Browsing by Author "Enoos, Bashier"

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    Supply chain analysis : a case study of differentiated physical distribution for chronic medicines in the public health sector of South Africa
    (Stellenbosch : Stellenbosch University, 2023-03) Enoos, Bashier; Louw, Johannes Jacobus; Pillay, Anban; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Logistics.
    ENGLISH SUMMARY: Timely, predictable, and sustained access to essential medicines is critical for ensuring long-term treatment adherence for chronic stable clients. In South Africa, ineffective and inefficient distribution processes compounded by a sizable and increasing burden of chronic diseases and shortages of health care professionals further strain the functioning of the public health supply chain. The Central Chronic Medicine Dispensing and Distribution (CCMDD) programme is an alternative supply chain dispensing and physical distribution model for chronic medicines and long-term therapies in South Africa, which leverages the dispensing, warehousing, and distribution infrastructure of private sector service providers. Although some studies have evaluated the performance of the CCMDD programme from a public health perspective, no study to date has specifically evaluated the programme through a supply chain lens. Six focused research questions provided insights into CCMDD programme indicators, defined the CCMDD segmented supply chain and illuminated opportunities toward continuous improvement. The purpose of this descriptive case study was to analyse the CCMDD programme and its contracting mechanism from a supply chain perspective. The analysis period spanned from July 2019 to September 2021. Quantitative secondary data from the South African National Department of Health (NDoH) were used for retrospective descriptive data analysis. Qualitative data, publicly available or provided by the NDoH, relevant to CCMDD programme contracting, segmentation and physical distribution were used to analyse the supply chain, supplemented by widely recognised models, tools, and frameworks. Six public health medicines supply chains were identified in South Africa using the SCOR model. Eight of 1 171 products on contracted supply agreements across all defined supply chains (by volume) were long-term therapy products, and equated to 22% of the total volume of all contracts. The CCMDD supply chain was defined as high-volume products with predictable demand for long-term chronic therapies. Reliability was identified as the CCMDD strategic driver with perfect order fulfilment as the key performance indicator. Further, by using a recognised “Supply Chain Dynamic Alignment Framework”, differences in the supply-side and demand-side, related to desired behaviour, were identified, with a transactional, lean approach on the supply-side opposed to a collaborative approach on the demand-side. Findings from this research also indicated that the CCMDD programme’s supply contracts and indicators did not comprehensively include all aspects of a balanced scorecard approach. By analysing the CCMDD programme indicators showed that: 1) client medicines parcels were delivered to 2917 external pick-up points outside of traditional internal public health medication distribution sites, 2) chronic stable clients were decanted to alternative external pick-up points outside of traditional internal public health medication distribution sites (1 449 644 active clients (59%)), 3) 52% of total registered clients were actively using the programme, 4) the highest demand for the programme came from antiretroviral therapy clients with 66% of active clients, followed by noncommunicable diseases with 20% and antiretroviral therapy with co-morbidities at 15%. The contracting of private sector service providers allowed the public health system to leverage private sector dispensing, warehousing, and distribution infrastructure for the CCMDD programme. The study concludes with recommendations for further research into client satisfaction, active client retention, increased enrolment of noncommunicable diseases client type, phase two of the SCOR roadmap, national centralisation of high-volume product lines, and CCMDD benchmarking toward a balanced scorecard approach.