02540nas a2200241   4500000000100000008004100001260004400042653001800086653003200104100001300136700001500149700001400164700001800178700001300196700001400209700001200223700001400235245013400249856008400383490000700467520181000474022001402284       2020                            d  bSpringer Science and Business Media LLC10aHealth policy10aHealth System Strengthening1 aJbaily A1 aFeldhaus I1 aBigelow B1 aKamareddine L1 aTolla MT1 aBouvier M1 aKiros M1 aVerguet S00aToward health system strengthening in low- and middle-income countries: insights from mathematical modeling of drug supply chains  uhttps://bmchealthservres.biomedcentral.com/track/pdf/10.1186/s12913-020-05549-z0 v203 aBackground<br>
Global health priority setting increasingly focuses on understanding the functioning of health systems and on how they can be strengthened. Beyond vertical programs, health systems research should examine system-wide delivery platforms (e.g. health facilities) and operational elements (e.g. supply chains) as primary units of study and evaluation.<br>

<br>Methods<br>
We use dynamical system methods to develop a simple analytical model for the supply chain of a low-income country’s health system. In doing so, we emphasize the dynamic links that integrate the supply chain within other elements of the health system; and we examine how the evolution over time of such connections would affect drug delivery, following the implementation of selected interventions (e.g. enhancing road networks, expanding workforce). We also test feedback loops and forecasts to study the potential impact of setting up a digital system for tracking drug delivery to prevent drug stockout and expiration.<br>

<br>Results<br>
Numerical simulations that capture a range of supply chain scenarios demonstrate the impact of different health system strengthening interventions on drug stock levels within health facilities. Our mathematical modeling also points to how implementing a digital drug tracking system could help anticipate and prevent drug stockout and expiration.<br>

<br>Conclusion<br>
Our mathematical model of drug supply chain delivery represents an important component toward the development of comprehensive quantitative frameworks that aim at describing health systems as complex dynamical systems. Such models can help predict how investments in system-wide interventions, like strengthening drug supply chains in low-income settings, may improve population health outcomes.  a1472-6963