The term “Logistics”is defined in the Merriam-Webster Collegiate Dictionary as “the aspect of military science dealing with procurement, maintenance and transport of materiel, facilities and personnel” or stated otherwise “the handling of the details of the operation”. While the term was initially used in a military sense, the term is now used widely in commerce, to refer to how resources are handled and moved along the supply chain. A brief scan of the internet reveals a multitude of universities offering under-graduate and post-graduate degrees in logistics and logistics management. Promoting these courses universities encourage prospective students that embarking on the these courses will prepare them for a successful career in the world of commerce.
Logistics management has become an essential component of the operation of companies and businesses across the world and it is summed up in the diagram below known as the “Seven R’s” of logistics.
As with an army, companies and health departments that fail to address the complexities of logistics are unlikely to succeed. My questions are how many public sector health departments have managers qualified in logistics management, to what degree does this lack of capacity impact on their ability to convert policy into action and consequently impact on service delivery to patients? In short, how many South African public sector health departments have a detailed managerial focus on the Seven R’s of logistics?
While the commercial environment may differ markedly from that in health services, many of the factors highlighted in the “Seven R’s”, remain relevant. Take for instance the fact that in many instances, in the midst of a pandemic, health workers have been unable to access appropriate personal protective equipment (PPE), which in a military analogy equates to sending troops into battle without appropriate body armour or helmets. The lack of the required medical equipment and drugs again equates to sending a soldier into battle without a weapon or ammunition. Further the failure, despite the time granted to the health services by the hardest of lockdowns intended to “flatten the curve” of infections, to complete construction projects to augment the numbers of hospital beds. The latter painfully highlighted by conditions in some State hospitals as South Africa entered the “second wave” of COVID-19 infections.
With the prospect of vaccines to provide immunity to coronavirus, the need for a focus on logistics becomes even more acute. While at a national level plans have been drawn up aiming to immunise 67% of the South African population, these ambitious plans are doomed to failure without detailed attention to the logistics required by such a complex undertaking. Even in a country with a far more robust health system than South Africa, such as the United Kingdom, the challenges of a similar program have proved formidable. How much more of a challenge will this be in a South African context where evidence of attention to logistics has been sorely lacking?
Certainly, South Africa possesses the logistics capacity to successfully manage the task of distributing, storing and administering the COVID-19 vaccine. But I would contend that much, if not most, of this capacity does not reside within the public health sector. An argument that the existing Expanded Programme on Immunisation (EPI) and the treatment programme for HIV/AIDS indicates that this capacity already exists is in my opinion fallacious. These programs target far smaller numbers, have been developed over years and have not been without challenges which in themselves reflect logistic challenges. An immunisation programme focusing on at least 67% of the South African population set up within at best several months presents an entirely different logistic challenge. A recognition of this fact is in my opinion a prerequisite for the success of this ambitious program so essential in the broadest sense for the immediate health of the nation.
Aside from the current challenges posed by the COVID-19 pandemic, the successful implementation of the envisaged National Health Insurance (NHI) system, in whatever from is finally approved, will depend on the logistic capability that resides within the public and private health sectors. The prerequisites for provision of quality health care depend on the ability of the provider, a health department, to deliver the right product to the right client (patient) at the right time and place, in the right form and quantity and at the right cost. That is once again, the “Seven R’s of logistics” as applied to the health sector. Although the dynamics and focus may differ, these principles can and should apply equally to both the public and private health sectors. While there may be an inclination to conclude that logistics resides within the supply chain management environment, which it does to a great extent, I believe that the principles simply outlined above extend further into other levels of management and in particular senior management within the health sector. It is not solely the responsibility of supply chain management but a matter that should entertain the minds of managers at all levels.
My analysis of the realities in the South African public health sector stemming from my years as a senior manager in this sector and subsequently in the various roles I have fulfilled, is that on many levels, the missing link leading to the failure to successfully deliver quality healthcare can be laid at the door of an inadequate grasp of the intricacies of logistics.
In the short term, capacity in logistics could and should be acquired wherever it exists within the country to address the shortcomings to which I have referred. The immediate need being the effective and efficient implementation of COVID-19 vaccination to the South African population. In the longer term, utilising the courses in this field offered by South African universities, I would propose an urgent initiative to fast-track training in logistics relevant to the health sector and the prioritisation of the recruitment of staff at all levels with certified training and proven skills in logistics.
If I am correct that logistics is indeed a missing link to enable successful healthcare delivery, then let it be the first priority to be addressed before the creation of more elaborate strategies to create quality healthcare delivery in this country!
