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This study has four objectives. First is to investigate and compare the immediate and carryover effects of four pharmaceutical marketing tools (prescriber detailing, medical events, journal ads and direct-to-consumer advertising [DTCA]) on sales. Based on the effect comparisons, the second objective is to determine whether advertising tools that are more compatible with prescriber’s behavior have superior impact on sales. Third is to examine empirical support for the argument that advertising directly to consumers, as a market follower versus leader, has a backfiring effect. Finally, this paper aims to assess the magnitude of variance in sales as a function of each advertising tool.

Data on unit sales and spending (on DTCA, journal ads, events and detailing) ranging 84 months are obtained for six prescription-only cholesterol-reducing brands. First, linearity is checked. Second, evolution versus stationarity is tested by applying the unit-root test. Third, potential endogeneity among variables is assessed with granger causality. Fourth, vector autoregressive model (VAR) that accounts for endogeneity and dynamic interactions is specified. Intercept, seasons and market share are added into the model specification as exogenous variables. Fifth, VAR with akaike selected lags and generalized impulse response are conducted. Finally, sales variance is decomposed with forecast error variance decomposition and Cholesky ordering.

A 10% increase on detailing or journal ads spending brought an immediate (one month) negative effect on sales in a market leader, whereas that same increase is insignificant in a market follower. A 10% increase on DTCA (vs detailing) spending led to a negative (vs positive) carryover effect for the market follower, giving empirical support to the backfiring effect of DTCA and partial evidentiary support suggested about prescriber friendly advertising. However, DTCA induces a larger short term and longer carryover effect in a market leader, with seven times more effect on sales than what detailing does. In addition, it explains 50% of the variation in sales.

The model applied captures extensive dynamics; hence, findings are robust. The analysis considered comparison in terms of prescriber friendly (vs not) advertising tools and brand market status and thus can make managers rethink strategy of advertising budget allocations. This study also introduced a new look onto DTCA and hence challenges the traditional thought held on consumer advertising response.

The increasing rate of environmental concern and awareness by society has attracted attention from researchers and organisations to consider how to proceed towards green supply chains. The purpose of this paper is to identify operational bottlenecks in the multi-tier supply chain to guide organisations towards where to concentrate their efforts to address their supply chain environmental challenges.

This paper presents a literature review identifying green supply chain challenges of multi-tier supply chains. Following the literature review is a case study of the Ethiopian health supply chain with 11 interviews, 11 international and 6 national surveys and data from public health information systems. An analysis based on multi-tier supply chain modelling is used to identify environmental supply chain bottlenecks.

This research found that the supply chain actors face severe challenges towards enhanced green supply chain performance mainly because of poor inventory management (IN), inefficient tracking and tracing (TR) and fake or sub-standard products in the supply chain, especially counterfeit medicines (CO). Specific environmental bottlenecks within each of the challenge areas IN, TR and CO where identified serving as recommendations for where supply chain actors should focus their work towards greener supply chains.

The data come from participants in a single country, Ethiopia; although the supply chain challenges are common for developing countries in general.

This research presents a modelling approach to identify supply chain activities considered as environmental bottlenecks in multi-tier supply chains. The environmental bottlenecks pinpoint supply chain activities to focus on for a transition towards green supply chains for manufacturers, public and private health organisations, hospitals and health care units.

This paper contributes to the literature on GSCM by developing a multi-tier modelling approach for identifying environmental supply chain bottlenecks. The applicability of the model is demonstrated by the identification of environmental bottlenecks in a healthcare supply chain supporting decisions on what challenges a green supply chain strategy should address. It serves as a basis for future research on where to implement GSCM practices in supply chains (SCs).