A supply chain coordination framework for Malaria treatment therapies in general hospitals in Uganda

Abstract

Building supply chain coordination frameworks is a popular practice in the private sector in many developed countries. Despite this fact, in developing countries such as Uganda, the public health sector has hardly adopted this practice. Although the existing frameworks offer a good platform for measuring and improving the understanding of concepts underlying coordination dimensions at the micro-environment, they have limited capacity to analyse coordination interactions within the health sector, especially in developing countries like Uganda. Using the business management environment framework, this study explored the critical supply chain coordination dimensions, logistics activities dimensions and the management environment (market and macro) dimensions affecting the availability of Artemisinin-based Combination Therapies for malaria (ACTs). The overall main research goal of this thesis was to develop a supply chain coordination framework for malaria treatment therapies (ACTs) in general hospitals in Uganda. To understand the coordination dimensions of ACTs, the study adopted an exploratory sequential mixed research design, which involved a mixture of qualitative and quantitative approaches. For the qualitative phase, four focus group discussions were held. From the results, an instrument was developed and later validated using the quantitative approach. Specifically, Exploratory Factor Analysis (EFA) with a maximum likelihood extraction method followed by Confirmatory Factor Analysis (CFA) were used to analyse quantitative data. Considering the volume of the dimensions, Analytical Process Hierarchy (AHP) was carried out to rank the dimensions in order of priority. Analysis of the factor correlation matrix shows no common variance among the components; therefore, the principal components were distinct from one another and there was no discriminant validity. The CFA results showed that the standardised parameter estimates of the initial measurement models were all significant (p<.05). CFA and APH outputs were somehow different simply because each technique has its own purpose and principles. It was indicated that the correlation between critical supply chain coordination dimensions and level of ACTs availability is moderately higher, followed by logistics, macro and market environments. By better understanding the supply coordination dimensions effects on ACTs in Uganda, the research provides important direction to African governments and international donor agencies in their efforts to make malaria treatment therapies available, especially to the rural poor and avert death. The findings serve as a platform to argue for revisiting coordination dimensions in view of conditions that include a resurgent market and macro-environment in developing countries. The insight raises implications for extending coordination frameworks that are geographically focused, and specific to ACTs. It may influence policy direction in this regard and thus contribute to the body of knowledge.