Developing a novel approach for improving supply chain management for SARS-CoV-2 point-of-care diagnostic services in resource-limited settings : a case study of Mopani district Municipality in Limpopo Province, South Africa

Abstract

Introduction: In settings with limited access to laboratory diagnostic services, point-of-care (POC) testing offers a suitable alternative for diagnosing COVID-19. We conducted a scoping review to guide the objectives of this study. The scoping review highlighted the importance of equitable access to diagnostic tests at POC through well-coordinated supply chain management (SCM) systems, particularly for settings with limited access to diagnostic laboratory services. It also revealed a research gap on SCM of POC diagnostic services in low- and middle-income countries (LMICs). Guided by the scoping review results, the overarching aim of this thesis is to contribute knowledge to inform development of a novel approach for improving SCM for COVID-19 POC diagnostic services in resource-limited settings with poor access to laboratory diagnostic services, using Mopani District in Limpopo Province, South Africa, as a study setting.

Methods: This multiphase mixed methods study consisted of four phases, starting with the scoping review that guided the thesis objectives. Phase 2 involved a geospatial analysis to assess the spatial distribution of COVID-19 POC testing services in the Mopani District. Phase 3 involved an audit of primary healthcare (PHC) clinics providing COVID-19 POC diagnostic services to evaluate the impact of SCM on accessibility and identify barriers and enablers. Based on the findings from the initial phases, Phase 4 employed a nominal group technique (NGT) to collaborate with key stakeholders in co-creating a novel approach for improving SCM systems for COVID-19 POC diagnostic services. Finally, we synthesised results from the above phases to inform development of an evidence-informed context specific framework for improving POC diagnostics services SCM.

Results: The geospatial analysis indicated that the majority of the population (78.2%) had adequate accessibility to COVID-19 diagnostic services, assuming they utilized the nearest healthcare facility. However, an uneven distribution of services within the region was identified. The audit revealed non-compliance with SCM practices in PHC clinics in the Mopani District, particularly in inventory management, distribution, and human resource capacity. However, compliance was observed in procurement, redistribution, and quality assurance. Through collaboration with key stakeholders we were able to identify key priority areas that needed to be addressed ix to improve SCM systems for POC diagnostic services in the Mopani District. The following areas were identified to be a priority: availability of testing kits, monitoring of stock levels, unknown demand, information on SCM during a pandemic, demand planning and standardisation of procurement policies. Informed by the above results, we proposed an intersectoral POC diagnostics SCM framework for resource-limited settings.

Conclusion: This thesis has successfully guided the development of a novel approach to improving SCM of SARS-CoV-2 POC diagnostic services in resource-limited settings, using Mopani District in Limpopo Province, South Africa, as a study setting. This thesis offers guidance on achieving increased accessibility, responsiveness, optimal inventory management, quality assurance, standardization, and data-driven decision-making. These advantages can contribute to more effective healthcare delivery, improved patient outcomes, and enhanced management of public health. Additionally, this thesis proposes implementing an intersectoral framework for improvement of SCM for POC diagnostics in resource-limited settings. The findings of this thesis have significant implications for policymakers and implementers involved in POC diagnostics in resource-constrained settings. Further research is necessary to determine the feasibility of implementing the intersectoral framework for improving SCM for POC diagnostics in resource-limited settings.