Is decentralization good for logistics systems? Evidence on essential medicine logistics in Ghana and Guatemala
Is decentralization good for logistics systems? Evidence on essential medicine logistics in Ghana and Guatemala
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DOI：
10.1093/heapol/czl041
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发表时间：
2007-03-01
影响因子：
3.2
通讯作者：
Amenyah, Johnnie K.
中科院分区：
文献类型：
--
作者：
Bossert, Thomas J.;Bowser, Diana M.;Amenyah, Johnnie K.
高效的物流系统将基本药物沿供应链向下运送到服务提供点，然后运送到最终用户。物流系统专家倾向于认为供应链需要集中控制才能最有效。然而，许多医疗改革涉及权力下放，专家担心这扰乱了供应链，使系统效率降低。在评估权力下放的有效性的适当方法上没有达成共识，只有少数研究试图解决后勤系统的权力下放问题。本文阐述了一个开拓性的探索性研究的框架和方法，探讨了在两个国家，危地马拉和加纳的权力下放的经验，并提出了权力下放如何影响其物流系统的性能的建议性结果。分析方法评估权力下放使用的主要作者的“决策空间”的方法，它定义权力下放的程度，地方官员对不同的卫生系统功能的选择。在这种情况下，该方法侧重于15个不同的物流功能，并测量了选择程度和每个功能的绩效指标之间的关系。（即更集中）与两个关键职能的更好绩效相关（库存控制和信息系统），而在规划和预算编制方面更多的选择（即更加分散）与更好的业绩有关。在加纳和危地马拉不同的采购系统，我们发现，一个系统的一些元素的采购是集中的（选择公司和价格固定的国家招标）是积极相关的危地马拉，但在加纳，负相关的“现购自运”成本回收系统允许更多的本地选择。作者的结论是，物流系统可以有效地分散一些功能，而其他人应该保持集中。然而，这些初步调查结果应采用其他方法加以确认。
Efficient logistics systems move essential medicines down the supply chain to the service delivery point, and then to the end user. Experts on logistics systems tend to see the supply chain as requiring centralized control to be most effective. However, many health reforms have involved decentralization, which experts fear has disrupted the supply chain and made systems less effective. There is no consensus on an appropriate methodology for assessing the effectiveness of decentralization in general, and only a few studies have attempted to address decentralization of logistics systems. This paper sets out a framework and methodology of a pioneering exploratory study that examines the experiences of decentralization in two countries, Guatemala and Ghana, and presents suggestive results of how decentralization affected the performance of their logistics systems. The analytical approach assessed decentralization using the principal author's 'decision space' approach, which defines decentralization as the degree of choice that local officials have over different health system functions. In this case the approach focused on 15 different logistics functions and measured the relationship between the degree of choice and indicators of performance for each of the functions.The results of both studies indicate that less choice (i.e. more centralized) was associated with better performance for two key functions (inventory control and information systems), while more choice (i.e. more decentralized) over planning and budgeting was associated with better performance. With different systems of procurement in Ghana and Guatemala, we found that a system with some elements of procurement that are centralized (selection of firms and prices fixed by national tender) was positively related in Guatemala but negatively related in Ghana, where a system of 'cash and carry' cost recovery allowed more local choice. The authors conclude that logistics systems can be effectively decentralized for some functions while others should remain centralized. These preliminary findings, however, should be subject to alternative methodologies to confirm the findings.