How lean thinking can be better applied in health supply chains in Africa

Lean thinking has long been touted as an important private sector manufacturing and operational approach. This approach has the potential to improve supply chain efficiencies in the public sector. Lean thinking is a philosophy that focuses on improving processes by removing waste, increasing efficiency, and providing a higher quality product or service.

Globally, public healthcare facilities are adopting different tools and techniques used in manufacturing industries to increase their supply chain efficiency. Lean thinking has become a pioneering approach to service operations improvements and is therefore being adopted by supply chain industries. Lean thinking in uncertain economies can maintain productivity, improve resource use, and uphold service quality despite reduced spending.

Despite the promising positive effects of lean thinking in healthcare supply chains, adoption is still in the infancy stage. Applying lean thinking in healthcare is uncertain due to unpredictable demand for medicine and supplies, hindering its implementation.

For it to be successful in healthcare, its scope of implementation should extend to the entire supply chain. It has been noted that very few empirical studies explore the applicability and implementation of lean in healthcare supply chains.

An ARC-funded study from Tanzania has identified major challenges that health supply chain faces when applying lean thinking approaches.

Findings

The study identified seven drivers for medical commodities: demand management, supplier development, institutional frameworks and governance, supply chain capabilities, culture and incentives. A notable difference between public and private health facilities was observed regarding the role of institutional frameworks and governance. Public facilities have clear directives for medicine acquisition and distribution, while private facilities lack an institutional framework for procurement.

Waste factors in the medical supply chain include excess inventory, operational and transactional costs, and movement delays. The study also showed that both public and private health facilities commonly used standardisation and automation or digitisation as lean tools. At the same time, visual management was typical for private health facilities. Moreover, public health facilities have longer supply chains than private ones, and private facilities often have more reliable funding sources.

Contextual factors such as unreliable internet, environmental uncertainty, and limitations in essential medicines list influence the link between drivers and waste.

This study offers valuable insights into lean practices, drivers, waste, and contextual factors in medical commodity supply chains in developing countries. Adopting effective lean practices and sustaining lean efforts will be impossible without understanding the possible wastes and their drivers.

Ordering process

Observations on medication ordering process show room for further development of lean thinking and systems in private and public sectors.

In both the public and private sectors, different levels of the supply chain have different ordering processes. Policies and established frameworks often dictate authorisation processes in the public health supply chain. These policies and frameworks result in order fulfillment delays and frustrations for healthcare workers managing stock levels in healthcare facilities. Guidelines for placing orders exist, but the availability of funds is crucial in determining the when, how, and quantity to order.

In contrast, the ordering procedures in private facilities are less clear but more agile. However, many private sector facilities rely on manual systems for ordering (public facilities must use a computerised system). Although these manual systems enable a quick response to orders, record keeping for facilities is considered a challenge.

Recommendations

This study provides valuable insight into supply chain strategy development and implementation. It can be used by different supply chain stakeholders in a number of ways.

Understanding identified drivers can help the Ministry of Health prioritise areas for system-wide reforms to support leaner supply chains. Ministries should collaborate with development partners to review management systems, identify shortcomings, and provide opportunities for improvement.

The government should harmonise supplier development and linkages to public health facilities to enable direct collaboration with the central medical store. This will reduce the follow-up times as well as the order cycle times, and also improve demand management.

The healthcare supply chain is very complex as it includes internal supply chains, such as clinical care processes, and external supply chains that range from the sourcing of suppliers to the distribution of medical materials. As healthcare operations become more complex, lean practices must be implemented at the inter-organizational level, not just within a single organisation.