Figures & Tables
Figures
- FIGURE 1
Overview of the Public Health Supply Chain in Rwanda
Abbreviations: BUFMAR, Bureau des Formations Médicales Agréées du Rwanda; FP/RH, family planning/reproductive health; HQ, headquarters; MEDIASOL, Medical & Allied Service solutions; MNCH, maternal, newborn, and child health; RBC, Rwanda Biomedical Centre; RMS, Rwanda Medical Supply.
- FIGURE 2
Simplified Version of the Human Resources for Supply Chain Management Theory of Change Model
Tables
Kigali City, No. (%) Southern Province, No. (%) Total, No. (%) Interviews (N=9) (N=26) (N=35) Position type Human resources 3 (33) 6 (23) 9 (26) Pharmacy 4 (44) 17 (54) 21 (60) Other 2 (22) 3 (12) 5 (14) Facility type Central level 6 (67) 0 (0) 6 (17) District level 1 (11) 8 (31) 9 (26) Hospital 1 (11) 12 (46) 13 (37) Health center 1 (11) 6 (23) 7 (20) Focus group (N=7) (N=21) (N=28) Position type Human resources 0 (0) 5 (71) 5 (54) Pharmacy 5 (83) 15 (24) 20 (71) Other 2 (33) 1 (5) 3 (11) Facility type Central level 4 (57) 0 (0) 4 (14) District level 1 (14) 6 (29) 7 (25) Hospital 0 (0) 11 (52) 11 (39) Health center 2 (29) 4 (19) 6 (22) # Outcome Result A4 Importance of SCM being acknowledged throughout health system & positioned accordingly. Intervention suggesteda Staffing pathway B1 All critical SCM positions and/or competencies filled. Future phaseb B2.1 Ability to recruit quality candidates. Future phase B2.2 Adequate pool of workers to fill SCM roles/positions. Future phase B2.3 Sufficient budget to fund required positions. Intervention suggested B3.1 Ability to develop the right job descriptions. Intervention suggested B3.2 An effective recruitment system is in place for SCM positions. In placec B3.3 SCM workers have job security. In place B3.4 Competitive salaries are offered. In place B3.5 SCM job opportunities are known. In place B3.6 Education is available to obtain all required qualifications within the SCM system. Intervention suggested B3.7 SCM career path exists. Intervention suggested B3.8 Supply chain management is a valued career. Intervention suggested B4.1 Precise qualifications for SCM positions are accurately described. In place B4.2 General recruitment and hiring policy exists. In place B4.3 Equal employment opportunity policies cover recruitment practice. Partially in placed B5.1 Public sector recruitment and hiring policies permit the hiring of staff with adequate SCM experience. In place Skills pathway C1 Workers apply their skills as appropriate at every level of the SCM. Future phase C2.1 SCM workers demonstrate adequate technical and managerial competencies. Intervention suggested C2.2 SCM workers have leadership skills within their sphere of operations. Intervention suggested C2.3 SCM workers understand their roles & responsibilities in the SCM system. Future phase C3.1 Workers have acquired adequate SCM competencies. Future phase C3.2 SCM workers develop competencies through coaching and mentoring. In place C3.3 SCM workers develop competence through learning and experience. Future phase C3.4 High-level SCM positions are recognized at a sufficient level of authority. In place C3.5 Formally defined roles match expected local practice. In place C3.6 Each position within SCM has defined roles and responsibilities. Future phase C4.1 SCM workers have access to training, education and professional development linked to core competencies. Intervention suggested C4.2 Opportunities exist to gain on-the-job experience. In place C4.3 The steps and competencies required to undertake SCM tasks are known. Intervention suggested Working conditions pathway D1 Working conditions support performance. Future phase D2.1 The social and emotional environment is favorable. Future phase D2.2 The physical environment is safe, clean and conducive to performance. Future phase D2.3 SCM workers have up to date and relevant tools and equipment to perform. Future phase D3.1 A problem-solving, solution-focused culture exists. In place D3.2 The organization culture supports positive social and emotional environment. In place D3.3 Supervisors are competent to implement equal employment opportunity and anti-harassment policies. Future phase D3.4 Supervisors have the skills to establish a safe and clean physical work environment. Future phase D3.5 The resources necessary for safe, clean physical environment are available. In place D3.6 The necessary tools and equipment are identified and made available. Intervention suggested D4.1 Workplace harassment policies, especially those safeguarding women, are in place. Partially in place D4.2 Equal employment opportunity policies are in place. Partially in place D4.3 Environmental and occupational safety policies are in place. Future phase D5.1 The characteristics of a safe and conducive environment are known. Intervention suggested Motivation pathway E1 SCM workers are motivated to do their jobs. Future phase E2.1 Good performance is supported within the system. Future phase E2.2 SCM workers understand and care about their role in the health care system. Intervention suggested E2.3 SCM workers have a sense of ownership over their role. In place E3.1 Poor performance is corrected. In place E3.2 Good performance is recognized and rewarded. In place E3.3 Good performance leads to career advancement. In place E3.4 There is an understanding of how SCM affects health outcomes. In place E3.5 Workers have the authority to make and implement decisions. In place E4.1 Financial incentives are in place. In place E4.2 Non-financial incentives are in place. In place E5.1 Supervisors provide supportive supervision and performance management to their staff. In place E6.1 Performance management policies are in place. In place E6.2 Supervisors understand the reasons for poor performance. In place E6.3 Supervisors feel able to provide constructive feedback. In place E6.4 Supervisors have the skills to communicate feedback on poor performance to staff. Intervention suggested Abbreviations: HR4SCM TOC; Human Resources for Supply Chain Management Theory of Change; SCM, supply chain management.
↵a Outcome was absent; intervention was suggested.
↵b Outcome was absent; intervention needs to be designed in a future phase, after the intervention suggested in this research develops a related precondition.
↵c Outcome was in place in the Rwandan system.
↵d Outcome partially in place; intervention was not suggested.
- TABLE 3.
Suggested Interventions to Develop Deficient Outcomes in the HR4SCM TOC Staffing Pathway and Indicators
Outcome Suggested Intervention Indicator Sufficient budget to fund required positions. 1.1 Forecast SCM positions. Include SCM positions in MOH staffing structure.
1.2 Allocate budget accordingly and support advocacy for SCM HR budget needs.
Evidence exists that vacant SCM positions are unfilled due to lack of funding (Y/N). Ability to develop the right job descriptions. 1.3 Develop job descriptions for SCM functions at the different levels of the health system that meet a MOH-defined standard. Percentage of SCM job descriptions that meet MOH’s standard for job descriptions. SCM is a valued career. 1.4 Develop and establish a recognized supply chain cadre. Percentage of SCM workers surveyed who consider SCM as a valued career. Education is available for all required qualifications within the SCM system. 1.5a. Map the education available and the programs needed.
1.5b. Identify which programs are required based on competency frameworks; Identify which roles require pre-service training and at which level(s).
1.5c. Engage in advocacy with Ministry of Education to develop qualifications identified to be missing.
1.5d. Institute developed program in line with MOH needs.
Educational training is available at all levels for all qualifications staff require (Y/N).
Training strategy that identifies educational requirements exists (Y/N).
Number of employees who received SCM training at pre-service courses.
Supply chain management career path exists. 1.6a. Define a career path that maps low-level to upper-level experience.
1.6b. Align continuing professional development/education opportunities with career progression.
Percentage of managerial SCM roles that have existing career paths.
Percentage of technical SCM roles that have existing career paths.
Abbreviations: HR4SCM TOC; Human Resources for Supply Chain Management Theory of Change; MOH, Ministry of Health; SCM, supply chain management.
- TABLE 4.
Suggested Interventions to Develop Deficient Outcomes in the HR4SCM TOC Skills Pathway and Indicators
Outcome Suggested Intervention Indicator The steps and competencies required to undertake SCM tasks are known. 2.1. Establish a competency framework and roles and responsibilities for SCM at all levels with corresponding SCM qualifications.
2.2. Conduct SCM competency mapping exercise.
Lists of critical SCM competencies have been documented for all SCM services (Y/N).
Competency frameworks, which define the knowledge, skills, and attributes needed, are available for all SCM cadres (Y/N).
All needed SCM competencies are assigned to SCM roles (Y/N).
SCM workers demonstrate adequate technical and managerial competencies. 2.3. Implement education and training interventions that address identified competency gaps.
2.4. Review job descriptions to ensure that appropriate qualifications are requested for the position.
Percentage of staff appraisals that assess SCM competencies. SCM workers have access to training, education and professional development linked to core competencies. 2.5. Put in place staff development plans to support desired development.
Percentage of SCM staff with individual staff development plans. SCM workers have leadership skills within their sphere of operations. 2.6. Incorporate leadership development into/as part of staff development plans.
2.7. Include a competency assessment in the performance evaluation process. Compare results of assessment with competencies listed in job description.
Percentage of staff who are competent in leadership competencies listed in their job description. Abbreviations: HR4SCM TOC; Human Resources for Supply Chain Management Theory of Change; SCM, supply chain management.
- TABLE 5.
Suggested Interventions to Develop Deficient Outcomes in the HR4SCM TOC Working Conditions Pathway and Indicators
Outcome Suggested Intervention Indicator The characteristics of a safe and conducive environment are known. 1.1. Consider policy development and list of required characteristics for safe and conducive environment with all personnel, implementing a checklist for confirmation.
1.2. Develop training materials on establishing safe and clean work environment.
List of required characteristics for a safe and conducive environment is accessible by all personnel (Y/N).
Training materials on establishing a safe and clean work environment exist (Y/N).
The necessary tools and equipment are identified and made available. 1.3. Develop list of required tools and equipment for each level and share list/circular with all staff.
List of necessary tools and equipment for each level is accessible by all (Y/N).
Abbreviation: HR4SCM TOC; Human Resources for Supply Chain Management Theory of Change.
- TABLE 6.
Suggested Interventions to Develop Deficient Outcomes in the HR4SCM TOC Motivation Pathway and Indicators
Outcome Suggested Intervention Indicator SCM workers understand and care about their role in the health care system. 4.1. Improve the staff onboarding and orientation processes, e.g., through a standard operating procedure for orientation. Percentage of staff who feel they understand their role. Supervisors have the skills to communicate feedback on poor performance to staff. 4.2. Develop and implement guidelines or procedures for supervisors on how to communicate feedback on poor performance. Guidelines for supervisors that cover how to give constructive feedback are operational (Y/N). Abbreviations: HR4SCM TOC; Human Resources for Supply Chain Management Theory of Change; SCM, supply chain management.
- TABLE 7.
Foundational Assumption of the HR4SCM TOC and Suggested Interventions and Indicators
Outcome Suggested Intervention Indicator The importance of the SCM is acknowledged throughout the health system and positioned accordingly. 5.1. Develop orientation and on-boarding materials for clinical health staff deployed by MOH that include supply chain system and roles of staff in the SCM system.
5.2. Identify opportunities and communication channels for the organization to communicate to staff how their jobs contribute to the health care system.
Orientation materials for new health system staff include mention of supply chain or SCM roles (Y/N). Abbreviations: HR4SCM TOC; Human Resources for Supply Chain Management Theory of Change; MOH, Ministry of Health; SCM, supply chain management.
Supplemental material
- Supplement 1 -
Supplement 1
- Supplement 2 -
Supplement 2
- Supplement 3 -
Supplement 3
- Supplement 1 -
