How coping can hide larger systems problems: The routine immunisation supply chain in Bihar, India

Bruce Lee, Patrick T Wedlock, Elizabeth A. Mitgang, Sarah N. Cox, Leila A. Haidari, Manoja K. Das, Srihari Dutta, Bhrigu Kapuria, Shawn T. Brown

Research output: Contribution to journalArticle

Abstract

Introduction: Coping occurs when health system personnel must make additional, often undocumented efforts to compensate for existing system and management deficiencies. While such efforts may be done with good intentions, few studies evaluate the broader impact of coping. Methods: We developed a computational simulation model of Bihar, India's routine immunisation supply chain where coping (ie, making additional vaccine shipments above stated policy) occurs. We simulated the impact of coping by allowing extra trips to occur as needed up to one time per day and then limiting coping to two times per week and three times per month before completely eliminating coping. Results: Coping as needed resulted in 3754 extra vaccine shipments over stated policy resulting in 56% total vaccine availability and INR 2.52 logistics cost per dose administered. Limiting vaccine shipments to two times per week reduced shipments by 1224 trips, resulting in a 7% vaccine availability decrease to 49% and an 8% logistics cost per dose administered increase to INR 2.73. Limiting shipments to three times per month reduced vaccine shipments by 2635 trips, which decreased vaccine availability by 19% to 37% and increased logistics costs per dose administered by 34% to INR 3.38. Completely eliminating coping further reduced shipments by 1119 trips, decreasing total vaccine availability an additional 24% to 13% and increasing logistics cost per dose administered by 169% to INR 9.08. Conclusion: Our results show how coping can hide major system design deficiencies and how restricting coping can improve problem diagnosis and potentially lead to enhanced system design.

Original languageEnglish (US)
Article numbere001609
JournalBMJ Global Health
Volume4
Issue number5
DOIs
StatePublished - Sep 1 2019

Fingerprint

India
Immunization
Vaccines
International Normalized Ratio
Costs and Cost Analysis
Health Personnel

Keywords

  • health systems
  • vaccines

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Lee, B., Wedlock, P. T., Mitgang, E. A., Cox, S. N., Haidari, L. A., Das, M. K., ... Brown, S. T. (2019). How coping can hide larger systems problems: The routine immunisation supply chain in Bihar, India. BMJ Global Health, 4(5), [e001609]. https://doi.org/10.1136/bmjgh-2019-001609

How coping can hide larger systems problems : The routine immunisation supply chain in Bihar, India. / Lee, Bruce; Wedlock, Patrick T; Mitgang, Elizabeth A.; Cox, Sarah N.; Haidari, Leila A.; Das, Manoja K.; Dutta, Srihari; Kapuria, Bhrigu; Brown, Shawn T.

In: BMJ Global Health, Vol. 4, No. 5, e001609, 01.09.2019.

Research output: Contribution to journalArticle

Lee, B, Wedlock, PT, Mitgang, EA, Cox, SN, Haidari, LA, Das, MK, Dutta, S, Kapuria, B & Brown, ST 2019, 'How coping can hide larger systems problems: The routine immunisation supply chain in Bihar, India', BMJ Global Health, vol. 4, no. 5, e001609. https://doi.org/10.1136/bmjgh-2019-001609
Lee, Bruce ; Wedlock, Patrick T ; Mitgang, Elizabeth A. ; Cox, Sarah N. ; Haidari, Leila A. ; Das, Manoja K. ; Dutta, Srihari ; Kapuria, Bhrigu ; Brown, Shawn T. / How coping can hide larger systems problems : The routine immunisation supply chain in Bihar, India. In: BMJ Global Health. 2019 ; Vol. 4, No. 5.
@article{918fa1d68afc485585936c1c75f5873b,
title = "How coping can hide larger systems problems: The routine immunisation supply chain in Bihar, India",
abstract = "Introduction: Coping occurs when health system personnel must make additional, often undocumented efforts to compensate for existing system and management deficiencies. While such efforts may be done with good intentions, few studies evaluate the broader impact of coping. Methods: We developed a computational simulation model of Bihar, India's routine immunisation supply chain where coping (ie, making additional vaccine shipments above stated policy) occurs. We simulated the impact of coping by allowing extra trips to occur as needed up to one time per day and then limiting coping to two times per week and three times per month before completely eliminating coping. Results: Coping as needed resulted in 3754 extra vaccine shipments over stated policy resulting in 56{\%} total vaccine availability and INR 2.52 logistics cost per dose administered. Limiting vaccine shipments to two times per week reduced shipments by 1224 trips, resulting in a 7{\%} vaccine availability decrease to 49{\%} and an 8{\%} logistics cost per dose administered increase to INR 2.73. Limiting shipments to three times per month reduced vaccine shipments by 2635 trips, which decreased vaccine availability by 19{\%} to 37{\%} and increased logistics costs per dose administered by 34{\%} to INR 3.38. Completely eliminating coping further reduced shipments by 1119 trips, decreasing total vaccine availability an additional 24{\%} to 13{\%} and increasing logistics cost per dose administered by 169{\%} to INR 9.08. Conclusion: Our results show how coping can hide major system design deficiencies and how restricting coping can improve problem diagnosis and potentially lead to enhanced system design.",
keywords = "health systems, vaccines",
author = "Bruce Lee and Wedlock, {Patrick T} and Mitgang, {Elizabeth A.} and Cox, {Sarah N.} and Haidari, {Leila A.} and Das, {Manoja K.} and Srihari Dutta and Bhrigu Kapuria and Brown, {Shawn T.}",
year = "2019",
month = "9",
day = "1",
doi = "10.1136/bmjgh-2019-001609",
language = "English (US)",
volume = "4",
journal = "BMJ Global Health",
issn = "2059-7908",
publisher = "BMJ Publishing Group",
number = "5",

}

TY - JOUR

T1 - How coping can hide larger systems problems

T2 - The routine immunisation supply chain in Bihar, India

AU - Lee, Bruce

AU - Wedlock, Patrick T

AU - Mitgang, Elizabeth A.

AU - Cox, Sarah N.

AU - Haidari, Leila A.

AU - Das, Manoja K.

AU - Dutta, Srihari

AU - Kapuria, Bhrigu

AU - Brown, Shawn T.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Introduction: Coping occurs when health system personnel must make additional, often undocumented efforts to compensate for existing system and management deficiencies. While such efforts may be done with good intentions, few studies evaluate the broader impact of coping. Methods: We developed a computational simulation model of Bihar, India's routine immunisation supply chain where coping (ie, making additional vaccine shipments above stated policy) occurs. We simulated the impact of coping by allowing extra trips to occur as needed up to one time per day and then limiting coping to two times per week and three times per month before completely eliminating coping. Results: Coping as needed resulted in 3754 extra vaccine shipments over stated policy resulting in 56% total vaccine availability and INR 2.52 logistics cost per dose administered. Limiting vaccine shipments to two times per week reduced shipments by 1224 trips, resulting in a 7% vaccine availability decrease to 49% and an 8% logistics cost per dose administered increase to INR 2.73. Limiting shipments to three times per month reduced vaccine shipments by 2635 trips, which decreased vaccine availability by 19% to 37% and increased logistics costs per dose administered by 34% to INR 3.38. Completely eliminating coping further reduced shipments by 1119 trips, decreasing total vaccine availability an additional 24% to 13% and increasing logistics cost per dose administered by 169% to INR 9.08. Conclusion: Our results show how coping can hide major system design deficiencies and how restricting coping can improve problem diagnosis and potentially lead to enhanced system design.

AB - Introduction: Coping occurs when health system personnel must make additional, often undocumented efforts to compensate for existing system and management deficiencies. While such efforts may be done with good intentions, few studies evaluate the broader impact of coping. Methods: We developed a computational simulation model of Bihar, India's routine immunisation supply chain where coping (ie, making additional vaccine shipments above stated policy) occurs. We simulated the impact of coping by allowing extra trips to occur as needed up to one time per day and then limiting coping to two times per week and three times per month before completely eliminating coping. Results: Coping as needed resulted in 3754 extra vaccine shipments over stated policy resulting in 56% total vaccine availability and INR 2.52 logistics cost per dose administered. Limiting vaccine shipments to two times per week reduced shipments by 1224 trips, resulting in a 7% vaccine availability decrease to 49% and an 8% logistics cost per dose administered increase to INR 2.73. Limiting shipments to three times per month reduced vaccine shipments by 2635 trips, which decreased vaccine availability by 19% to 37% and increased logistics costs per dose administered by 34% to INR 3.38. Completely eliminating coping further reduced shipments by 1119 trips, decreasing total vaccine availability an additional 24% to 13% and increasing logistics cost per dose administered by 169% to INR 9.08. Conclusion: Our results show how coping can hide major system design deficiencies and how restricting coping can improve problem diagnosis and potentially lead to enhanced system design.

KW - health systems

KW - vaccines

UR - http://www.scopus.com/inward/record.url?scp=85072039018&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85072039018&partnerID=8YFLogxK

U2 - 10.1136/bmjgh-2019-001609

DO - 10.1136/bmjgh-2019-001609

M3 - Article

C2 - 31565408

AN - SCOPUS:85072039018

VL - 4

JO - BMJ Global Health

JF - BMJ Global Health

SN - 2059-7908

IS - 5

M1 - e001609

ER -