Functions for which higher logistic decision space was related to lower performance in both countries
The following section describes the specific measures used to determine the logistic decision space for each function,and the measures of performance that were used for those functions for which higher decision space—that is,more decentralization—was shown to be related to lower performance in both Guatemala and Ghana.
The studies showed that there are some functions in logistics systems for which centralized decisions were related to better performance.In both countries we found that granting higher logistic decision space to local authorities for inventory control and LMIS led to poorer performance in these functions.
Inventory control relates to the logistics functions of product handling and the processes involved in a product's withdrawal or use,as well as to the information for stock management.In health logistics systems,it is recommended that products be managed on a first-to-expire-first-out (FEFO) basis.The FEFO method requires that products that will expire first be removed from inventory for use,as opposed to other inventory management systems that are managed,for instance,on a first-in-first-out (FIFO) basis.This method,in turn,drives the type of record keeping to facilitate management based on these FEFO principles.The record keeping is done on ‘stock cards’,which can be imposed by central decisions or designed locally.The authors focused the logistic decision space questions on the use of guidelines for facilities in Ghana and Guatemala.
In Ghana,although there were explicit guidelines on inventory control,facilities were not consistently required to adhere to the guidelines.The logistic decision space questions investigated how having or not having guidelines influenced behaviour related to inventory control.Some districts and facilities reported that they had received no guidelines and were instead expected to have formulated their own.These districts and facilities were interpreted as having higher logistic decision space.In addition,since the ‘stock cards’ were a key inventory control document provided from the central level as part of guidelines for inventory control,districts and facilities that had chosen not to use them were also assigned a higher logistic decision space.