Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands.
BMC Health Serv Res. 2024 Jan 24;24(1):130. doi: 10.1186/s12913-023-10487-7.
Health systems worldwide struggled to obtain sufficient personal protective equipment (PPE) and ventilators during the COVID-19 pandemic due to global supply chain disruptions. Our study's aim was to create a proof-of-concept model that would simulate the effects of supply strategies under various scenarios, to ultimately help decision-makers decide on alternative supply strategies for future similar health system related crises.
We developed a system dynamics model that linked a disease transmission model structure (susceptible, exposed, infectious, recovered (SEIR)) with a model for the availability of critical supplies in hospitals; thereby connecting care demand (patients' critical care in hospitals), with care supply (available critical equipment and supplies). To inform the model structure, we used data on critical decisions and events taking place surrounding purchase, supply, and availability of PPE and ventilators during the first phase of the COVID-19 pandemic within the English national health system. We used exploratory modelling and analysis to assess the effects of uncertainties on different supply strategies in the English health system under different scenarios. Strategies analysed were: (i) purchasing from the world market or (ii) through direct tender, (iii) stockpiling, (iv) domestic production, (v) supporting innovative supply strategies, or (vi) loaning ventilators from the private sector.
We found through our exploratory analysis that a long-lasting shortage in PPE and ventilators is likely to be apparent in various scenarios. When considering the worst-case scenario, our proof-of-concept model shows that purchasing PPE and ventilators from the world market or through direct tender have the greatest influence on reducing supply shortages, compared to producing domestically or through supporting innovative supply strategies. However, these supply strategies are affected most by delays in their shipment time or set-up.
We demonstrated that using a system dynamics and exploratory modelling approach can be helpful in identifying the purchasing and supply chain strategies that contribute to the preparedness and responsiveness of health systems during crises. Our results suggest that to improve health systems' resilience during pandemics or similar resource-constrained situations, purchasing and supply chain decision-makers can develop crisis frameworks that propose a plan of action and consequently accelerate and improve procurement processes and other governance processes during health-related crises; implement diverse supplier frameworks; and (re)consider stockpiling. This proof-of-concept model demonstrates the importance of including critical supply chain strategies as part of the preparedness and response activities to contribute to health system resilience.
由于全球供应链中断，在 COVID-19 大流行期间，全球各国的卫生系统都难以获得足够的个人防护设备 (PPE) 和呼吸机。我们的研究旨在创建一个概念验证模型，该模型可以模拟在各种情况下供应策略的效果，最终帮助决策者为未来类似的卫生系统相关危机选择替代供应策略。
我们开发了一个系统动力学模型，将疾病传播模型结构（易感、暴露、感染、恢复 (SEIR)）与医院关键供应品的可用性模型联系起来；从而将护理需求（医院患者的重症监护）与护理供应（可用的关键设备和用品）联系起来。为了为模型结构提供信息，我们使用了在 COVID-19 大流行第一阶段期间英国国家卫生系统中发生的关于 PPE 和呼吸机采购、供应和供应的关键决策和事件的数据。我们使用探索性建模和分析来评估在不同情景下，英国卫生系统中不同供应策略对不确定性的影响。分析的策略包括：(i) 从全球市场采购或 (ii) 通过直接招标，(iii) 库存，(iv) 国内生产，(v) 支持创新供应策略，或 (vi) 从私营部门借用呼吸机。
通过探索性分析，我们发现在各种情况下，PPE 和呼吸机的长期短缺可能会很明显。在考虑最坏情况下，我们的概念验证模型表明，与国内生产或通过支持创新供应策略相比，从全球市场或通过直接招标采购 PPE 和呼吸机对减少供应短缺的影响最大。然而，这些供应策略最容易受到运输时间或设置延迟的影响。
我们证明，使用系统动力学和探索性建模方法可以帮助确定有助于危机期间卫生系统准备和响应的采购和供应链策略。我们的研究结果表明，为了提高大流行或类似资源受限情况下卫生系统的弹性，采购和供应链决策者可以制定危机框架，提出行动计划，从而在与卫生相关的危机期间加速和改善采购流程和其他治理流程；实施多样化的供应商框架；并（重新）考虑库存。该概念验证模型表明，将关键供应链策略纳入准备和应对活动的重要性，有助于提高卫生系统的弹性。
