Harvard Case - Improving Maternal Health by Addressing Stockouts: Integrating the Private Sector into the Public Health Supply Chain in Senegal
"Improving Maternal Health by Addressing Stockouts: Integrating the Private Sector into the Public Health Supply Chain in Senegal" Harvard business case study is written by Julie Rosenberg, Iman Ahmad, Nour Sharara, Rebecca Weintraub. It deals with the challenges in the field of Business & Government Relations. The case study is 32 page(s) long and it was first published on : Oct 1, 2021
At Fern Fort University, we recommend a multi-pronged approach to address stockouts of essential maternal health supplies in Senegal, leveraging a public-private partnership (PPP) model. This model will involve the private sector in the procurement, distribution, and management of essential medicines and supplies, while ensuring quality control, transparency, and accountability.
2. Background
This case study examines the critical issue of stockouts of essential maternal health supplies in Senegal, leading to preventable maternal and infant mortality. The Senegalese Ministry of Health (MoH) faces challenges in effectively managing the public health supply chain due to inadequate infrastructure, limited financial resources, and bureaucratic inefficiencies. The case study highlights the potential of engaging the private sector to address these challenges.
The main protagonists are:
- The Senegalese Ministry of Health (MoH): Responsible for public health policy, planning, and implementation, including managing the public health supply chain.
- Private sector companies: Potential partners in providing essential maternal health supplies, offering expertise in procurement, distribution, and logistics.
- International Development Partners: Organizations like USAID and the World Bank, providing financial and technical support to strengthen the health system in Senegal.
- Civil Society Organizations (CSOs): Non-profit organizations advocating for improved maternal health outcomes and monitoring the performance of the health system.
3. Analysis of the Case Study
The case study presents a complex situation with multiple factors contributing to stockouts. To analyze the situation, we can utilize a framework encompassing strategic, operational, and economic dimensions:
Strategic:
- Government Policy and Regulation: The MoH needs to develop clear policies and regulations for private sector participation in the public health supply chain, ensuring transparency, accountability, and quality control.
- Business and Government Relations: Building strong and collaborative relationships between the MoH and private sector companies is crucial for successful PPP implementation.
- Corporate Social Responsibility: Private sector companies should be encouraged to adopt a strong CSR approach, prioritizing the provision of essential health services and contributing to sustainable development.
- International Relations: Engaging international development partners is essential for securing funding, technical expertise, and knowledge sharing to support the PPP initiative.
Operational:
- Supply Chain Management: The MoH needs to improve its supply chain management system by implementing robust inventory control, forecasting, and procurement processes.
- Infrastructure Development: Investing in infrastructure, such as warehouses, transportation, and communication systems, is crucial for efficient distribution and timely delivery of supplies.
- Technology and Analytics: Leveraging technology, such as data analytics and mobile applications, can enhance supply chain visibility, optimize stock levels, and improve decision-making.
Economic:
- Financial Sustainability: The PPP model needs to be financially sustainable, ensuring cost-effectiveness and value for money.
- Investment Management: Attracting private sector investment requires a clear framework for risk sharing, return on investment, and contract management.
- Economic Growth: Improving maternal health outcomes contributes to economic growth by reducing healthcare costs and increasing workforce productivity.
4. Recommendations
1. Establish a Public-Private Partnership Framework:
- Government Policy and Regulation: The MoH should develop a clear policy framework outlining the roles and responsibilities of private sector partners, including procurement, distribution, quality control, and monitoring mechanisms.
- Government Contracts: The MoH should establish transparent and competitive bidding processes for awarding contracts to private sector companies, ensuring fair and equitable selection based on quality, cost, and delivery timelines.
- Regulatory Compliance: The MoH should ensure that private sector partners comply with all relevant regulations, including quality standards, safety protocols, and ethical guidelines.
2. Enhance Supply Chain Management:
- Inventory Management: Implement robust inventory control systems, including accurate stock tracking, forecasting, and demand planning, to minimize stockouts and ensure timely replenishment of essential supplies.
- Distribution Network: Develop an efficient distribution network that reaches all healthcare facilities, including remote areas, leveraging existing infrastructure and exploring innovative delivery models.
- Technology Integration: Utilize technology, such as data analytics and mobile applications, to improve supply chain visibility, optimize stock levels, and enable real-time monitoring of supply chain performance.
3. Foster Collaboration and Capacity Building:
- Partnerships: The MoH should actively engage with private sector companies, CSOs, and international development partners to build strong collaborative relationships and leverage their expertise.
- Capacity Building: Invest in training programs for MoH staff and private sector partners to enhance their skills in supply chain management, procurement, and quality control.
- Knowledge Sharing: Facilitate knowledge sharing and exchange of best practices between stakeholders to improve the overall efficiency and effectiveness of the public health supply chain.
4. Implement a Monitoring and Evaluation Framework:
- Performance Indicators: Establish clear performance indicators to track the effectiveness of the PPP initiative, including stockout rates, delivery times, and cost-effectiveness.
- Regular Monitoring: Conduct regular monitoring and evaluation of the PPP program to identify areas for improvement and ensure accountability.
- Transparency and Reporting: Ensure transparency and accountability by publishing regular reports on the performance of the PPP initiative, including financial statements, stock levels, and delivery data.
5. Basis of Recommendations
These recommendations are based on the following considerations:
- Core Competencies and Consistency with Mission: The recommendations align with the MoH's core mission of improving maternal health outcomes and ensuring access to essential healthcare services.
- External Customers and Internal Clients: The recommendations address the needs of both external customers (mothers and newborns) and internal clients (healthcare providers) by ensuring timely and reliable access to essential supplies.
- Competitors: The recommendations consider the competitive landscape by encouraging private sector participation and promoting innovation in the delivery of essential health services.
- Attractiveness: The recommendations are attractive to private sector companies by offering opportunities for profit, social impact, and market expansion.
- Assumptions: The recommendations are based on the assumption that the MoH is committed to improving maternal health outcomes and is willing to collaborate with the private sector to achieve this goal.
6. Conclusion
By implementing these recommendations, the Senegalese government can effectively address stockouts of essential maternal health supplies, improve maternal and infant mortality rates, and strengthen the public health system. The PPP model offers a sustainable and cost-effective solution for ensuring access to quality healthcare services for all mothers and newborns.
7. Discussion
Alternatives:
- Solely relying on the public sector: This approach has proven ineffective due to financial constraints, bureaucratic inefficiencies, and limited capacity.
- International aid: While international aid can provide temporary solutions, it is not a sustainable long-term strategy.
Risks:
- Lack of government commitment: The success of the PPP model depends on the government's commitment to collaboration, transparency, and accountability.
- Corruption: Corruption can undermine the effectiveness of the PPP initiative, leading to inefficiencies, waste, and substandard supplies.
- Lack of private sector interest: Attracting private sector investment requires a clear framework for risk sharing, return on investment, and contract management.
Key Assumptions:
- The MoH is committed to improving maternal health outcomes and is willing to collaborate with the private sector.
- Private sector companies are interested in participating in the PPP initiative and are willing to adhere to ethical and quality standards.
- International development partners will continue to provide financial and technical support.
8. Next Steps
- Develop a detailed PPP framework: This framework should outline the roles and responsibilities of all stakeholders, including the MoH, private sector partners, and international development partners.
- Pilot the PPP model: Pilot the PPP model in a few selected regions to test its effectiveness and identify areas for improvement.
- Scale up the PPP model: Based on the pilot results, scale up the PPP model to other regions of Senegal.
- Monitor and evaluate the PPP initiative: Conduct regular monitoring and evaluation to ensure the PPP initiative is achieving its objectives and identify areas for improvement.
By taking these steps, Senegal can create a sustainable and effective public health supply chain that ensures access to essential maternal health supplies for all mothers and newborns, contributing to a healthier future for the country.
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Case Description
This case traces the development of a series of initiatives to intended to reduce stockouts of family planning commodities in Senegal's public health system and the eventual scale up of the redesigned supply chain to include additional commodities and its transfer of management to the government. After providing some background on the history of Senegal, including its governance and health system, the case explores early efforts to overhaul the supply chain in the country and reproductive health efforts. It then describes the Gates Foundation's involvement and how the relationship between family planning and supply chain management came to light. The Gates Foundation, along with others, supported the launch of the Informed Push Model with Third Party Logisticians (IPM-3PL), which proved to reduce stockouts dramatically. Despite significant initial support from both government ministries and international donor agencies, as the program scaled IPM-3PL did not survive the transition to a fully government-run model, and the program was eventually discontinued in 2019 after two attempts to hand over the program to Senegal's National Supply Pharmacy (Pharmacie Nationale d'Approvisionnement; PNA), the government agency in charge of distribution of medicines. The case ends with the director of the PNA contemplating what was next for Senegal and what she could tell others who had been so closely watching the country as an example.
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