Toward health system strengthening in low- and middle-income countries: insights from mathematical modeling of drug supp
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RESEARCH ARTICLE
Open Access
Toward health system strengthening in low- and middle-income countries: insights from mathematical modeling of drug supply chains Abdulrahman Jbaily1 , Isabelle Feldhaus1 , Benjamin Bigelow2 , Leila Kamareddine1 , Mieraf Taddesse Tolla1 , Marion Bouvier3 , Mizan Kiros4 and Stéphane Verguet1*
Abstract Background: Global health priority setting increasingly focuses on understanding the functioning of health systems and on how they can be strengthened. Beyond vertical programs, health systems research should examine system-wide delivery platforms (e.g. health facilities) and operational elements (e.g. supply chains) as primary units of study and evaluation. Methods: We use dynamical system methods to develop a simple analytical model for the supply chain of a low-income country’s health system. In doing so, we emphasize the dynamic links that integrate the supply chain within other elements of the health system, and we examine how the evolution over time of such connections would affect drug delivery following the implementation of selected interventions (e.g. enhancing road networks, expanding workforce). We also test feedback loops and forecasts to study the potential impact of setting up a digital system for tracking drug delivery to prevent drug stockout and expiration. Results: Numerical simulations that capture a range of supply chain scenarios demonstrate the impact of different health system strengthening interventions on drug stock levels within health facilities. Our mathematical modeling also points to how implementing a digital drug tracking system could help anticipate and prevent drug stockout and expiration. Conclusion: Our mathematical model of drug supply chain delivery represents an important component toward the development of comprehensive quantitative frameworks that aim at describing health systems as complex dynamical systems. Such models can help predict how investments in system-wide interventions, like strengthening drug supply chains in low-income settings, may improve population health outcomes. Keywords: Drug supply chain, Mathematical modeling, Health system modeling, Value for money, Health system strengthening, Low- and middle-income countries
*Correspondence: [email protected] Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA Full list of author information is available at the end of the article 1
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creati
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