RT Journal Article
SR Electronic
T1 How coping can hide larger systems problems: the routine immunisation supply chain in Bihar, India
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e001609
DO 10.1136/bmjgh-2019-001609
VO 4
IS 5
A1 Bruce Y Lee
A1 Patrick T Wedlock
A1 Elizabeth A Mitgang
A1 Sarah N Cox
A1 Leila A Haidari
A1 Manoja K Das
A1 Srihari Dutta
A1 Bhrigu Kapuria
A1 Shawn T Brown
YR 2019
UL http://gh.bmj.com/content/4/5/e001609.abstract
AB Introduction Coping occurs when health system personnel must make additional, often undocumented efforts to compensate for existing system and management deficiencies. While such efforts may be done with good intentions, few studies evaluate the broader impact of coping.Methods We developed a computational simulation model of Bihar, India’s routine immunisation supply chain where coping (ie, making additional vaccine shipments above stated policy) occurs. We simulated the impact of coping by allowing extra trips to occur as needed up to one time per day and then limiting coping to two times per week and three times per month before completely eliminating coping.Results Coping as needed resulted in 3754 extra vaccine shipments over stated policy resulting in 56% total vaccine availability and INR 2.52 logistics cost per dose administered. Limiting vaccine shipments to two times per week reduced shipments by 1224 trips, resulting in a 7% vaccine availability decrease to 49% and an 8% logistics cost per dose administered increase to INR 2.73. Limiting shipments to three times per month reduced vaccine shipments by 2635 trips, which decreased vaccine availability by 19% to 37% and increased logistics costs per dose administered by 34% to INR 3.38. Completely eliminating coping further reduced shipments by 1119 trips, decreasing total vaccine availability an additional 24% to 13% and increasing logistics cost per dose administered by 169% to INR 9.08.Conclusion Our results show how coping can hide major system design deficiencies and how restricting coping can improve problem diagnosis and potentially lead to enhanced system design.