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This paper aims to examine lean thinking in medical commodities supply chains by considering its applications and success factors. It determines the drivers and wastes of medical commodity supply chain, and the existing lean tools and practices together with their application in the supply chain processes. The paper also examined the challenges and success factors for effective lean application in the medical commodities supply chains.

The study used qualitative approaches, in-depth interviews and focus group discussions with key informants to form the basis for data collection. Through thematic analysis, the collected data were analyzed by developing themes reflecting the objectives of the study.

The main drivers for waste associated with the supply chain were demand management, supplier development, institutional framework and governance. The wastes were observed at the level of inventory, operation costs, transaction costs, delays in terms of service, commodity delivery time and quality. Digitalization, information technology and standardization were the tools for medical supply chain. Poor infrastructure, unreliable internet supply, environmental uncertainty and poor management support were challenges to realizing an effective supply chain.

Although the qualitative approach used in the study provides detailed information, a quantitative study covers a larger sample for generalization.

Capacity building and professionalism should be given a priority because the philosophy of lean focuses on waste removal and continuous improvement, which highly depends on the quality of human resource (Brito et al., 2020). Limited human resource capabilities in supply chain management will, therefore, result into poor operational efficiency, which are wasted. Moreover, systems interoperability is key waste minimization and, therefore, demands interventions.

The government under the Ministry of Health and other key sector ministries such as local and regional governments should better understand the role of the waste drivers and adopt system-wide reforms to support improvements to remove waste in the medical supply chain. For example, the current institutional framework creates an administrative block and hence leads to wastes. This bureaucratic procedure should be removed to minimize wastes along the chain.

This study is among the first studies to determine applicability and implementation of lean in a resource-constrained context. The paper identifies contextual factors for lean implementation. This paper focused on a holistic view of the entire supply chains to enhance a well-functioning supply chain in delivering health commodities.

The COVID-19 pandemic has had a disruptive effect on the health system. Health facility leaders were at the forefront of maintaining service delivery and were exposed to varied stressors in the early phase of the pandemic. This study aims to explore the leadership experiences of health facility leaders during the early phase of the COVID-19 pandemic in Nigeria’s epicentre.

This study conducted an exploratory descriptive qualitative study. To achieve this, 33 health facility leaders of different cadres across primary, secondary, and tertiary levels of the public health care system in Lagos, Nigeria, were remotely interviewed. The key informant interviews were transcribed verbatim and were analysed by using thematic analysis.

The health facility leaders experienced heightened levels of fear, anxiety and stressors during the early phase of the pandemic. They also had genuine concerns about exposing their family members to the virus and had to manage some health-care workers who were afraid for their lives and reluctant. Coping mechanisms included psychological and social support, innovative hygiene measures at health facility and at home, training and staff welfare in more ways than usual. They were motivated to continue rendering services during the crisis because of their passion, their calling, the Hippocratic oath and support from the State government.

The experiences of health facility leaders from different parts of the world have been documented. However, to the best of the authors’ knowledge, this is one of the first studies that specifically report multi-layer leadership experiences of health facility leaders during the early phase of the COVID-19 pandemic in sub-Saharan Africa.

Africa has been identified as an area where higher mortality happens due to un-accessibility to health care, drugs and other health facilities. Nigeria, as one of the African countries, is not excluded from such difficulties. This study aims to examine the determinants of efficient last-mile delivery at selected health facilities and the Kaduna State Health Supplies Management Agency (KADSHMA).

The study sourced data from KADSHMA and the health facilities’ staff, with a total of 261 observations used. Likewise, the respondents were picked from warehouses of each health facility and KADSHMA. The data was analysed using the partial least square structural equation modelling analysis to estimate the relationship among the variables of the study.

The study’s findings revealed that all five variables of the study (i.e. determinants) were significantly affecting the efficient last-mile delivery. Four constructs (delivery cost [DC], delivery time [DT], mode of delivery [MD] and facilities technology [FT]) have shown a positive and significant association with efficient last-mile delivery, whereas one variable (product mix [PM]) indicated a negative and significant association with efficient last-mile delivery. The study concludes that DC, DT, MD, FT and PM played significant roles in efficient last-mile delivery.

The study provides that specific means of transportation should always be on standby to transport health supplies. Time schedules should always be prepared and adhered to when transporting health supplies to the facilities, and each facility should network with robust technology to ease communication in terms of order and order planning. Additionally, facilities should try as much as possible to reduce the varieties of products when ordering health supplies, as it will increase the efficiency of the delivery.

To the best of the authors’ knowledge, this study is the first of its kind that considered these five variables (DC, DT, MD, FT and PM) with impact on the last-mile delivery in one model, especially in the Nigerian case. This is a great contribution to knowledge, more importantly, to the last-mile delivery of the health sector. The result confirmed the importance of these determinants (DC, DT, FT and PM) of last-mile delivery efficiency in saving lives.

Pre-eclampsia and eclampsia (PE/E) are rising in Sub-Saharan Africa, including Nigeria. This study aims to evaluate the availability and logistics management of sixteen items from the Nigerian essential medicine list required for managing these conditions.

A cross-sectional study in 50 health-care facilities in Lagos State, Nigeria, at the beginning of the COVID-19 pandemic by interviewing the facility’s main person in charge of health commodities. Data were recorded during the visit and in the previous six months using the adapted Logistics Indicators Assessment Tool (LIAT). In addition, descriptive analysis was conducted based on the World Health Organization availability index.

The availability of 13 (81%) of the commodities were high, and 3 (19%) were relatively high in the facilities, stock out rate during the visitation and previous six months varied with the commodities: urinalysis strip (22%) and (40%), hydralazine (20%) and (20%), labetalol injection (8%) and (20%), labetalol tablet (24%) and (24%) and sphygmomanometer (8%) and (8%). No stock out was recorded for 11 (69%) commodities. All the facilities observed 9 (75%) out of the 12 storage guidelines, and 36 (72%) had a perfect storage condition score.

Current state of PE/E health commodities in the selected facilities is highlighted, and the strengths and weaknesses of the supply chain in these health facilities were identified and discussed.

These commodities’ availability ranged from reasonably high to very high. Regular supportive supervision is germane to strengthening the logistics management system for these commodities to prevent the negative impact on the health and well-being of the people during the COVID-19 pandemic and post-pandemic.

This study aims to determine the influence of the role of hospital leaders, the COVID-19 budget and health service facilities at regional general hospitals (RSUDs) to Indonesia on hospital responses in overcoming the COVID-19 pandemic, moderated by hospital class level.

This research was designed as quantitative research using partial least square-structural equation modeling (PLS-SEM) to test hypotheses.

Using a sample of 185 RSUDs, it was found that the role of hospital leaders, the COVID-19 budget and health service facilities in RSUDs had a positive and significant effect on the hospital's response to the COVID-19 pandemic. The findings show that the role of hospital leaders, in this case, the RSUD director, is essential in improving health services during the COVID-19 pandemic. The COVID-19 budget and health service facilities at RSUD can run effectively during the COVID-19 pandemic if the RSUD director issues appropriate policies during the COVID-19 pandemic crisis.

This study is the first to determine the influence of hospital leaders, the health budget for COVID-19 and hospital health service facilities simultaneously on the hospital's response to the COVID-19 pandemic. This study also provides empirical evidence regarding the idea of stewardship theory, which suggests the role of leaders in supervising organizations to achieve organizational goals effectively in times of crisis.

Heating, ventilating, air-conditioning and cooling (HVAC) systems are crucial in daily health-care facility services. Design-related defects can lead to maintenance issues, causing service disruptions and cost overruns. These defects can be avoided if a link between the early design stages and maintenance feedback is established. This study aims to use experts’ experience in HVAC maintenance in health-care facilities to list and evaluate the risk of each maintenance issue caused by a design defect, supported by the literature.

Following semistructured interviews with experts, 41 maintenance issues were identified as the most encountered issues. Subsequently, a survey was conducted in which 44 participants evaluated the probability and impact of each design-caused issue.

Chillers were identified as the HVAC components most prone to design defects and cost impact. However, air distribution ducts and air handling units are the most critical HVAC components for maintaining healthy conditions inside health-care facilities.

The unavailability of comprehensive data on the cost impacts of all design-related defects from multiple health-care facilities limits the ability of HVAC designers to furnish case studies and quantitative approaches.

This study helps HVAC designers acquire prior knowledge of decisions that may have led to unnecessary and avoidable maintenance. These design-related maintenance issues may cause unfavorable health and cost consequences.

Advancing behavioral health and primary care integration is a priority for helping clients overcome the complex health challenges impacting healthcare deserts like those in Arizona, United States of America (USA). This study aimed to explore the perspectives of people with a substance use disorder (SUD) on accessing integrated primary care (IPC) services in a rural-serving behavioral healthcare organization in Arizona.

Clients from a behavioral health facility in Arizona (n = 10) diagnosed with SUDs who also accessed IPC participated in a 45-min semi-structured interview.

The authors identified six overarching themes: (1) importance of IPC for clients being treated for SUDs, (2) client low level of awareness of IPC availability at the facility, (3) strategies to increase awareness of IPC availability at the behavioral health facility, (4) cultural practices providers should consider in care integration, (5) attitudes and perceptions about the experience of accessing IPC and (6) challenges to attending IPC appointments. The authors also identified subthemes for most of the main themes.

This is the first study in rural Arizona to identify valuable insights into the experiences of people with SUDs accessing IPC, providing a foundation for future research in the region on care integration.

Sexual and reproductive health (SRH) interventions demand diverse services, encompassing medical, social and psychological care to ensure the overall wellbeing of service users. In the absence of multidisciplinary response to SRH interventions, service users could be deprived of crucial SRH services, which could undermine their safety and wellbeing. Based on this knowledge, our study was designed to map the interprofessional space in primary healthcare (PHC) facilities in Ebonyi State, Nigeria that deliver SRH services.

Interviews with 20 health workers and group discussions with 72 young people aged 15–24 years provided the data for the study. We analyzed data deductively, focusing on the assessments of the presence or absence of specific professionals that are typically expected to provide different aspects of SRH services.

We found conspicuous absence of laboratory diagnostic, social care, psycho-cognitive and some medical services expected of primary care. These absences necessitated unnecessary referrals, encouraged breaches in confidentiality, undermined social care and justice, increased cost of care and discouraged young clients from utilizing SRH services provided in PHCs. Our study, therefore, emphasizes the need for integrated care in the delivery of SRH services, which would involve relevant diverse professionals contributing their expertise toward comprehensive care for SRH service users.

The study provides human resource insights toward strengthening primary healthcare in Nigeria vis-à-vis efficient delivery of SRH services to guarantee the health security of service users.

Blockchain technology enhances information management in healthcare supply chains by securing healthcare information and providing medical resource traceability. However, there is no decision framework to support blockchain implementation for managing information, especially in emerging economies’ healthcare supply chains. This paper develops a hierarchical decision model for implementing blockchain technology for information management in emerging economies’ healthcare supply chains.

This study uses 20 health supply chain experts in Ghana to rank 17 decision criteria for implementing blockchain for healthcare information management using the best-worst method (BWM) multi-criteria decision technique.

The results show that “security” and “privacy,” “infrastructural facility” and “presence of training facilities” are the top three critical factors impacting blockchain adoption in the health supply chain for healthcare information management. Other sub-factors are prioritized.

To implement blockchain effectively to enhance information management in the healthcare supply chain, health institutions, blockchain technology providers and state authorities should concentrate on the highly critical factors extracted from the study.

This is the first study that develops a hierarchical decision model for implementing blockchain technology in emerging economies' health supply chains.

The new Italian National Recovery and Resilience Plan (NRRP) has prioritised a new healthcare model that will establish the additional community healthcare facilities (CHFs). The paper proposes a methodology for supporting decision-making on location of the future facilities according to new parameters that consider how proximity to healthcare benefits communities. Rethinking the spatial parameters for locating future CHFs, focusing on fragile areas, creates a novel decision support system.

The methodology is based on multifactor analysis and on geographic information system (GIS) mapping to simulate the potential and risks associated with the proposed location of CHFs, focusing on territorial contexts of metropolitan cities, medium-sized cities, and Inner Areas, characterized by different fragilities. This method aims to innovate urban planning practices by updating the practice of per-capita urban planning standards and promoting implementation of the 15-minute city model.

The method defines new spatial parameters useful to inform the appropriate location of CHFs in Italy's Inner Areas. This offers a new integrated approach to spatial design mixing urban planning and healthcare dimensions.

The methodology will bring about an integrated urban planning approach, which guides both transformative urban choices and health services' implementation according to the needs of communities.