Tetteh Ebenezer Kwabena
Department of Pharmacy Practice & Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
Explor Res Clin Soc Pharm. 2022 Jan 19;5:100105. doi: 10.1016/j.rcsop.2022.100105. eCollection 2022 Mar.
Public health-sectors of most low- and middle-income countries (LMICs) run a central medical stores (CMS) model that is monopolistic in character. Concerns raised about monopolistic CMS arrangements stress the need to encourage cost-reducing efforts and improve service levels (outputs) by having multiple competing logistics institutions. This paper examines the desirability of consolidation or multiplicity in supply logistics by focusing on the task of inventory management (that is, distribution, storage and warehousing). The paper uses theory and historical evidence to describe and suggest a desired form of multiplicity in LMICs. Consolidation shouldn't progress to the point of monopoly and multiplicity doesn't mean having an infinite number of logistics institutions. A limited number (2-10) of logistics institutions, that are full-line and national in their scope and scale of operations, should be enough to provide choice, support competition and minimize the risk of supply disruptions. Health policy and planning in LMICs should explore ways of turning existing logistics institutions in the public, private and non-governmental sectors into a multiplicity of types that are capable of assuring uninterrupted supplies of health commodities.
大多数低收入和中等收入国家（LMICs）的公共卫生部门采用一种具有垄断性质的中央医疗用品储备库（CMS）模式。对垄断性的CMS安排所提出的担忧强调，需要通过建立多个相互竞争的物流机构来鼓励降低成本的努力并提高服务水平（产出）。本文通过关注库存管理任务（即配送、存储和仓储）来研究供应物流整合或多元化的可取性。本文运用理论和历史证据来描述并提出LMICs中一种理想的多元化形式。整合不应发展到垄断的程度，多元化也不意味着要有无限数量的物流机构。数量有限（2至10个）、业务范围全面且覆盖全国的物流机构，应足以提供选择、支持竞争并将供应中断的风险降至最低。LMICs的卫生政策和规划应探索各种方式，将公共、私营和非政府部门现有的物流机构转变为多种类型，以确保卫生用品的不间断供应。
