Stock-out severity index: tool for evaluating inequity in drug stock-outs
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Stock‑out severity index: tool for evaluating inequity in drug stock‑outs Biplab Bhattacharya1 · Li Lin1 · Rajan Batta1 · Pavani K. Ram2
© Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract The United Nations (UN) urged acceleration efforts to tackle inequity through its Sustainable Development Goals set in 2015. The need for focusing on equity has been highlighted in the field of public health for improved health outcomes. Drug stock-outs at the last mile is a complex challenge that hinders the efforts of equitable pharmaceutical access and availability. Severity experienced due to drug stock-outs are not equal among a group of mutually exclusive and collectively exhaustive populations. This paper proposes the stock-out severity index (SSI) to measure severity due to availability of drugs or lack thereof by incorporating risk factors and determinants of health from a combination of data sources. The spread of inequity among these groups of populations can be measured using the mean absolute deviation or the GINI coefficient on the SSI assigned to each population group. The paper demonstrates how the SSI can help define priority levels of varying population groups, rather than making decisions solely from an equality perspective that assumes uniformity across populations. It also demonstrates the impact on rearranging the priorities when the SSI is used. The paper presents guidelines for incorporating and implementing the SSI. Keywords Health inequity · Drug stock-outs · Pharmaceutical supply chain · Inequity · Last mile * Biplab Bhattacharya [email protected] Li Lin [email protected] Rajan Batta [email protected] Pavani K. Ram [email protected] 1
Department of Industrial and Systems Engineering, University at Buffalo, State University of New York, Buffalo, NY 14260, USA
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Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY 14260, USA
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B. Bhattacharya et al.
1 Introduction, literature review and objectives 1.1 Introduction: global burden of drug stock‑outs Reducing under-5 mortality to 25 deaths per 1000 live births is an aim of Goal 3: Good Health and Well-Being of the Sustainable Development Goals (SDG) set by the UN in 2015. As many as 52 countries are set to miss this goal unless there is an acceleration toward the effort (UNICEF 2018). Many of the leading causes of mortality worldwide are preventable or treatable with currently available therapeutic drugs. Unfortunately, public sector availability of generic medicines is less than 60% according to a study conducted in 43 countries by the World Health Organization (WHO) (Cameron et al. 2011). Given that a key requirement of successful implementation of public health programs is availability of essential medicines at the point of care, drug stock-outs have been recognized as an important and complex global challenge (Cameron et al. 2011; Kangwana et al. 2009; Andy Gray 2012; Bateman 2013). To overcome the high disease burden, low- and midd
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