People that Deliver (PtD) has just published its Business case for investment in human resources for health supply chain management.
PtD collected data on the country-level budgeted investments for human resources for supply chain management (HR for SCM) from three donor organisations – Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria and USAID – over the period 2017-2020. This data was accompanied by questionnaire responses and interviews with supply chain managers in countries.
The report shows tht over the four-year period the three organisations allocated 65 percent ($109 million) of their human resources (HR) for supply chain management (SCM) budgets to skills and 27 percent ($45 million) to staffing. Motivation received just 5 percent ($9 million) of allocations while the amount attributed to working conditions was just $0.7 million.
PtD’s foundational framework, the Human resources for supply chain management Theory of Change (ToC) helps to analyse the conditions needed to ensure that workers at every level of the SC perform optimally and fulfil all the necessary functions of an effective SC system. It suggests that the staffing, skills, motivation and working conditions of supply chain workers must be addressed if the health supply workforce is to perform optimally and access to health commodities is to increase.
The survey and interview responses in the report support this and posit that investments in HR for SCM offer value for money to improve health outcomes. This is reinforced by two case studies: in Malawi and Ethiopia.
Investing in the four pathways in Malawi and Ethiopia
The introduction of trained pharmacy assistants (PAs) into pharmacies in Malawi in 2018 led to improvements related to skills, staffing, motivation and working conditions. The addition of the PAs saved clinicians six days per month on average, allowing them to spend more time with patients, and led to a spill over effect of knowledge and skills within their own facilities. It also led to improved retention and according to survey responses the introduction of the PAs helped to boost motivation.
Crucially, stockouts improved at facilities that had introduced PAs.
The implementation of the HR4SCM ToC in Ethiopia also provides evidence to support investments in all of the four pathways. Following interventions across the four areas, tangible supply chain improvements were seen, including a 25 percent decrease in procurement lead time, a 35 percent decrease in contract signing lead time and a 5.5 percent decrease in tender lead time.
The recommendations: Motivation and working conditions require attention
The report recommends that investments in HR for SCM as a whole increase, in particular in the often-overlooked motivation and working conditions pathways. As laid out in the ToC, addressing all four of the pathways is necessary if commodities are to be available in the most cost-effective way possible, and if health outcomes are to be improved.
The research revealed a lack of data on the impact of investments in HR for SCM; this causes myriad problems. First, it is impossible to document with certainty how investments are having a positive impact on supply chain performance. What’s more, without impact assessments in each pathway (staffing, skills, motivation and working conditions) the exact necessary budget allocations in each area cannot be determined. It is therefore recommended that mechanisms be developed and implemented to monitor and evaluate the impact of investments in the four pathways. Without such monitoring, it will not be possible to determine the isolated impact of investments in HR4SCM the return on investments in the four pathways.
It was acknowledged that budget data would not allow PtD to precisely depict the actual HR for SCM spend in countries. This is because budgets don’t necessarily reflect the actual amount spent. The data, however, does provide an illustrative overview of the budget allocations attributed to HR for SCM in countries, which is sufficient for the purpose of this business case.