Global Health: Science and Practice (GHSP)
December 2014 | Volume 2 | Issue 4
http://www.ghspjournal.org/content/current

It’s not Ebola … it’s the systems
Victor K Barbiero
Glob Health Sci Pract 2014;2(4):374-375. First published online October 31, 2014. http://dx.doi.org/10.9745/GHSP-D-14-00186
The 2014 Ebola outbreak in West Africa demonstrates key deficiencies in investment in health systems. Despite some modest investment in health systems, our field has instead largely chosen to pursue shorter-term, vertical efforts to more rapidly address key global health issues such as smallpox, polio, malaria, and HIV/AIDS. While those efforts have yielded substantial benefits, we have paid a price for the lack of investments in general systems strengthening. The Ebola deaths we have seen represent a small portion of deaths from many other causes resulting from weak systems. Major systems strengthening including crucial nonclinical elements will not happen overnight but should proceed in a prioritized, systematic way.

COMMENTARIES
The future of routine immunization in the developing world: challenges and opportunities
Angela K Shen, Rebecca Fields, Mike McQuestion
Glob Health Sci Pract 2014;2(4):381-394. http://dx.doi.org/10.9745/GHSP-D-14-00137
Vaccine costs in the developing world have grown from < US$1/child in 2001 to about $21 for boys and $35 for girls in 2014, as more and costlier vaccines are being introduced into national immunization programs. To address these and other challenges, additional efforts are needed to strengthen 8 critical components of routine immunization: (1) policy, standards, and guidelines; (2) governance, organization, and management; (3) human resources; (4) vaccine, cold chain, and logistics management; (5) service delivery; (6) communication and community partnerships; (7) data generation and use; and (8) sustainable financing.

Strategies to reduce risks in ARV supply chains in the developing world
Chris Larson, Robert Burn, Anja Minnick-Sakal, Meaghan O’Keefe Douglas, Joel Kuritsky
Glob Health Sci Pract 2014;2(4):395-402. http://dx.doi.org/10.9745/GHSP-D-14-00105
Key strategies of the main ARV procurement program for PEPFAR to reduce supply chain risks include: (1) employing pooled procurement to reduce procurement and shipping costs and to accommodate changing country needs by making stock adjustments at the regional level, and (2) establishing regional distribution centers to facilitate faster turnaround of orders within defined catchment areas.

VIEWPOINTS
A stewardship approach to shaping the future of public health supply chain systems
Alan Bornbusch, Todd Dickens, Carolyn Hart, Chris Wright
Glob Health Sci Pract 2014;2(4):403-409. First published online October 29, 2014. http://dx.doi.org/10.9745/GHSP-D-14-00123
Guiding Principles: (1) Governments should see themselves as stewards of supply chains, providing vision, guidance, and oversight, not necessarily as operators of supply chains. (2) Governments should not be afraid to leverage the multiple supply chain actors and diverse options available; these can be woven into a coherent, integrated system, providing flexibility and reducing risk. (3) Governments will need new skills in leadership, regulation, market research, contract design, oversight of outsourced providers, financial analysis, and alliance-building.