How coping can hide larger systems problems: the routine immunisation supply chain in Bihar, India

Area of Science:

• Public Health
• Supply Chain Management
• Health Systems Research

Background:

• Coping involves undocumented efforts by health personnel to address system deficiencies.
• While often well-intentioned, the broader impact of coping on health systems is understudied.

Purpose of the Study:

• To evaluate the impact of "coping" (additional vaccine shipments) on the routine immunisation supply chain in Bihar, India.
• To simulate the effects of varying levels of coping on vaccine availability and logistics costs.

Main Methods:

• A computational simulation model of the Bihar immunisation supply chain was developed.
• Simulations assessed the impact of coping by allowing extra shipments as needed, then limiting them to twice weekly, thrice monthly, and finally eliminating them.

Main Results:

• Unrestricted coping led to 3754 extra shipments, 56% vaccine availability, and INR 2.52 cost/dose.
• Eliminating coping reduced shipments by 4908 but decreased availability to 13% and increased cost to INR 9.08.

Conclusions:

• Coping can obscure significant deficiencies in health system design.
• Restricting coping facilitates problem diagnosis and can drive improvements in system design and vaccine delivery.