because if not, you’re going to have major constraint to the system and programme performance. Some challenges faced by countries include understaffed supply chain programmes with no [INAUDIBLE] to attract the most qualified workforce, difficulty linking supply chain human resources to national human resources for health when this isn’t planned, and even difficulties in defining competencies for the human resources needed at the different levels, from central so community levels.
It’s very different, the competencies that you’re going to need at the Ministry of Health that what you’re going to need at the source point of care.
CLAUDIA VIVAS TORREALBA: Then how can we consider sustainability when addressing supply chains management?
ARLETTY PINEL: Well, the first thing is to remember that sustainability is not just about money. Yes, financial sustainability is important. And with the current flux of countries receiving foreign aid and then having to generate their own, that brings a lot of problems in terms of planning for financial sustainability. But this can be counteracted if we pay attention to three other elements. One of the elements is institutional sustainability, those that deal with governance and policy, and ensure that those things that are put into place have the backing of the government. We also have programmatic sustainability. We have to pay attention to the human resources, because the depletion of the human resources will threaten the system.
Weak management practises and short term gap filling of supply chain strategies will also attempt against programmatic sustainability. And finally, community sustainability, because any large scale initiative– any time you want to really go to scale, you really need the community component. And this is often absent in supply chain management planning.
CLAUDIA VIVAS TORREALBA: Finally, can you tell us what would be the main takeaways of the role of supply chains management for health system threatening?
ARLETTY PINEL: I think we have to look at four key messages. First of all, the supply chain management crosses all levels of the health system and continue health care. Secondly, health programmes cannot achieve their goals without reliable and continuous supply of health products. Thirdly, the resiliency of the supply chain is directly influenced by the country’s health system capacity. And finally, system-wide approaches have to consider strengthening procurement supply chain management at all levels– national, subnational, and community levels.
CLAUDIA VIVAS TORREALBA: Thank you very much, Arletty, for your thoughtful insights. This has been a pleasure.
ARLETTY PINEL: The pleasure has been all mine. Thank you very much.

We wonder if you noticed the links to the previous week (human resources for health) in Arletty’s comments in this video. We were struck by her comments about the challenge of attracting the right people with the right skills who get the right support into the supply chain management system. She highlighted the following difficulties:

  • Understaffed supply chain programs with no “allure” to attract the most qualified workforce
  • Difficulty linking supply chain human resources to national human resources for health policies and plans
  • Difficulty in defining competencies for the human resources needed in a supply chain management program from central to community levels
  • Going beyond short-term training to comprehensive solutions that train, support and reward human resources
  • Delivery in hard-to-reach areas is heavily dependent on community health workers that have multiple responsibilities

Reflecting on last week’s material, what might be some good first steps to address these challenges? Remember: “we manage what we measure”; do we have measures for the human resources and their skills required for a well functioning supply chain? Share your ideas in the comments section below.

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