Complex Transfusion Management in a Sickle Cell Patient With Anti-Fy3 Alloimmunization: A Case Report.

Fy3 is a high-prevalence red blood cell antigen of the Duffy (Fy) blood group system. Anti-Fy3 antibodies are rare and solely arise in individuals with a Duffy null phenotype (Fy(a-b-)), which is a phenotype that mainly occurs in people of African descent. Clinically, anti-Fy3 antibodies can cause both acute and delayed hemolytic transfusion reactions in adults as well as hemolytic disease in fetuses and newborns. Here, we report the case of a 26-year-old male with sickle cell disease (SCD) and a history of anti-E alloantibodies, who was admitted to the hospital with a vaso-occlusive crisis (VOC) and associated low hemoglobin (Hb) level. For the latter he received one unit of antigen-matched and crossmatch-compatible packed red blood cells (pRBCs) without complications. Ten days later the patient was readmitted with a further VOC and associated low Hb level, again requiring a red cell transfusion. However, no crossmatch-compatible pRBCs could be identified. Laboratory testing demonstrated pan-reactivity with additional reference testing demonstrating the presence of anti-E, anti-Fy3 and anti-Jkb alloantibodies. This case highlights the diagnostic and therapeutic challenges associated with blood transfusion in SCD patients with rare alloimmunization profiles.

Capacity Planning of Virtual Wards for Frail and Elderly Patients.

This paper investigates the planning of virtual ward (VW) capacity including the remote monitoring of frail and elderly patients. The main objective is to optimize VW hub locations across a region in the United Kingdom. Furthermore, assigning the optimal number of clinicians to different regions needs to be considered. We develop a mathematical model that minimizes the setup and travel costs of VW hubs and staff. Our experimental analysis evaluates different levels of demand considering postcode areas within different Trusts, also known as Health Boards, in the National Health Service (NHS). Furthermore, our experiments provide insights into how many hub locations should be deployed and staffed. This can be used to individually find the number of remote monitors and clinicians for each facility as well as the system overall.

Blood Demand Forecasting and Supply Management: An Analytical Assessment of Key Studies Utilizing Novel Computational Techniques.

Use of data-driven methodologies in enhancing blood transfusion practices is rising, leveraging big data, machine learning, and optimization techniques to improve demand forecasting and supply chain management. This review used a narrative approach to identify, evaluate, and synthesize key studies that considered novel computational techniques for blood demand forecasting and inventory management through a search of PubMed and Web of Sciences databases for studies published from January 01, 2016, to March 30, 2023. The studies were analyzed for their utilization of various techniques, and their strengths, limitations, and areas for improvement. Seven key studies were identified. The studies focused on different blood components using various computational methods, such as regression, machine learning, hybrid models, and time series models, across different locations and time periods. Key variables used for demand forecasting were largely derived from electronic health record data, including clinical related predictors such as laboratory test results and hospital census by location. Each study offered unique strengths and valuable insights into the use of data-driven methods in blood bank management. Common limitations were unknown generalizability to other healthcare settings or blood components, need for field-specific performance measures, lack of ABO compatibility consideration, and ethical challenges in resource allocation. While data-driven research in blood demand forecasting and management has progressed, limitations persist and further exploration is needed. Understanding these innovative, interdisciplinary methods and their complexities can help refine inventory strategies and address healthcare challenges more effectively, leading to more robust, accurate models to enhance blood management across diverse healthcare scenarios.

Automating Perioperative Inventory Management: A Quality Improvement Project.

Preference cards are a foundation for perioperative inventory management processes; however, they can add to nurses' perceived workload, introduce variability into supply management processes, and increase costs. The purpose of this quality improvement project was to implement an automated perioperative inventory management system to decrease nurses' workload and increase their efficiency. Goals included improving preference card accuracy, decreasing add-on supplies, and decreasing the supply costs for each procedure. Using a preintervention-postintervention survey design, the project team evaluated the outcomes of workload, preference card accuracy, add-on supplies, and procedural cost. Nurses' perception of workload decreased in the supply management processes and cost of supplies categories and increased in the documenting supply use category. A four-month 7.7% improvement in preference card accuracy reduced the average procedure supply cost by $86.72 for each procedure and saved the hospital $260,467. The number of add-on supplies was reduced by 4,177 for a 20% reduction.

Pharmacist Assistants' role in medicine supply management at a primary healthcare setting.

Background: The need to improve essential medicine supply in the public sector is of paramount importance to ensure that the drugs used in treatment regimens are accessible, acceptable, safe, cost effective and affordable to the population. Aim: To assess the role of post-basic pharmacist assistants at primary healthcare clinics in order to make recommendations aimed at improving essential medicine supply management. Setting: The study covered five provinces namely: Eastern Cape, Free State, Gauteng, KwaZulu-Natal and Mpumalanga. Method: A qualitative, exploratory, descriptive research design was followed, using a semi-structured interview guide to collect data from 11 District Pharmaceutical Service Managers together with medicine availability reports review. Data analysis was performed using Colaizzi's seven steps. Results: The study found that there is a shortage of post-basic pharmacist assistants in primary healthcare clinics, which affects the management and availability of medicine supplies. Placement of the post-basic pharmacist assistants would improve medicine supply management in the primary healthcare clinics. Conclusion: At least one post-basic pharmacist assistant should be appointed at each primary healthcare clinic in order to ensure efficient medicine supply management and consistent medicine availability. Contribution: The study provides evidence that primary healthcare clinics without post-basic pharmacist assistants are more likely to have erratic medicine supply management practices and confirms that post-basic pharmacist assistants play a positive role in the medicine supply management processes in primary healthcare clinics.

A procurement-based classification of pharmaceutical supplies for diabetes disease management.

Background and Aims: Diabetes is among the most prevalent noncommunicable chronic diseases globally and carries a substantial expense in worldwide health care. Pharmaceutical supplies related to diabetes management account for 20%-40% of the disease's management cos, and this percentage continues to increase. This study examines the pharmaceutical expenses associated with one of the most common chronic diseases: diabetes. Specifically, we measure the extent to which patient health and demographic factors drive the annual cost of pharmaceutical supplies for diabetes management. Second, the study applied a procurement-centric classification scheme to pharmaceutical items involved in diabetes treatment. Methods: Data on 98,648 pharmaceutical-dispensing transactions (related to 2828 patients) over 1 year were collected from a specialized diabetes health center. Pharmaceutical prices from the sample were compared internationally to ensure that the findings apply to other countries. The association between the item cost and the number of unique patients prescribed pharmaceutical products was estimated at the category and subcategory levels. Results: Approximately 80% of total pharmaceutical expenditures were attributed to 20% of patients. Two of 20 pharmaceutical categories-anti-diabetes drugs and insulin-accounted for 34% of products dispensed and 57% of total pharmaceutical expenditures. Age, body mass index, and diabetes type were essential factors in predicting supply cost per patient. Conclusion: Applying the portfolio purchasing model also suggested that some clinically similar items, like insulin types, are best procured through divergent procurement strategies or vendors for optimal cost efficiency. A better understanding of the diverse array of diabetes supplies can reveal opportunities for better strategic supply management. This supply classification approach can also be applied in other supply-intensive specialties, such as orthopedics.

Implementation of supply management strategies by the pharmacy service in a general hospital during the COVID-19 pandemic.

Objective: Given the global uncertainty faced due to the Covid-19 pandemic, health services were forced to adjust inventory management and purchase projections. This publication aims to describe the strategies taken and their impact on the supply chain indicators by the pharmacy service in the management of drug purchases during the pandemic to expose the importance of pharmacist in charge of the supply chain. Methods: This observational study describes the drug purchasing system in a general hospital and the strategies used to manage drug supply. The actions proposed by the pharmacy department are listed chronologically related to inventory issues and purchasing decisions. The accuracy of the purchase forecast was evaluated by calculating indicators such as the mean absolute standard deviation (MAD) and the variance of the forecast error (MSE). Inventory days and inventory turnover indicators were also compared in pre-pandemic and pre-pandemic periods. Findings: In general, the forecast error given by MAD and MSE tended to decrease. Specifically, from the 82 drug categories, during the pandemic period, this indicator decreased in 72 (88%), increased in 9 (11%), and remained the same in only 1 (1%) of the categories. In financial terms, comparing the 2018-2019 and 2020-2021 periods, a favorable result was obtained when evaluating the inventory turnover indicators, which decreased by 0.01 points and the days of inventory increased on average by two days. Conclusions: The implementation and use of these indicators prevented drug shortages, reducing inventory forecast errors. A pharmacist with knowledge in inventory management allows managing a process of continuous improvement and tactics for efficient inventory management without neglecting the benefit to patients or the economic profitability of the service. There were limitations since digital operating systems do not generate centralized or organized data for this type of analysis.

Challenges and Barriers of Humanitarian Hygiene Items Management in Recent Disasters in Iran.

OBJECTIVE: The provision and continuation of the basic needs of affected communities, including water, food, and shelter remain the most important priorities in responding to disasters. In this regard, this study sought to investigate the management challenges of humanitarian hygiene items in recent disasters in Iran. METHODS: This qualitative study was conducted through a semi-structured interview. Nineteen participants with different experiences, roles, and responsibilities in the recent disaster of Iran and experiences of various events in the national and international arenas were included in the study. A thematic analysis was used, and an initial conceptual framework was defined based on the study aim. The relationship between the components was compared and interpreted in this framework and the main and subthemes were extracted accordingly. RESULTS: Six main themes and 21 subthemes were extracted based on the results. The main challenges in recent disasters were the lack of protocols and standard guidelines, inappropriate selection of items in each hygiene kit, the lack of standard distribution of hygiene kits, and the lack of attention to the affected population's culture. CONCLUSIONS: Overall, it is necessary to define a system for preparation, supply, storage, and timely distribution of hygiene. Finally, it is suggested that an organization should be appointed for this purpose.

COVID-19 pandemic and blood transfusion services: The impact, response and preparedness experience of a tertiary care blood center in southern Karnataka, India

Abstract Introduction With the outbreak of COVID-19 and its containment measures, blood centers faced a huge challenge in balancing blood demand and supply and devising a preparedness plan to withstand the uncertain situation. This study assesses the effect of the COVID-19 pandemic on blood transfusion services and discusses the appropriate mitigation strategies adopted. Methods We analyzed our center's blood transfusion services during the first half-period of the pandemic (Y3) and non-pandemic years 2018(Y1) and 2019(Y2) in two-quarters Q1 (pre-lockdown), from January to March and Q2 (post-lockdown), from April to June. The blood donation variables, the packed red blood cells (PRBCs) demand and the utilization pattern were compared between pandemic (Y3) and non-pandemic years (Y1 and Y2) in each quarter. The mitigation strategy adopted at every step of the transfusion service is highlighted. Results During post-lockdown (Q2) of the pandemic year (Y3), the blood donation was majorly by repeat donors (83%) from the in-house site (82.5%). Furthermore, the proportion of outdoor donation, deferral, blood collection, demand and issue demonstrated a significant drop of 50%, 32.6%, 33%, 31.8% and 32.3%, respectively, in comparison to Q2 of the non-pandemic years (Y1 and Y2), with a statistically significant difference for surgical and hemorrhagic indications (p < 0.05). Coping strategies, such as blood donor education and motivation using e-platforms emphasizing eligibility during the pandemic, staggering of donor in-flow, postponement of elective surgeries and donor and staff' COVID-19 safety assurance, were followed. Conclusion The timely adoption of coping strategies played a crucial role in the better handling of shortcomings at our center's blood transfusion services caused by the COVID-19 pandemic.

COVID-19 pandemic and blood transfusion services: The impact, response and preparedness experience of a tertiary care blood center in southern Karnataka, India.

INTRODUCTION: With the outbreak of COVID-19 and its containment measures, blood centers faced a huge challenge in balancing blood demand and supply and devising a preparedness plan to withstand the uncertain situation. This study assesses the effect of the COVID-19 pandemic on blood transfusion services and discusses the appropriate mitigation strategies adopted. METHODS: We analyzed our center's blood transfusion services during the first half-period of the pandemic (Y3) and non-pandemic years 2018(Y1) and 2019(Y2) in two-quarters Q1 (pre-lockdown), from January to March and Q2 (post-lockdown), from April to June. The blood donation variables, the packed red blood cells (PRBCs) demand and the utilization pattern were compared between pandemic (Y3) and non-pandemic years (Y1 and Y2) in each quarter. The mitigation strategy adopted at every step of the transfusion service is highlighted. RESULTS: During post-lockdown (Q2) of the pandemic year (Y3), the blood donation was majorly by repeat donors (83%) from the in-house site (82.5%). Furthermore, the proportion of outdoor donation, deferral, blood collection, demand and issue demonstrated a significant drop of 50%, 32.6%, 33%, 31.8% and 32.3%, respectively, in comparison to Q2 of the non-pandemic years (Y1 and Y2), with a statistically significant difference for surgical and hemorrhagic indications (p < 0.05). Coping strategies, such as blood donor education and motivation using e-platforms emphasizing eligibility during the pandemic, staggering of donor in-flow, postponement of elective surgeries and donor and staff' COVID-19 safety assurance, were followed. CONCLUSION: The timely adoption of coping strategies played a crucial role in the better handling of shortcomings at our center's blood transfusion services caused by the COVID-19 pandemic.

Risk assessment and water safety planning for rural water supply in Uttarakhand, India.

A water safety plan (WSP) has been developed for rural water supply in Dehradun district, Uttarakhand, India. Four public water utilities were chosen to demonstrate the application of WSP in improving the rural drinking water quality along with improved sanitation. Hazard identification and risk assessment carried out identified 10 hazardous events at all four utilities. Intermittent water supply, poor repair and maintenance of the supply channel machinery, and individual household sanitation practices were the potential sources of contamination. The study showed encouraging results, where the evaluated risks decreased substantially after implementing the control measures, along with improved water quality after WSP implementation which showed statistically significant results (p < .05) for all tested parameters, namely, turbidity (p = .000), total dissolved solids (p = .004), residual-free chlorine (p = .004), total coliforms (p = .000), and fecal coliforms (p  = .003). The sanitation condition of water source and households also improved by adopting the suggested measures. The study recommends water safety planning, to empower the rural communities to safeguard their water sources, and for sustainable water supply management.

Supply Management 2.0: A Policy Assessment and a Possible Roadmap for the Canadian Dairy Sector.

Many believe the current Canadian Dairy supply management system is outdated. Examining a recent consumer survey suggests consumers, especially among the younger generations, have mixed feelings about how the Canadian dairy industry is good for the environment or whether animals in the sector are humanely treated. The general Canadian public strongly supports financial stability for farmers, though is not fully educated about how supply management works. Issues regarding the centralization and amalgamation of the industry, making many regions underserved; recent milk dumping due to a strong shift in demand caused by COVID-19; and the popularity of dairy alternatives, show that the dairy sector in Canada is ill-prepared for major change. Dairy farmers are receiving compensation for trade deals recently ratified by the federal government, creating a precedent that will lead to an overcapitalized industry. The aim of this paper is to review the industry's current state and suggest a roadmap for a more prosperous future.

Management of blood supply and demand during the COVID-19 pandemic in King Abdullah Hospital, Bisha, Saudi Arabia.

BACKGROUND: Maintaining blood supply is essential since blood transfusions are lifesaving in many conditions. The 2003 infectious outbreak of SARS-CoV had a negative impact on blood supply. This study aimed to measure donor attendance and blood demand in order to help find efficient ways of managing blood supply and demand during the COVID-19 pandemic and similar public emergencies in the future. MATERIALS AND METHODS: Data from donor attendance, mobile blood drives and blood inventory records were retrospectively obtained for the period between 1 September 2019 and 1 May 2020 to assess the impact of COVID-19 on donor attendance and the management of blood supply and demand in King Abdullah Hospital, Bisha, Saudi Arabia. Data were analysed using SPSSStatistics, version 25.0. Categorical variables were described using frequencies and percentages. RESULTS: After imported cases of COVID-19 were reported in Saudi Arabia, donor attendance and blood supply at blood bank-based collections showed a drop of 39.5%. On the other hand, blood demand during the same period was reduced by 21.7%. CONCLUSIONS: The COVID-19 pandemic had a negative impact on donor attendance and blood supply and adversely affected blood transfusion services. Guidelines that prioritize blood transfusion should prepare at the beginning of emergencies similar to this pandemic. Close monitoring of blood needs and blood supply and appropriate response is essential for avoiding sudden blood shortage. An evidence-based emergency blood management plan and flexible regulatory policy should be ready to deal with any disaster and to respond quickly in the case of blood shortage.

Catastrophe in Radiology: Considerations Beyond Common Emergencies.

Disasters often occur without warning and have the potential to affect large numbers of people. Those in the radiology environment experience unique effects on them, their equipment, and their ability to provide quality patient care. Lessons can be learned by reviewing events and their impact on imaging departments around the world. Radiology departments need to be actively involved in the disaster planning and the management of disasters when they occur. Common themes emerge regardless of the type of disaster, and these themes should be included in all planning.

Aplicação de uma planilha de controle de estoque em uma unidade de alimentação e nutrição / Application of a stock control sheet in a food and nutrition unit

Introdução: O profissional nutricionista tem, entre suas atribuições, o planejamento de cardápios e o controle de estoque. Dentre as inúmeras atividades inerentes ao setor de alimentação coletiva, a importância da gestão de suprimentos pode passar despercebida e acarretar problemas na execução dos cardápios, gerando monotonia nos mesmos. Assim, ferramentas de controle são necessárias, visto que a monotonia alimentar pode acarretar problemas à saúde dos usuários. Objetivo: Este trabalho teve como objetivo apresentar a elaboração e implantação de uma planilha de controle de estoque em uma unidade de alimentação e nutrição (UAN) de uma instituição de ensino superior pública. Métodos: O trabalho foi desenvolvido e executado no Restaurante Universitário da Escola Agrícola de Jundiaí, da Universidade Federal do Rio Grande do Norte, localizada no distrito de Jundiaí, Macaíba, Rio Grande do Norte, Brasil, com levantamento das fichas de controle. Resultados: O produto deste trabalho foi uma planilha no formato Excel® para controle dos gêneros alimentícios secos do estoque. Observou-se que, além de controlar a entrada e a saída dos gêneros, a planilha auxiliou na tomada de decisão de compra e reabastecimento de suprimentos. Conclusão: Diante dos objetivos almejados, a planilha foi desenvolvida e aplicada com êxito, alcançando a finalidade esperada pelo serviço. (AU)

Introduction: the professional nutritionist has the tasks of planning menus and, consequently, stock control. Among countless activities inherent to the collective food sector, the importance of supply management can go unnoticed and cause problems in the execution of the menus, generating monotony in them. So, control tools are needed, since food monotony can cause health problems for users. Objective: this study aimed to present the preparation and implementation of a stock control spreadsheet in a food and nutrition unit (FNU) of a public higher education institution. Methods: the study was developed and carried out at the Restaurante Universitário da Escola Agrícola de Jundiaí (University Restaurant of the Agricultural School of Jundiaí), of the Universidade Federal do Rio Grande do Norte (Federal University of Rio Grande do Norte), located in the District of Jundiaí, Macaíba, Rio Grande do Norte, Brazil, with a survey of control cards. Results: the product of this study was a spreadsheet in Excel® format to control dry foodstuffs from the stock. It was observed that in addition to controlling the entry and exit of the genders, the spreadsheet also helped in the decision to purchase and replenish supplies. Conclusion: in view of the desired objectives, the spreadsheet was developed and applied successfully, reaching the purpose expected by the service. (AU)

Una nueva visión en la gestión de la logística de aprovisionamientos en la industria biotecnológica cubana / A new vision in the management of supply logistics in the cuban biotechnological industry

El objetivo de esta investigación es proponer una nueva metodología en la gestión logística de los aprovisionamientos para las industrias biotecnológicas cubanas que funcionan esencialmente con un ciclo completo de desempeño empresarial, desde la investigación básica de nuevos biofármacos, hasta llegar a la fabricación y comercialización de sus productos, donde la amplia y compleja gama de surtidos a suministrar en un contexto adverso para el país, conlleva a utilizar diferentes métodos de gestión de los aprovisionamientos en correspondencia con su destino y frecuencia de uso. De esta manera, se propone dividir las materias primas y materiales a proveer en: 1) insumos de proyectos, que emplean de forma esporádica pequeñas, pero múltiples variedades de mercancías 2) insumos de procesos, que se caracterizan por consumir altos volúmenes de productos, pero poco diversos, como sucede en las actividades de producción. Finalmente, se evalúa la implementación de este procedimiento en una de las entidades biotecnológicas de mayor prestigio en Cuba, el Centro de Inmunología Molecular, demostrando las ventajas y alcance de esta propuesta que permitió elevar la efectividad en la gestión de los aprovisionamientos, y de esta manera la eficiencia empresarial(AU)

The objective of this work is to propose a new methodology for the logistics management of supplies in Cuban biotechnological industries. They work essentially on a full cycle of enterprise performance, from basic research to the manufacture and marketing of new biopharmaceuticals products. The wide and complex range of supply requirements, in an adverse country-wide context, leads to the use of different methods for managing supplies, in accordance with their destination and frequency of use. We propose to divide the supplies and materials into two categories: 1) supplies for projects, for those that are highly varied, used sporadically and in small quantities, 2) process supplies, for those that are regularly used in large volumes -such as manufacture process-, and a relatively small variety of supply types. The implementation of this methodology is assessed in one of the most prestigious biotechnological entities in Cuba, the Molecular Immunology Center. The effectiveness in the management of supplies was increased, and therefore, business efficiency(AU)

Future irrigation expansion outweigh groundwater recharge gains from climate change in semi-arid India.

Simultaneous effects of future climate and irrigation intensification on surface and groundwater systems are not well understood. Efforts are needed to understand the future groundwater availability and associated surface flows under business-as-usual management to formulate policy changes to improve water sustainability. We combine measurements with integrated modeling (MIKE SHE/MIKE11) to evaluate the effects of future climate (2040-2069), with and without irrigation expansion, on water levels and flows in an agricultural watershed in low-storage crystalline aquifer region of south India. Demand and supply management changes, including improved efficiency of irrigation water as well as energy uses, were evaluated. Increased future rainfall (7-43%, from 5 Global Climate Models) with no further expansion of irrigation wells increased the groundwater recharge (10-55%); however, most of the recharge moved out of watershed as increased baseflow (17-154%) with a small increase in net recharge (+0.2mm/year). When increased rainfall was considered with projected increase in irrigation withdrawals, both hydrologic extremes of well drying and flooding were predicted. A 100-year flow event was predicted to be a 5-year event in the future. If irrigation expansion follows the historical trends, earlier and more frequent well drying, a source of farmers' distress in India, was predicted to worsen in the future despite the recharge gains from increased rainfall. Storage and use of excess flows, improved irrigation efficiency with flood to drip conversion in 25% of irrigated area, and reduced energy subsidy (free electricity for 3.5h compared to 7h/day; $1 billion savings) provided sufficient water savings to support future expansion in irrigated areas while mitigating well drying as well as flooding. Reductions in energy subsidy to fund the implementation of economically desirable (high benefit-cost ratio) demand (drip irrigation) and supply (water capture and storage) management was recommended to achieve a sustainable food-water-energy nexus in semi-arid regions.

Managing the Planned Cessation of a Global Supply Market: Lessons Learned From the Global Cessation of the Trivalent Oral Poliovirus Vaccine Market.

The Polio Eradication and Endgame Strategic Plan 2013-2018 calls for the phased withdrawal of OPV, beginning with the globally synchronized cessation of tOPV by mid 2016. From a global vaccine supply management perspective, the strategy provided two key challenges; (1) the planned cessation of a high volume vaccine market; and (2) the uncertainty of demand leading and timeline as total vaccine requirements were contingent on epidemiology. The withdrawal of trivalent OPV provided a number of useful lessons that could be applied for the final OPV cessation. If carefully planned for and based on a close collaboration between programme partners and manufacturers, the cessation of a supply market can be undertaken with a successful outcome for both parties. As financial risks to manufacturers increase even further with OPV cessation, early engagement from the cessation planning phase and consideration of production lead times will be critical to ensure sufficient supply throughout to achieve programmatic objectives. As the GPEI will need to rely on residual stocks including with manufacturers through to the last campaign to achieve its objectives, the GPEI should consider to decide on and communicate a suitable mechanism for co-sharing of financial risks or other financial arrangement for the outer years.

The impact of facility audits, evaluation reports and incentives on motivation and supply management among family planning service providers: an interventional study in two districts in Maputo Province, Mozambique.

BACKRGOUND: Good progress is being made towards universal access to contraceptives, however stock-outs still jeopardize progress. A seldom considered but important building block in optimizing supply management is the degree to which health workers feel motivated and responsible for monitoring supply. We explored how and to what extent motivation can be improved, and the impact this can have on avoiding stock-outs. METHODS: Fifteen health facilities in Maputo Province, Mozambique, were divided into 3 groups (2 intervention groups and 1 control), and 10 monthly audits were implemented in each of these 15 facilities to collect data through examination of stock cards and stock-counts of 6 contraceptives. Based on these audits, the 2 intervention groups received a monthly evaluation report reflecting the quality of their supply management. One of these 2 groups was also awarded material incentives conditional on their performance. A Wilcoxon-Mann Whitney test was used to detect differences between the groups in the average number of stocked-out centres, while changes over time were verified through applying a Friedman test. Additionally, staff motivation was measured through interviewing health care providers of all centres at baseline, and after 5 and 10 months. To detect differences between the groups and changes over time, a Kruskal Wallis and a Wilcoxon signed-rank test were applied, respectively. RESULTS: Motivation reported by providers (n = 55, n = 40 and n = 39 at baseline, 1st and 2nd follow-up respectively) was high in all groups, during all rounds, and did not change over time. Facilities in the intervention groups had better supply management results (including less stock-outs) during the entire intervention period compared with those in the control group, but the difference was only significant for the group receiving both material incentives and a monthly evaluation. However, our data also suggest that supply management also improved in control facilities, receiving only a monthly audit. During this study, more stock-outs occurred for family planning methods with lower demand, but the number of stock-outs per family planning method in the intervention groups was only significantly lower, compared with the control group, for female condoms. CONCLUSIONS: While a rise in motivation was not measurable, stock management was enhanced possibly as a result of the monthly audits. This activity was primarily for data collection, but was described as motivating and supportive, indicating the importance of feedback on health workers' accomplishments. More research is needed to quantify the additional impact of the interventions (distribution of evaluation reports and material incentives) on staff motivation and supply management. Special attention should be paid to supply management of less frequently used contraceptive methods.

Five focus strategies to organize health care delivery.

PURPOSE: The focused factory is one of the concepts that decision-makers have adopted for improving health care delivery. However, disorganized definitions of focus have led to findings that cannot be utilized systematically. The purpose of this paper is to discuss strategic options to focus health care operations. DESIGN/METHODOLOGY/APPROACH: First the literature on focus in health care is reviewed revealing conceptual challenges. Second, a definition of focus in terms of demand and requisite variety is defined, and the mechanisms of focus are explicated. A classification of five focus strategies that follow the original idea to reduce variety in products and markets is presented. Finally, the paper examines managerial possibilities linked to the focus strategies. FINDINGS: The paper proposes a framework of five customer-oriented focus strategies which aim at reducing variety in different characteristics of care pathways: population; urgency and severity; illnesses and symptoms; care practices and processes; and care outcomes. RESEARCH LIMITATIONS/IMPLICATIONS: Empirical research is needed to evaluate the costs and benefits of the five strategies and about system-level effects of focused units on competition and coordination. PRACTICAL IMPLICATIONS: Focus is an enabling condition that needs to be exploited using specific demand and supply management practices. It is essential to understand how focus mechanisms differ between strategies, and to select focus that fits with organization's strategy and key performance indicators. ORIGINALITY/VALUE: Compared to previous more resource-oriented approaches, this study provides theoretically solid and practically relevant customer-oriented framework for focusing in health care.