Global Health: Science and Practice最新文献

Background: The majority of neonatal deaths occur in low- and middle-income countries, most often due to perinatal events, prematurity, and/or infection. Reprocessing of neonatal resuscitation equipment is vital for ensuring the availability of clean equipment and preventing transmission of infection to a newborn. Staff at Tenwek Hospital, a tertiary referral hospital in rural Kenya, identified reprocessing medical equipment as a gap in improving neonatal care. We sought to implement steam-based high-level disinfection (HLD) for reprocessing neonatal resuscitation equipment in the labor and delivery ward of Tenwek Hospital.

Needs assessment: Before implementation, a needs assessment was conducted to identify existing facilitators and barriers to reprocessing through semistructured interviews with key stakeholders at the hospital (N=12) and identify gaps in the hospital's existing reprocessing procedures. A chemical, chlorine-based method of disinfection was used for neonatal resuscitation equipment in the ward. We conducted baseline bacterial burden of neonatal resuscitation equipment before clinical use, after clinical use, and after reprocessing. There was not a significant decrease in bacterial burden after reprocessing.

Implementation: After implementing a new steam-based HLD process, we conducted bacterial burden testing, which showed a reduction. However, staff preferences and implementation challenges compelled us to modify our original plan and instead implement optimized chemical HLD using chlorine. Although testing showed improved bacterial burden from baseline, in our small number of samples, bacterial burden testing after implementing the optimized chemical HLD process did not differ significantly compared to steam-based HLD.

Conclusions: Optimal chemical HLD was felt to be feasible and sustainable in the local setting. Reprocessing methods should be designed for unique challenges in low-resource settings.

Introduction: Many countries have an insufficient supply of adequately skilled supply chain workers to manage health commodities, and no global standards in education or experience exist for the supply chain management (SCM) workforce managing health products. We present a professionalization framework for the health SCM workforce that provides a systematic process that countries can use to standardize and elevate the health SCM profession.

Methods: In 2019, semistructured interviews were conducted with individuals from 10 leading organizations supporting in-country public health supply chains to explore approaches for an SCM professionalization framework. Interview data were analyzed using direct thematic analysis. Findings were then validated through a validation workshop with 11 individuals from 8 leading SCM organizations.

Results: Four associated components of this framework were developed: (1) The Library of Competencies and Designations contains management competencies grouped in 7 domains and supply chain technical competencies assigned to 5 professional designations; (2) The Collection of Roles and Job Descriptions contains 96 sample job descriptions; (3) The Mapping of Education displays the education offerings relevant to each competency across the 5 professional designations; and (4) The Implementation Approach for Health Supply Chains leads project teams to systematically apply these 3 tools in the supply chain context of a country.

Conclusion: The SCM Professionalisation Framework provides a valuable tool to increase the supply of and demand for health SCM workers, increasing the recognition and use of SCM professionals within national health systems. Its utilization is a critical step in addressing the current workforce gap, particularly in low- and middle-income countries, and ensuring that the health SCM workforce possesses the right competencies, skills, and qualifications to fulfill its roles. The comprehensive framework can be used by governments, employers, and education institutions to define and align SCM professional standards, competencies, and curricula with job requirements.

This article describes exploratory research conducted to understand pathways to entering the public health supply chain (PHSC) workforce in low- and middle-income countries (LMICs) to identify potential barriers for women working in this field and gather suggestions on how to improve gender equity in the PHSC workforce. Key informant interviews were conducted in the Democratic Republic of Congo and Malawi with health sciences students, health science education professionals, individuals currently working in the PHSC workforce, and global stakeholders. An online survey was conducted with responses from PHSC professionals across 26 countries. The survey and interviews revealed that respondents perceived that there were gender imbalances and inequities at all levels of the PHSC workforce. Respondents reported on barriers for women to receive the education, training, mentorship, and leadership opportunities needed to advance in this profession, barriers to traveling for work due to cultural norms and safety concerns, and a lack of policy and structural support for women to feel safe and supported at work. To improve gender equity in the PHSC workforce, we recommend strengthening career pathways for women; fostering mentorship opportunities among women; making recruitment practices more gender sensitive; implementing gender-sensitive policies; improving access to financial, physical, and technological resources; collecting and using gender-disaggregated data; and increasing the number of women in leadership positions.

Background: The health supply chain (SC) system in Rwanda experienced a number of workforce-related challenges, including insufficient skilled supply chain management (SCM) professionals with the necessary competencies. The Human Resources for Supply Chain Management (HR4SCM) Theory of Change (TOC) provides a methodology to assess human resources (HR) management systems by explaining the preconditions required to achieve optimized workforce performance. We applied this model to design interventions to strengthen the Rwanda health SC workforce.

Methods: We compared conditions in the health SC HR system in Rwanda with the 60 outcomes described as necessary for optimized workforce performance in the HR4SCM TOC model. We used a survey and participatory workshop at the central level, followed by structured interviews (N=35) with SC professionals in health centers, hospitals, and regional warehouses (N=20) in Southern Province and Kigali City to identify which outcomes already existed in the Rwandan HR system and which outcomes required strengthening through targeted interventions. We used focus groups (N=2) to refine interventions.

Findings: We identified that 31 of the 60 outcomes were not sufficiently in place in the Rwandan health SC HR system. SCM workers had gaps in the technical and managerial competencies and did not have access to adequate training and professional development opportunities for certain required competencies. An SCM career path did not exist, and education was not available for all required SCM qualifications. Fourteen of these outcomes were prioritized for strengthening. We designed 20 workforce interventions with the Ministry of Health to address these deficiencies and selected indicators to monitor the interventions.

Conclusion: Applying this HR TOC model enabled a systematic process to identify gaps, develop and prioritize interventions, and select indicators. Practitioners designing and evaluating SC workforce interventions should consider applying this methodology to design more effective, theory-driven interventions to improve SC workforce performance.

The Theory of Change for Building Human Resources for Supply Chain Management (TOC) offers a practical framework outlining 4 interdependent pathways-staffing, skills, working conditions, and motivation-to manage the workforce quantity and capability necessary to operate health supply chains effectively. We conducted a desk review of project reports on applications of the TOC as a diagnostic and analytical framework for health supply chains in Cameroon, Ethiopia, Malawi, Rwanda, and the Philippines. We compared approaches to program development, project management, and implementation to reach conclusions and make recommendations based on experience in each country. The TOC can be applied in multiple country contexts, is useful in highlighting supply workforce challenges, and provides a framework that allows governments and technical partners to readdress them.

Low and middle-income countries (LMICs) continue to have a limited supply of skilled supply chain (SC) management professionals in the public sector. In addition, the SC workforce lacks the competencies demanded by new technologies and markets. Young people may be an untapped resource for the procurement and SC management workforce. We present 3 use cases in which career development paths were created for young SC professionals in Benin, Kenya, and South Africa. In Benin, with advocacy from L'Association des Logisticiens Béninois, the professional body of logisticians, career development opportunities were made through creating specific programs like the Young Logisticians Professionals Program. SAPICS, the professional body for SC management in South Africa, has been providing opportunities for career development by giving students and young professionals access to subject matter experts, conferences, site visits, and various industry-specific training and networking opportunities, as well as general "job readiness" training through coaching and mentorship programs. In Kenya, the Girls on the Move program focuses on introducing SC management as a career path to girls through internships, skills training, and mentorship, all aimed at equipping them for successful work placements. The COVID-19 pandemic underscored the critical importance of SC management and highlighted vulnerabilities that demand greater responsiveness and resilience. In the post-COVID era, it is imperative for the public SC sector to build an agile and skilled workforce capable of addressing immediate needs and supporting long-term pandemic preparedness. The cases presented show how opportunities for training, mentorship, and work experience were made available to young professionals and highlight some of the positive outcomes of these initiatives. The cases also illustrate innovative approaches to developing career pathways for youth in LMICs that aim to expand the pool of skilled professionals who can strengthen public SCs and enhance their capacity to respond to future challenges.

Performance gaps in health supply chains in low- and middle-income countries contribute significantly to inefficiencies and underperformance of their health systems. Some significant factors hindering the performance of supply chains in low and middle-income countries include low human resource capacity and capability, weak structures for monitoring supply chain performance, weak in-service and pre-service training programs, chronic underfunding, lack of transparency and an overdependence on obsolete methods, like manual data gathering, record-keeping, and analyses. Although proven health supply chain strengthening techniques exist, the level of adoption of these practices has varied across countries, resulting in multiple capacity gaps and underperforming supply chains. The resulting challenges require complementary and needs-based practices to address the gaps. While it is recognized that there is no "one-size-fits-all" solution to these issues, we demonstrate that real benefits can be achieved by using "promising practices"-that is, using targeted, innovative interventions. To demonstrate the potential of using promising practices in the health supply chain in Africa and the breadth of possible solutions available, we present 3 case studies from different contexts and with different objectives.