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The Impact of Inventory Management on Stock-Outs of Essential Drugs in Sub-Saharan Africa: Secondary Analysis of a Field Experiment in Zambia

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  • Ngai-Hang Z Leung
  • Ana Chen
  • Prashant Yadav
  • Jérémie Gallien

Abstract

Objective: To characterize the impact of widespread inventory management policies on stock-outs of essential drugs in Zambia’s health clinics and develop related recommendations. Methods: Daily clinic storeroom stock levels of artemether-lumefantrine (AL) products in 2009–2010 were captured in 145 facilities through photography and manual transcription of paper forms, then used to determine historical stock-out levels and estimate demand patterns. Delivery lead-times and estimates of monthly facility accessibility were obtained through worker surveys. A simulation model was constructed and validated for predictive accuracy against historical stock-outs, then used to evaluate various changes potentially affecting product availability. Findings: While almost no stock-outs of AL products were observed during Q4 2009 consistent with primary analysis, up to 30% of surveyed facilities stocked out of some AL product during Q1 2010 despite ample inventory being simultaneously available at the national warehouse. Simulation experiments closely reproduced these results and linked them to the use of average past monthly issues and failure to capture lead-time variability in current inventory control policies. Several inventory policy enhancements currently recommended by USAID | DELIVER were found to have limited impact on product availability. Conclusions: Inventory control policies widely recommended and used for distributing medicines in sub-Saharan Africa directly account for a substantial fraction of stock-outs observed in common situations involving demand seasonality and facility access interruptions. Developing central capabilities in peripheral demand forecasting and inventory control is critical. More rigorous independent peer-reviewed research on pharmaceutical supply chain management in low-income countries is needed.

Suggested Citation

  • Ngai-Hang Z Leung & Ana Chen & Prashant Yadav & Jérémie Gallien, 2016. "The Impact of Inventory Management on Stock-Outs of Essential Drugs in Sub-Saharan Africa: Secondary Analysis of a Field Experiment in Zambia," PLOS ONE, Public Library of Science, vol. 11(5), pages 1-18, May.
    • Handle: RePEc:plo:pone00:0156026
    DOI: 10.1371/journal.pone.0156026
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    1. Armelle Pasquet & Eugène Messou & Delphine Gabillard & Albert Minga & Ayeby Depoulosky & Sylvie Deuffic-Burban & Elena Losina & Kenneth A Freedberg & Christine Danel & Xavier Anglaret & Yazdan Yazdanp, 2010. "Impact of Drug Stock-Outs on Death and Retention to Care among HIV-Infected Patients on Combination Antiretroviral Therapy in Abidjan, Côte d'Ivoire," PLOS ONE, Public Library of Science, vol. 5(10), pages 1-9, October.
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    Cited by:

    1. Jónas Oddur Jónasson & Sarang Deo & Jérémie Gallien, 2017. "Improving HIV Early Infant Diagnosis Supply Chains in Sub-Saharan Africa: Models and Application to Mozambique," Operations Research, INFORMS, vol. 65(6), pages 1479-1493, December.
    2. De Boeck, Kim & Decouttere, Catherine & Jónasson, Jónas Oddur & Vandaele, Nico, 2022. "Vaccine supply chains in resource-limited settings: Mitigating the impact of rainy season disruptions," European Journal of Operational Research, Elsevier, vol. 301(1), pages 300-317.
    3. Jérémie Gallien & Ngai‐Hang Z. Leung & Prashant Yadav, 2021. "Inventory Policies for Pharmaceutical Distribution in Zambia: Improving Availability and Access Equity," Production and Operations Management, Production and Operations Management Society, vol. 30(12), pages 4501-4521, December.
    4. Amir Karimi & Anant Mishra & Karthik V. Natarajan & Kingshuk K. Sinha, 2021. "Managing Commodity Stock‐outs in Public Health Supply Chains in Developing Countries: An Empirical Analysis," Production and Operations Management, Production and Operations Management Society, vol. 30(9), pages 3116-3142, September.
    5. Harwin De Vries & Lisa E. Swinkels & Luk N. Van Wassenhove, 2021. "Site Visit Frequency Policies for Mobile Family Planning Services," Production and Operations Management, Production and Operations Management Society, vol. 30(12), pages 4522-4540, December.
    6. Vanvuchelen, Nathalie & De Boeck, Kim & Boute, Robert N., 2024. "Cluster-based lateral transshipments for the Zambian health supply chain," European Journal of Operational Research, Elsevier, vol. 313(1), pages 373-386.
    7. Fernando Rojas & Víctor Leiva & Peter Wanke & Camilo Lillo & Jimena Pascual, 2019. "Modeling lot-size with time-dependent demand based on stochastic programming and case study of drug supply in Chile," PLOS ONE, Public Library of Science, vol. 14(3), pages 1-24, March.
    8. Varun Karamshetty & Harwin De Vries & Luk N. Van Wassenhove & Sarah Dewilde & Warnyta Minnaard & Dennis Ongarora & Kennedy Abuga & Prashant Yadav, 2022. "Inventory Management Practices in Private Healthcare Facilities in Nairobi County," Production and Operations Management, Production and Operations Management Society, vol. 31(2), pages 828-846, February.
    9. Kovacs, Gyöngyi & Moshtari, Mohammad, 2019. "A roadmap for higher research quality in humanitarian operations: A methodological perspective," European Journal of Operational Research, Elsevier, vol. 276(2), pages 395-408.
    10. Erika Linnander & Christina T Yuan & Shirin Ahmed & Emily Cherlin & Kristina Talbert-Slagle & Leslie A Curry, 2017. "Process evaluation of knowledge transfer across industries: Leveraging Coca-Cola’s supply chain expertise for medicine availability in Tanzania," PLOS ONE, Public Library of Science, vol. 12(11), pages 1-16, November.

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