TY - JOUR T1 - Multiplicity in public health supply systems: a learning agenda JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 154 LP - 159 DO - 10.9745/GHSP-D-12-00042 VL - 1 IS - 2 AU - Alan Bornbusch AU - James Bates Y1 - 2013/08/01 UR - http://www.ghspjournal.org/content/1/2/154.abstract N2 - Supply chain integration—merging products for health programs into a single supply chain—tends to be the dominant model in health sector reform. However, multiplicity in a supply system may be justified as a risk management strategy that can better ensure product availability, advance specific health program objectives, and increase efficiency. Conventional wisdom in health sector reform tends to favor supply chain integration—merging supply chain functionalities, such as distribution, across different health programs—to improve efficiency and health systems overall. Supply chain research and application in the commercial sector, however, point toward multiplicity in supply systems—that is, structuring a supply system to take advantage of multiple supply chains or supply chain segments to reduce risk and maintain supply. We explore the role that multiplicity has played historically in public health supply systems and consider recent examples where multiplicity has been introduced to reduce risk and improve system performance. The limited, but suggestive, evidence from public health supply systems thus far, combined with recent methodological advances, point to the need and opportunity for further inquiry into the case for multiplicity in public health supply systems in low- and middle-income countries. In Africa, Asia, and Latin America, the “central medical store” (CMS) supply chain model dominates in public-sector health programs—a model that is both administratively and physically centralized. Procurement typically takes place at the national level; most stock enters distribution through a centrally located warehouse in the capital city; and a public-sector entity implements (or at least oversees) distribution. CMSs have long been perceived to be burdened with the inefficiencies and shortcomings widely associated with monopolistic systems, and sometimes are even described as “monopolies.” The term is not inappropriate. In most cases, CMSs have handled a predominate share of supplies distributed within the public sector. More importantly, their roles have often been protected … ER -