A structural equation modeling of supply chain strategies for artemisinin-based combination therapies in Uganda

Abstract

Introduction: Malaria is a killer disease in the tropical environment; artemisinin-based combination therapies (ACTs) play a central role in treating malaria. Thus, the supply and presence of ACT drugs in hospitals are a key feature in the fight against malaria. Supply chain management literature has focused on the private sector, and less attention has been paid to the public sector, especially hospitals. Aim: This study uses an interdisciplinary lens in investigating how to boost the supply and distribution of ACTs to save lives in low-income countries, specifically in Uganda. Methodology: The study adopted a quantitative research design using a questionnaire as the data collection instrument. Of the 440-population size, 304 of the sample population participated in the study. The model was estimated using structural equation modeling (SEM) to establish the causal relationship among the variables. Results: From the SEM analysis, all the hypotheses were significant at p < 0.05. The availability of ACTs is strongly affected by strategic dimensions (0.612), followed by operation dimensions (0.257); strategic determinants significantly affect operational determinants by a magnitude of 0.599. The indirect influence of the strategic determinants via operational determinants on the availability of ACTs is not significant. Overall, the factors explained 63.9% of the observed variance in the availability of ACTs, and the ACT availability can be predicted as follows: ACT availability = 0.612 × strategic determinants + 0.256 × operation determinants. Top management commitment and organizational responsiveness are among the items that positively affect the availability of ACTs. Conclusion: Strategically, hospital management should invest in cheap technology and software to minimize the unavailability of medicines. Our research suggests that strategic and operational determinants should be integrated into the hospitals’ core business and implemented by the top management. The article contributes to theoretical and policy direction in the public sector medicine supply chain, specifically in public hospitals.

Health supply chain system in Uganda: current issues, structure, performance, and implications for systems strengthening

“…Furthermore, it contributes to disruptions often witnessed across several supply chain functions including forecasting, inventory management, warehouse and stores management, stock management and fails to address the commodity needs of end users (health facilities). These structural inefficiencies aggravate other supply chain challenges including insufficient coordination, inadequate financing, lack of incentivization, schemes for supply chain personnel [ 31 ], [ 44 ], [ 53 ], [ 66 ]. Regulatory frameworks and governance Governance is a critical component of a well-functioning health system [ 60 ].…”

Determinant Variables of Logistic Management in Micro and Small Enterprises

“…Research is reported that highlights the necessary system approach that must characterize logistics management (Shvartsburg and Zaborowski, 2019), as well as a required strategic conception. Although investigations are reported for the multiple sub-processes that make up logistics management, the most recurrent theme is the conception of the supply chain (Nagitta and Mkansi, 2019;Zimon and Madzík, 2019;. Through an analysis of 302 publications of the 614 identified as oriented to MSMEs, the orientation of these investigations was characterized according to the object of the logistics under study.…”

Macro environment determinants affecting the availability of artemisinin-based combination therapies in Uganda

“…Nonetheless, some public health facilities in Sub-Saharan Africa run out of stock of malaria medicines, while in others, the medicines expire, leaving the majority of the impoverished populace desperate for treatment (Rassi et al, 2016;Sugiharto, 2010;Ushie et al, 2016). Achieving a malaria-free environment may be farfetched, especially in Sub-Sahara Africa, because of the multiplicity of stakeholders from the macromanagement environment (Khuluza and Heide, 2017;Mwathi and Ben, 2014), unless both the internal and external chain partners are coordinated (Nagitta and Mkansi, 2019). Hospitals ought to manage the supply and distribution interdependency of medicines with local, regional and international partners on harmonization and standards development to harness the mutual benefits and learning from the partnership.…”

“…When adopted as the first-line treatment for malaria, ACTs are either free of charge or at a highly subsidized price. In Uganda, public hospitals are vital in treating malaria-affected patients (Nagitta et al , 2021). Nonetheless, some public health facilities in Sub-Saharan Africa run out of stock of malaria medicines, while in others, the medicines expire, leaving the majority of the impoverished populace desperate for treatment (Rassi et al , 2016; Sugiharto, 2010; Ushie et al , 2016).…”