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12th Annual Global Health Supply Chain Summit


November 19, 2019

Hilton Hotel, 138 Rivonia Road  I  Sandton 2196  I  South Africa


Improving health outcomes through supply-and demand-side innovations in care delivery

Background and motivation

In low and middle-income countries, access to diagnostic services, care, and medicines is limited for many. Contributing factors include shortages in healthcare providers and facilities, medicines, financial services, transportation services, and communication infrastructure. 

In the last decade, innovations for improving access to health services and products have been developed in various resource-constrained settings, and they have the potential to be scaled and impact population health and health equity. These innovations address both supply- and demand-side barriers that hinder patients from receiving and staying on life-saving treatment. One set of innovations can be collectively classified as Differentiated Service Delivery (DSD) models where the provision of medicines and related services is adapted to both better serve the needs of patients and reduce unnecessary burden on the health system. The four broad types of these models are: Health care worker-managed groups, Patient self-organized groups, facility-based models, and out of clinic/closer to home product delivery. In South Africa, for example, the Central Chronic Medicine Dispensing and Distribution (CCMDD) initiative by the National Department of Health is an out of clinic model that has allowed patients with chronic diseases including HIV to access their medicines at convenient pick-up points. Because the CCMDD is implemented in conjunction with National Health Insurance (NHI), financing and delivery are integrated, and patients do not incur additional costs. Several areas in South Africa have also seen the rollout of drug-dispensing vending machines and ATMs, for example by Right to Care.

These promising new delivery innovations in product and service delivery can be bundled with other operational innovations using the concept of automation or semi-automation and easy access technologies like diagnostics (e.g., blood pressure, glucose measurement, EKG and many others) where services can either be automated, or technology leveraged to improve adherence and delivered with the help of a community worker. One such example of such product & service delivery innovations is Operation ASHA that operates in India, Cambodia and Afghanistan. More generally, the value of bundling DSD with locations, such as the Unjani Clinics in S. Africa, that can offer services like counseling, tracking adherence, etc., related to the product is worth exploring.

These successful and promising innovations can be deployed widely across the globe. To facilitate a thoughtful discussion the potential of such innovations to improve access to health care delivery, the organizing committee of the GHSCS is holding a pre-conference workshop where invited participants will (1) identify and catalog major innovations,(2) identify core design principles that enable swift and large-scale implementation, and (3) discuss underlying economic and financing issues, as well as operational challenges. By providing a space for free exchange of ideas, the committee hopes to explore additional opportunities and to determine means to effectively support the growth of innovations and innovators.

Workshop structure and schedule

The one-day invitational workshop to be held on November 19, 2019, at the Hilton Hotel in Sandton, Johannesburg. We anticipate about 30 participants. The workshop will consist of two sessions. The first session will focus on innovations that improve access to medicines/treatment for existing patients. The second session will focus on the use of (existing) innovations to improve access to diagnostics and care for populations who have yet been served by the healthcare system. The outcome of the workshop is a white paper that will attempt to characterize the overall health outcome improvement from integrating demand-side innovation into supply system design and identify opportunities to develop models that capture the health system benefits and unintended consequences of such innovations. Upon the agreement of all attendees, the white paper may be submitted as a perspective piece to a peer-reviewed global health journal.

Issues to discuss during this workshop:

  1. Technology for dispensing:
    1. What is it?
    2. Deployment strategy – location, fulfillment, operation, and maintenance
    3. Benefits, risks, implementation challenges;
    4. Stakeholders and their perspectives;
    5. Data collection: what, how, and its usefulness?
  2. Need for ancillary services, e.g., diagnostics, consultation, counseling, etc. How are they addressed now? How could they be addressed? Are these ancillary services to be bundled with product delivery? Or should they be unbundled?
  3. Do these innovations address the needs of patients who are not already in the system? If not, can they? If so, how?
  4. Applicability of the above to different clinical areas, e.g., TB, Diabetes, etc.
  5. Geographic scalability issues? What are determinants of success in a country?

Professor Ravi Anupindi, Conference Co-Chair - University of Michigan, Ann Arbor, MI (USA)

Anton L.V. Avanceña, PhD Candidate - School of Public Health, University of Michigan, MI (USA)

Professor Yehuda Bassok, Conference Co-Chair - University of Southern California, Los Angeles, CA (USA)

Dr. Shabir Banoo, Chief Technical Specialist for Pharmaceutical Programmes - Right to Care

Professor Sriram Dasu - University of Southern California, Los Angeles, CA (USA)

Professor David Katerere - Tshwane University of Technology & Co-founder of PharmaConnect Africa

Dr. Prashant Yadav - Visiting Fellow, Center for Global Development; Affiliate Professor, INSEAD



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