Health supply chains must attract women, youth and marginalised groups if they are to appropriately reflect and serve the communities they are built to support. This is the central message behind the new edition of People that Deliver (PtD)’s second edition of its foundational document: Building human resources for supply chain management theory of change (TOC).
Bridget McHenry, strategic advisor to PtD, said, “When we launched the first edition of the Theory of Change, it was a bold step toward recognising that health supply chains can only be as strong as the people who run them. This second edition builds on that foundation and responds to today’s moment—with a deeper integration of equity, inclusion and practical tools for implementation.”
The TOC helps to create a pool of skilled and qualified professionals
The second edition of the TOC retains the technical rigour and practical orientation of the original framework, which was developed in 2018, but strengthens it with insights gained from country implementation and new evidence. It now considers diversity, equity, inclusion and accessibility (DEIA) throughout every pathway, assumption, indicator and intervention.
Given that the health workforce shortage is predicated to be 11 million globally by 2030 (WHO), with expected increases due to the cuts in overseas development assistance, governments and health supply chain organisations will need to not only attract more people to the profession, but also retain them. Doing so requires encouraging previously underrepresented demographics to pursue a career in health supply chain management (SCM).
According to Bridget McHenry, “With its clear articulation of the causal pathways that lead to stronger workforce performance, the updated TOC gives countries a roadmap to design, fund and evaluate strategic HR interventions in supply chain management. It helps practitioners assess system effectiveness across staffing, skills, working conditions and motivation while also generating the evidence needed to advocate for the long-term investments that sustainable supply chains require.”
This updated version of the TOC offers practitioners targeted interventions to attract a broad range of professionals to a supply chain organisation. This includes using local languages in the recruitment process to widen the pool of applicants, removing bias where possible to hire the most skilled and qualified candidates, and considering the unique needs of women and mothers once hired.
It also includes indicators to allow organisations to self-evaluate to understand, for instance, if all employees have access to training, to be able to identify where policies may be lacking, and to have processes to deal with claims of harassment.
Who is the TOC for?
The TOC is designed for health supply chain management practitioners, HR managers and policy makers, among others. It was created to help with improving policies in key public and private sector entities, increasing and improving resources (government, non-government; national and international) to support a qualified, educated health supply chain workforce, and to improve mechanisms to support the professionalisation of a qualified, educated health supply chain workforce.
The TOC analyses the conditions needed to ensure that workers at every level are performing optimally and fulfil all the necessary functions of an effective health supply chain system. Four pathways—staffing, skills, working conditions and motivation—are necessary to build HR for effective health supply chain management.
Its structure helps practitioners prioritise the workforce interventions required to make the improvements or changes needed to strengthen health supply chains. It helps practitioners consider the impact of interventions and maps the chain of events between actions and objectives, helping them design a health supply chain improvement programme with specific interventions, activities and priorities.
The TOC led to supply chain improvements in Rwanda
The Rwanda Ministry of Health (MOH), in partnership with PtD and USAID’s Global Health Supply Chain Program – Procurement and Supply Management (GHSC-PSM), used the TOC to evaluate workforce performance and prioritise interventions across the four pathways. Of the 60 outcomes identified in the TOC as essential for an optimised supply chain workforce, the team in Rwanda found that 31 were deficient. These included a lack of dedicated budget for SCM positions, insufficient technical and managerial competencies, inadequate tools and equipment, and weak performance feedback systems
Owing to the application of the TOC, new SCM roles were created in the MOH staffing structure, e-learning modules and leadership training were rolled out to build staff capacity, and SCM was integrated into broader HR development efforts, improving visibility and recognition.
Read about this in more detail in the paper Applying a Theory of Change for Human Resources Development in Public Health Supply Chains in Rwanda, published in Global Health: Science and Practice in 2024.
Read or download the second edition of the TOC
