data warehouse research articles

A data warehouse, or enterprise data warehouse (EDW), is a system that aggregates data from different sources into a single, central, consistent data store to support data analysis, data mining, artificial intelligence (AI) and machine learning .

A data warehouse system enables an organization to run powerful analytics on large amounts of data (petabytes and petabytes) in ways that a standard database cannot.

Data warehousing systems have been a part of business intelligence (BI) solutions for over three decades, but they have evolved recently with the emergence of new data types and data hosting methods. Traditionally, a data warehouse was hosted on-premises—often on a mainframe computer—and its functionality was focused on extracting data from other sources, cleansing and preparing the data, and loading and maintaining the data in a relational database. More recently, a data warehouse might be hosted on a dedicated appliance or in the cloud, and most data warehouses have added analytics capabilities and data visualization and presentation tools.

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Generally speaking, data warehouses have a three-tier architecture, which consists of a:  

Bottom tier :  The bottom tier consists of a data warehouse server, usually a relational database system, which collects, cleanses, and transforms data from multiple data sources through a process known as Extract, Transform, and Load (ETL) or a process known as Extract, Load, and Transform (ELT). For most organizations that use ETL, the process relies on automation, and is efficient, well-defined, continuous and batch-driven.  

Middle tier :  The middle tier consists of an OLAP (online analytical processing) server which enables fast query speeds. Three types of OLAP models can be used in this tier, which are known as ROLAP, MOLAP and HOLAP. The type of OLAP model used is dependent on the type of database system that exists.  

Top tier :  The top tier is represented by some kind of front-end user interface or reporting tool, which enables end users to conduct ad-hoc data analysis on their business data.

Most data warehouses will be built around a relational database system, either on-premise or in the cloud, where data is both stored and processed. Other components would include a metadata management system and an API connectivity layer enabling the warehouse to pull data from organizational sources and provide access to analytics and visualization tools.

A typical data warehouse has four main components: a central database, ETL tools, metadata and access tools. All of these components are engineered for speed so that you can get results quickly and analyze data on the fly.

The data warehouse has been around for decades. Born in the 1980s, it addressed the need to optimize analytics on data. As companies’ business applications began to grow and generate/store more data, they needed data warehouse systems that could both manage the data and analyze it. At a high level, database admins could pull data from their operational systems and add a schema to it via transformation before loading it into their data warehouse.

As data warehouse architecture evolved and grew in popularity, more people within a company started using it to access data–and the data warehouse made it easy to do so with structured data. This is where metadata became important. Reporting and dashboarding became a key use case, and SQL (structured query language) became the de facto way of interacting with that data.

Let's take a closer look at each component.

When database analysts want to move data from a data source into their data warehouse, this is the process they use. In short, ETL converts data into a usable format so that once it’s in the data warehouse, it can be analyzed/queried/etc. 

Metadata is data about data. Basically, it describes all of the data that’s stored in a system to make it searchable. Some examples of metadata include authors, dates or locations of an article, create date of a file, the size of a file, etc. Think of it like the titles of a column in a spreadsheet. Metadata allows you to organize your data to make it usable, so you can analyze it to create dashboards and reports.

SQL is the de facto standard language for querying your data. This is the language that analysts use to pull out insights from their data stored in the data warehouse. Typically data warehouses have proprietary SQL query processing technologies tightly coupled with the compute. This allows for very high performance when it comes to your analytics. One thing to note, however, is that the cost of a data warehouse can start getting expensive the more data and SQL compute resources you have.

The data layer is the access layer that allows users to actually get to the data. This is typically where you’d find a data mart . This layer partitions segments of your data out depending on who you want to give access to, so you can get very granular across your organization. For instance, you may not want to give your sales team access to your HR team’s data, and vice versa.

This is related to the data layer in that you need to be able to provide fine-grained access and security policies across all your organization’s data. Typically data warehouses have very good data governance and security capabilities built in, so you don’t need to do a lot of custom data engineering work to include this. It’s important to plan for governance and security as you add more data to your warehouse and as your company grows.

While access tools are external to your data warehouse, they can be seen as its business-user friendly front end. This is where you’d find your reporting and visualization tools, used by data analysts and business users to interact with the data, extract insights and create visualizations that the rest of the business can consume. Examples of these tools include Tableau, Looker and Qlik.

OLAP (online analytical processing) is software for performing multidimensional analysis at high speeds on large volumes of data from unified, centralized data store, such as a data warehouse. OLTP (online transactional processing ), enables the real-time execution of large numbers of database transactions by large numbers of people, typically over the internet. The main difference between OLAP and OLTP is in the name: OLAP is analytical in nature, and OLTP is transactional. 

OLAP tools are designed for multidimensional analysis of data in a data warehouse, which contains both historical and transactional data. Common uses of OLAP include data mining and other business intelligence apps, complex analytical calculations, and predictive scenarios, as well as business reporting functions like financial analysis, budgeting, and forecast planning.

OLTP is designed to support transaction-oriented applications by processing recent transactions as quickly and accurately as possible. Common uses of OLTP include ATMs, e-commerce software, credit card payment data processing, online bookings, reservation systems, and record-keeping tools.

For a deep dive into the differences between these approaches, check out " OLAP vs. OLTP: What's the Difference? " 

Schemas are ways in which data is organized within a database or data warehouse. There are two main types of schema structures, the star schema and the snowflake schema, which will impact the design of your data model .

Star schema:  This schema consists of one fact table which can be joined to a number of denormalized dimension tables. It is considered the simplest and most common type of schema, and its users benefit from its faster speeds while querying.

Snowflake schema:  While not as widely adopted, the snowflake schema is another organization structure in data warehouses. In this case, the fact table is connected to a number of normalized dimension tables, and these dimension tables have child tables. Users of a snowflake schema benefit from its low levels of data redundancy, but it comes at a cost to query performance. 

Data warehouse, database, data lake , and data mart are all terms that tend to be used interchangeably. While the terms are similar, important differences exist:

Data warehouse vs. data lake  

Using a data pipeline , a data warehouse gathers raw data from multiple sources into a central repository, structured using predefined schemas designed for data analytics. A data lake is a data warehouse without the predefined schemas. As a result, it enables more types of analytics than a data warehouse. Data lakes are commonly built on big data platforms such as Apache Hadoop.

Data warehouse vs. data mart  

A data mart is a subset of a data warehouse that contains data specific to a particular business line or department. Because they contain a smaller subset of data, data marts enable a department or business line to discover more-focused insights more quickly than possible when working with the broader data warehouse data set.

Data warehouse vs. database  

A database is built primarily for fast queries and transaction processing, not analytics. A database typically serves as the focused data store for a specific application, whereas a data warehouse stores data from any number (or even all) of the applications in your organization.

A database focuses on updating real-time data while a data warehouse has a broader scope, capturing current and historical data for predictive analytics, machine learning, and other advanced types of analysis.

Cloud data warehouse  

A cloud data warehouse is a data warehouse specifically built to run in the cloud, and it is offered to customers as a managed service. Cloud-based data warehouses have grown more popular over the last five to seven years as more companies use cloud computing services and seek to reduce their on-premises  data center  footprint.

With a cloud data warehouse, the physical data warehouse infrastructure is managed by the cloud company, meaning that the customer doesn’t have to make an upfront investment in hardware or software and doesn’t have to manage or maintain the data warehouse solution.

Data warehouse software (on-premises/license)  

A business can purchase a data warehouse license and then deploy a data warehouse on their own on-premises infrastructure. Although this is typically more expensive than a cloud data warehouse service, it might be a better choice for government entities, financial institutions, or other organizations that want more control over their data or need to comply with strict security or data privacy standards or regulations.

Data warehouse appliance  

A data warehouse appliance is a pre-integrated bundle of hardware and software—CPUs, storage, operating system, and data warehouse software—that a business can connect to its  network  and start using as-is. A data warehouse appliance sits somewhere between cloud and on-premises implementations in terms of upfront cost, speed of deployment, ease of scalability, and data management control.

A data warehouse provides a foundation for the following:

• Better data quality:  A data warehouse centralizes data from a variety of data sources, such as transactional systems, operational databases, and flat files. It then cleanses the operational data, eliminates duplicates, and standardizes it to create a single source of the truth.
• Faster, business insights:  Data from disparate sources limit the ability of decision makers to set business strategies with confidence. Data warehouses enable data integration, allowing business users to leverage all of a company’s data into each business decision. Data warehouse data makes it possible to report on themes, trends, aggregations, and other relationships among data collected from an engineering lifecycle management (ELM) app.
• Smarter decision-making:  A data warehouse supports large-scale BI functions such as data mining (finding unseen patterns and relationships in data), artificial intelligence, and machine learning—tools data professionals and business leaders can use to get hard evidence for making smarter decisions in virtually every area of the organization, from business processes to financial management and inventory management.
• Gaining and growing competitive advantage:  All of the above combine to help an organization finding more opportunities in data, more quickly than is possible from disparate data stores.

As companies start housing more data and needing more advanced analytics and a wide range of data, the data warehouse starts to become expensive and not so flexible. If you want to analyze unstructured or semi-structured data, the data warehouse won’t work. We’re seeing more companies moving to the data lakehouse architecture, which helps to address the above. The open data lakehouse allows you to run warehouse workloads on all kinds of data in an open and flexible architecture. This data can also be used by data scientists and engineers who study data to gain business insights. Instead of a tightly coupled system, the data lakehouse is much more flexible and also can manage unstructured and semi-structured data like photos, videos, IoT data and more.

The data lakehouse can also support your data science, ML and AI workloads in addition to your reporting and dashboarding workloads. If you are looking to upgrade from data warehouse architecture, then developing an open data lakehouse is the way to go.

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Please note you do not have access to teaching notes, an empirical study on data warehouse systems effectiveness: the case of jordanian banks in the business intelligence era.

EuroMed Journal of Business

ISSN : 1450-2194

Article publication date: 12 May 2022

Issue publication date: 23 October 2023

Despite the increasing role of the data warehouse as a supportive decision-making tool in today's business world, academic research for measuring its effectiveness has been lacking. This paucity of academic interest stimulated us to evaluate data warehousing effectiveness in the organizational context of Jordanian banks.

Design/methodology/approach

This paper develops a theoretical model specific to the data warehouse system domain that builds on the DeLone and McLean model. The model is empirically tested by means of structural equation modelling applying the partial least squares approach and using data collected in a survey questionnaire from 127 respondents at Jordanian banks.

Empirical data analysis supported that data quality, system quality, user satisfaction, individual benefits and organizational benefits have made strong contributions to data warehousing effectiveness in our organizational data context.

Practical implications

The results provide a better understanding of the data warehouse effectiveness and its importance in enabling the Jordanian banks to be competitive.

Originality/value

This study is indeed one of the first empirical attempts to measure data warehouse system effectiveness and the first of its kind in an emerging country such as Jordan.

• Data warehouse system
• DeLone and McLean model
• Business intelligence
• Structural equation modelling

Al-Okaily, A. , Al-Okaily, M. , Teoh, A.P. and Al-Debei, M.M. (2023), "An empirical study on data warehouse systems effectiveness: the case of Jordanian banks in the business intelligence era", EuroMed Journal of Business , Vol. 18 No. 4, pp. 489-510. https://doi.org/10.1108/EMJB-01-2022-0011

Emerald Publishing Limited

Copyright © 2022, Emerald Publishing Limited

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Original research article, assessment of veterinary pharmaceutical warehouse management practices and its associated challenges in four selected zones and bahir dar city of amhara regional state, ethiopia.

• 1 Department of Veterinary Pharmacy, Pharmaceutical Supply Chain Management, University of Gondar, Gondar, Ethiopia
• 2 Department of Logistic and Supply Chain Management, University of Gondar, Gondar, Ethiopia
• 3 Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethio
• 4 Department of Veterinary Pharmacy, Pharmaceutical Quality Assurance and Regulatory Affairs, University of Gondar, Gondar, Ethiopia

A pharmaceutical warehouse is part of the pharmaceutical supply chain and is essential to maintaining the quality and efficacy of veterinary pharmaceuticals for successful animal health service delivery. However, poor storage conditions, improper handling, and inappropriate use and disposal constitute challenges for veterinary supplies in animal health services. Therefore, this study aimed to assess the existing practices and challenges in warehouse management in government veterinary clinics and private veterinary drug wholesalers in Ethiopia. A cross-sectional study was conducted on 37 veterinary health facilities in four selected zones (south Gondar, west Gondar, central Gondar, and west Gojam zones) and Bahir Dar administrative city. Zones were selected using a simple random sampling technique. Data was collected using a structured questionnaire, pre-defined and tested observational checklists, and semi-structured interview guides. Descriptive statistics were used to analyze the quantitative data, while qualitative data was analyzed using a thematic approach. The study revealed the presence of poor stock management practices, such as the absence of standard operating procedures for warehouse activities in ~59.5% of facilities surveyed. In none of the surveyed facilities, bin cards and system software utilization were satisfactory. The absence of disposal guidelines was detected in 83.8% of the facilities, and the practice of timely disposal of expired drugs was not satisfactory. Compared to the government veterinary clinics, private veterinary drug wholesalers had better storage practices (86.25%) following theoretical recommendations. The storage conditions in government clinics were rated poor at 48.3% (>80%, which is the limit to the acceptable rate for good storage conditions). The challenges of inadequate infrastructure, a lack of qualified staff, problems with the availability and affordability of pharmaceutical products, insufficient regulatory practice, and budget constraints were identified. A holistic approach involving related stakeholders should be followed to improve the existing challenges and the sector's efficiency.

Introduction

In Africa, livestock plays a significant role in economic growth, and Ethiopia has the biggest livestock population on the continent ( 1 ). However, Ethiopia's livestock productivity is lower compared to the country's livestock population ( 2 , 3 ). The improper handling, inappropriate use, and poor disposal practices of veterinary pharmaceuticals are global issues that reduce livestock productivity and affect successful animal health services ( 4 – 7 ).

Veterinary pharmaceuticals are the foundation of animal disease diagnosis, treatment, prevention, and control, while the quality, safety, and efficacy of pharmaceuticals in a supply chain significantly depend on warehouse management ( 8 , 9 ). A warehouse is a functional and organizational structure designed for storing tangible products (stocks) in a dedicated area using proven technology, managed by a group of people, and furnished with the necessary technical tools. Warehouse management (WM) is part of a logistics system that comprises accepting, storing, issuing, recording, and tracking information flow throughout the process. In pharmaceutical supply chain management (SCM), strategic warehouse operations are the foundation of a service's success ( 10 , 11 ).

Good veterinary supplies management practices play a pivotal role in maintaining the quality of drugs and ensuring the delivery of successful animal health services. They also reduce non-conformities, promote efficient labor allocation, and reduce average operation time. Studies indicate that effective WM practices can save 15.7% of space across manufacturing and healthcare organizations and account for 2% to 5% of the cost of sales ( 12 , 13 ). On the other hand, improper handling of veterinary drugs impedes the quality of animal health services; it is also a leading cause of the risk of antimicrobial resistance (AMR) in humans ( 14 ).

According to the European Medicine Association (EMA), to achieve good veterinary drug management practices and reduce the wastage of veterinary supplies (VS) at any veterinary service delivery point (SDP), proper installation of warehouse and storage facilities, trained and qualified professionals, and standardized written manuals, policies, and guidelines are necessary components that must be fulfilled ( 15 ). In high-income nations, systems have been established to evaluate and track the quality of veterinary pharmaceuticals (VPs) available in the market and at SDP. However, most low- and middle-income nations find it difficult to monitor the use of veterinary drugs in livestock ( 4 ).

In most African countries, the poor advancement of animal healthcare is due to the influx of poor-quality drugs and complex drug distribution chains that involve many actors (both formal and informal) ( 4 , 16 , 17 ). According to a study conducted in Sub-Saharan Africa, the weak distribution of infrastructure and services and the multiplication of non-professional actors in the veterinary drug chains are the major constraints for farmers to access good-quality drugs ( 18 ). Another study conducted in Dares Salaam, Tanzania, revealed that poor record-keeping and the lack of guidelines on the appropriate disposal of veterinary medicines are the factors that affect drug handling and management ( 19 ). A study conducted in Nigeria showed that Africa had lost USD 4 billion due to preventable livestock diseases ( 4 ).

Until the French Veterinary Mission started offering modern veterinary services in 1908, Ethiopia's veterinary healthcare services were managed traditionally ( 20 ). However, currently, the government provides considerable veterinary healthcare services through clinics in every district and kebele (Ethiopia's fourth administrative level, following regions, zones, and districts). Veterinary clinics, designated to deliver veterinary healthcare services, veterinary pharmacy importers, wholesalers, and retail outlets, the majority of which are franchise veterinary drug businesses, professionally distribute veterinary pharmaceuticals throughout the country ( 2 ). Due to the interdependence and dependence among the activities in the veterinary pharmaceutical supply chain, a failure in one activity will have a detrimental impact on subsequent actions. For the provision of high-quality, sustainable animal health services, various service delivery institutions, such as veterinary drug importers, wholesalers, retailers, governmental animal health service providers (AHSP), animal health administrators, research and educational institutions, policymakers, legal affairs, and livestock owners, must all work together in the veterinary drug supply chain ( 20 – 22 ).

Literature indicates that the livestock sub-sector in Ethiopia is vulnerable to several veterinary pharmaceutical supply chain issues, including poor drug handling during purchase, irrational use of drugs, illegal marketing, poor-quality medicines, a lack of waste management practices, low rates of adherence to rules and policies, a lack of qualified public and private animal health services, and a lack of qualified and trained staff ( 5 , 6 , 21 , 23 , 24 ). Another study conducted in Ethiopia on the quality of veterinary drugs during post-marketing surveillance, re-registration, consignment checking, and pre-registration indicated that 8.2% of the examined veterinary medication samples were labeled as being of poor quality, and ~12 (1.3%) of the examined products had flaws in their appearance, packaging, or labeling ( 25 ). Veterinary drugs and biological products produced, imported, distributed, and used in the country are not effectively regulated and managed in terms of quality, safety, and efficacy ( 2 , 22 ).

Currently, due to the prevalence of animal diseases, VPs are widely used. However, in Africa, including Ethiopia, the VP sector, especially veterinary supplies warehouse management practices, is a neglected research area, except for some fragmented studies that show the presence of poor handling of veterinary drugs ( 4 , 5 , 24 ). Besides, the researcher had the opportunity to visit a few veterinary drug warehouses and noticed and understood that warehouse management practices lacked attention even though the products were expensive, unique, and dealt with animal life.

Implementing good veterinary supplies, particularly through WM, in the context of veterinary health facilities served as inspiration for addressing such types of issues and maintaining the overall veterinary pharmaceutical supply chain operations, which are crucial to improving veterinary healthcare services through the provision of quality VPs. Hence, the current study was conducted to assess the veterinary supplies warehouse management practices in relation to stock management, storage conditions, warehousing activities (receiving, storing, and issuing), human and material resources, and identifying the challenges encountered linked to the fundamental veterinary supplies warehouse operations at government district veterinary clinics and private veterinary drug wholesalers in four selected zones and Bahir Dar city of the Amhara region, Ethiopia.

Methods and materials

Study area and period.

The study was conducted in four selected zones and Bahir Dar administrative city in the Amhara region of Ethiopia from April 1, 2022, to January 15, 2023. The Amhara region is located in the north-western part of Addis Ababa, the capital city of Ethiopia. The study area covers the northern and western parts of the region. Administratively, there are 12 zones in the Amhara region. For this study, Bahir Dar City (the capital city of the Amhara region) was purposefully selected because most veterinary drug wholesalers are located in Bahir Dar City. The four zones, namely south Gondar, central Gondar, west Gondar, and west Gojam zones were selected based on the inclusion criteria of political stability and security concern at the time of data collection and veterinary health services coverage. In the study area, according to the 2022 report acquired from the Veterinary Drug and Feed Administration Control Authority (VDFACA) of the Amhara regional branch and the Amhara regional state livestock and fisheries resource development office, there are 66 facilities (14 private veterinary drug wholesalers and 52 government district veterinary clinics) serving to care for over 23 million livestock. Most veterinary drug wholesalers are found in the region's capital city, while others are scattered at the zonal level, and government veterinary clinics are at the district/woreda level.

Study design

A facility-based descriptive cross-sectional study design complemented by qualitative research approaches was conducted. The study mostly used a quantitative approach to produce numerical data, whereas a qualitative approach was used to explore the challenges faced in the catchment area and strengthen the quantitative data. The survey was done at veterinary health facilities using self-administered questionnaires, observational checklists, and face-to-face interviews with key informants (KI).

Source and study population

Source population.

The source population included all government veterinary clinics, all private veterinary drug wholesalers, all veterinary health professionals working with veterinary drugs in the warehouse and storage areas, and those who had a position related to pharmaceutical supply chain management in the four specified zones and Bahir Dar administrative city of Amhara regional state, Ethiopia.

Study population

Selected district government veterinary clinics and private veterinary drug wholesalers in the selected four zones and Bahir Dar city of the Amhara region were assessed to collect the necessary data. The government district veterinary clinic's veterinary drug and input supply officer, veterinary drug store personnel and veterinary drug dispenser, veterinary drug wholesale owners, wholesaler technical managers, wholesaler assistant storekeepers, district livestock and fishery resource development heads, and animal health department coordinators were all contacted and invited to participate in this study.

Inclusion and exclusion criteria

District veterinary clinics, veterinary drug wholesalers, and employees working with veterinary drugs and had positions related to veterinary drug handling and management practices for at least the last 6 months during data collection participated in the study. Zones that suffered from political instability and security concerns during data collection were excluded. Government animal health posts located at the kebele level, private veterinary clinics, and private retail outlets were also excluded as they did not have a permit to hold veterinary pharmaceutical stock.

Sample size determination and sampling techniques

Sample size determination.

The formula developed by Cochran in 1963 for calculating sample sizes when the proportion is the parameter of research was applied, and a 90% confidence level with a 10% margin of error was used. Using this formula and assuming a 10% non-respondent rate, 37 health facilities were selected as a study sample from a refined population of 66 facilities (government district veterinary clinics and private veterinary drug wholesalers) in the study area. The quantitative and qualitative data were obtained from 29 government district veterinary clinics and eight private veterinary drug wholesalers ( Supplementary material 1 ).

The general formula was calculated using Equation (1) :

Where, no is the sample size required, Z is the Z value (1.64 for a 90% confidence level), and p is the estimated prevalence of the indicator. The product of [p] and [q] is maximized when p = 0.5. Therefore, when the prevalence is unknown, 0.5 should be used, and e2 = the 10% margin of error used in estimating the prevalence, e2 = 0.1. However, the sample size (n 0 ) was adjusted to n: This adjustment can substantially reduce the necessary sample size for small populations and is also called the population correction factor ( 26 ) ( Equation 2 ):

Where, n = the adjusted new sample size; N = the population size; n 0 = the sample size obtained from the general formula.

n = 33.5–34 facilities, with a 10% non-response rate, 37 facilities.

Accordingly, 37 veterinary health facilities were selected proportionally from the four zones and Bahir Dar city, and 75 participants working in the selected veterinary health facilities participated. The selection was purposefully made based on their direct involvement in pharmaceutical warehouse management activities and their position in the facilities. Practically, during data collection, some facilities did not have veterinary drug and input supply employees, others did not have drug store and control employees, and a few others did not have a drug dispenser. Due to the small size of the target population in the selected facilities, all 75 professionals participated in this study. Key informants for qualitative data collection were determined based on the viewpoints of different researchers and the principle of data saturation ( 27 , 28 ). The KIs were selected from the 37 veterinary health facilities. Their positions, being decision-makers and having information on the issues of veterinary supply warehouse management practices, were considered during the selection of KIs. Accordingly, the districts' livestock and fishery resource development heads, animal health department coordinators, private veterinary drug wholesale owners, and veterinary drug wholesaler technical managers working from the selected facilities were invited.

Sampling techniques

In the Amhara region, there are 12 zones, so it was difficult to address all district veterinary clinics and private veterinary drug wholesalers in these zones. Therefore, for general representation of the study site, the four zones and Bahir Dar administrative city were selected based on the inclusion criteria and because of their high density of veterinary health facilities and service coverage. Veterinary clinics and drug wholesalers in the four zones and Bahir Dar city were completely enumerated and listed. Then, the health facilities were stratified according to the types of facilities, such as government district veterinary clinics or private veterinary drug wholesalers. Finally, the number of veterinary health facilities included in the sample from each stratum was determined using a proportional size allocation technique ( 28 ). The study was conducted at 37 facilities, of which 29 were government district veterinary clinics, and eight were private veterinary drug wholesalers, selected by a simple random sampling technique ( Supplementary material 2 ).

Regarding study participants, district veterinary clinic drug store personnel, district veterinary clinic drug store manager, district veterinary drug input and supply officer (from the selected government district veterinary clinics), wholesaler veterinary drug assistant storekeeper, and wholesaler veterinary drug technical manager (from private veterinary health facilities) were invited to fill out the self-administered structured questionnaire. For key informants, the district livestock and fishery resource development heads, animal health department coordinators, private veterinary drug wholesale owners, and veterinary drug wholesaler technical managers (from the selected private veterinary health facilities) were invited to participate in the interview. The selection of the KI was based on their position as decision-makers and because they are familiar with pharmaceutical supply chain information and related activities. Moreover, they also have information about the challenges and related factors in the veterinary supplies warehouse management practice.

Data collection tools and procedures

To collect the primary data, structured self-administered five-level Likert scale questionnaires [that were rated from strongly disagree to strongly agree where 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, and 5 = strongly agree], observational checklists, and a semi-structured interview guide [adopted from standard criteria from the Logistic Indicator Assessment Tool (LIAT) developed by the USAID Deliver Project and data collection tools] from various related articles were referred for adoption and customized to the local context ( 11 , 24 , 29 – 31 ).

Two veterinary pharmacists and the principal investigators were allocated and participated as data collectors for quantitative and qualitative data. Quantitative data used to assess veterinary pharmaceutical stock management-related practices was collected using structured, self-administered questionnaires. The five-level Likert scale questionnaires were used to assess warehousing activities and human and material resource management practices at the selected facilities, and 75 participants filled out the questionnaire. The veterinary supplies storage conditions of the facilities were evaluated using checklists through direct physical observation ( Supplementary material 3 ), and a semi-structured, open-ended interview guide was used to collect the qualitative data through face-to-face interviews.

The district veterinary clinics veterinary drug and input supply officer, veterinary drug store and control personnel, drug dispensers, veterinary drug wholesalers technical managers, and assistant storekeepers from the sampled facilities participated in filling out the self-administered questionnaire. The qualitative data was collected through face-to-face interviews with KIs using the prepared interview guide. Interviews were conducted with district livestock and fishery resource development heads, district animal health department coordinators, private veterinary drug wholesaler owners, and wholesaler technical managers. Interview guides were prepared in English and then translated into Amharic, the working and local language in the study area. The principal investigator interviewed the KIs in depth for an average of 30 min. Notes were taken, and KI responses were also audio-taped.

Data quality assurance

The study questionnaire and interview guide were derived from a standard tool and developed after reviewing previously studied related research ( 11 , 24 , 30 ). To maintain the quality of the data and to encourage the meaningful participation of the respondents, the layout of the questionnaires was kept clear and very simple. Prior to data collection, the principal investigator provided training to data collectors on data collection procedures and the significance of the study. Before being entered into the Statistical Packages for Social Science (SPSS) and MS Excel, the collected data was carefully checked for accuracy, cleaned for completeness, consistency, omissions, and irregularities., Every day, during data collection, the misunderstood questions were elaborated accordingly. To ensure the reliability of self-administered questionnaires and the respondent's understanding of the questions, the questionnaire was pretested with 5% of the total sample size of the study, which is not included in the study area.

A scale reliability test was conducted for Likert scale items and reliability analysis; Cronbach's alpha was calculated using SPSS version 26. If the Cronbach's alpha coefficient is close to 1.0, then there is greater internal consistency in the items, and a value >0.700 is considered very acceptable for SCM activities (72). For this study, the value of Cronbach's alpha ( Table 1 ) for the Likert scale questionnaire is >0.70.

Table 1 . Summary of the reliability analysis test.

For qualitative data, the probing and flexible questions and interview guide were initially prepared in English and then translated into Amharic by the principal investigator after consulting with people with good command of the two languages. Data collection was undertaken by the researcher, and the interviews were transcribed each day after the interview. Missing ideas and any need for clarification were addressed throughout the process. For data consistency and completeness, all Amharic transcripts were cross-checked with the oral discourse. After repeated reading of the filled-out notes and careful listening to the audio records, coding, and recoding of the contents were done with peer review. The principal investigator also used the reflexivity method to improve the quality of data collection, which enabled better probing, fewer assumptions, the avoidance of premature interpretation, and an accentuated sense of curiosity during the interview ( 32 ).

Data analysis and interpretation

The collected primary data was used to show the magnitude of stock management, storage conditions of the facilities, warehousing activities of the facilities using the target variables (receiving, storing, and issuing), and human and material resource management practices at a facility level. The quantitative data was coded and entered into SPSS version 26 and Microsoft Excel 2010 for analysis. Descriptive statistics (frequency, percentage, mean, and standard deviations) were computed, and summary results were presented using tables, graphs, and charts. The qualitative data obtained from the in-depth interview was analyzed and summarized using a thematic approach ( 33 ). The grand mean and standard deviation (SD) were used to interpret the Likert scale data gathered to assess the warehousing activities of the target variables (receiving, storing, and issuing) and the human and material resource management practices at a facility level. Each warehousing activity (receiving, storing, and issuing) was assessed using four items, and human and material resource management practices were assessed using seven items. The grand mean and SD of the target variables were computed from the respective items ( Table 7 ). The interval range of the 5-likert scale ( Table 2 ) was calculated according to the principle of the grouped data frequency distribution formula ( 34 ). The mean of their response scores for each variable represented their level of satisfaction with pharmaceutical warehousing activities and human and material resource management practices, whereas the SD represented their deviation from the central value ( 35 , 36 ).

Table 2 . The interval range of Likert scale questionnaires used for this study.

The results of the computed mean were then leveled as “strongly disagreeing” if a variable with a mean score fell in the interval of 1–1.8, “disagreeing” if the score fell in the interval of 1.81–2.60, “neutral” if the score fell in the interval of 2.61–3.4, “agreeing” if the score fell in the interval of 3.41–4.2, and “strongly agreeing” if the score fell in the interval of 4.21–5. An SD of > 0.9 implies a significant difference in the target variable among respondents ( 37 , 38 ).

To interpret the results of the mean and SD easily and clearly, the scales were reassigned as follows, and the verbal interpretation was made based on the recommendations of previous researchers ( 37 – 39 ) ( Table 3 ).

Table 3 . Verbal interpretation of the scale.

The percentage of storage conditions was calculated as the average number of “yes” responses in the checklist and the number of standard storage conditions in the checklist ( 40 ) using Equation (3) .

The management of storage conditions associated with veterinary pharmaceutical products was also classified as “poor” and “good” store management. The interpretation was made based on the recommendation from previous research and the principles of pharmaceutical warehouse operations management of the Ethiopian Pharmaceutical Fund Supply Agency (PFSA), now known as the Ethiopian Pharmaceutical Supply Services (EPSS), published in 2015 ( 11 ). Based on this, pharmaceutical warehouses or facilities that fulfilled at least 80% of the criteria for good storage conditions were considered acceptable and have good storage conditions, whereas those that fulfilled <80% were considered poor storage conditions ( 40 ).

For the qualitative data, the principal investigator performed face-to-face, in-depth interviews to explore the challenges faced in veterinary pharmaceutical warehouse management practices. The investigator transcribed the audio recordings of in-depth interviews and discussions verbatim. Textual notes and audio-recorded data were repeatedly read and listened to. Audio recordings and notes were translated into English. The thematic analysis technique was used to analyze the data collected from the KIs as per the approach and steps recommended by Braun and Clarke ( 41 ). By doing so, the investigator became familiar with the textual notes and audio recordings and began taking notes accordingly. Then, the data was coded and written up using MS Word. The coded data was organized to search for themes and subthemes. After that, similar subthemes were grouped, named, and described thematically. Thematic contents were formulated, and a master list of themes was developed based on the research questions and conceptual framework. Finally, the report was produced using an exploratory approach and triangulated with the quantitative result.

The background information of veterinary health facilities and respondents' profile

To assess pharmaceutical warehouse management practices and their challenges, 37 veterinary health facilities−29 (78.4%) district veterinary clinics and 8 (21.6%) private veterinary drug wholesalers—were invited. All 37 facilities participated with a 100% response rate. Among the respondents, the majority (27; 36%) were district veterinary clinic drug store personnel, and 6 (8%) were veterinary drug wholesaler technical managers ( Figure 1 ).

Figure 1 . Professional designations of the respondents from district government veterinary clinics and private veterinary drug wholesalers.

The majority of respondents (35; 46.7%) were qualified in advanced animal health, and 4 (5.3%) had veterinary pharmacy professional qualifications ( Figure 2 ). Furthermore, 36 (48%) of the respondents held degrees, 35 (46.7%) held diplomas, and 4 (5.3%) had obtained MSc level of education. In terms of work experience, 42 (56%) had 3–6 years, 18 (24%) had >7 years, and 15 (20%) had 0–2 years of experience.

Figure 2 . Professional qualifications of the respondents. AH, Animal health; BVSC, Bachelor of Veterinary Science; Vet, Veterinary; DVM, Doctor of Veterinary Medicine.

Advanced animal health: animal health professionals who took advanced animal health qualification courses at the college level for 3 years and were certified.

Bachelor of Veterinary Science: Veterinary professionals who took animal health qualification courses at the university level for 3 years and were certified.

Veterinary Pharmacy: Professionals who have been certified by taking full veterinary pharmacy qualification courses for 4 years at the university level.

Doctor of Veterinary Medicine: a veterinary professional who took animal health qualification courses at the university level for 6 years and was certified.

Assessment of veterinary drug warehouse management practices of the facilities

Veterinary pharmaceutical stock management-related practices of the facility.

All the facilities managed both veterinary drugs (medicines) and other equipment and supplies used in veterinary healthcare services. The majority of the facilities (26; 70.3%) used mixed-type drug arrangement methods, while 8 (21.6%) used pharmacological drug arrangement methods. Bin cards and system software/electronic data interchange technology were not used in any of the surveyed facilities. Of the surveyed facilities, in 23 (62.2%), pharmaceutical information was handled manually or on paper, and 4 (10.8%) utilized mixed-based information handling methods. More than half of the facilities (59.5%) also reported that they did not have a written manual or standard operating procedure (SOP) to manage warehouse practices. The majority of facilities did not dispose of expired products on time (32; 86.5%) and did not have documented policies and guidelines (31; 83.8%) for the management of veterinary drug waste ( Table 4 ).

Table 4 . Summary of stock management practices at the facility.

Assessment of storage conditions by facility type

Storage conditions of district government veterinary clinics.

The storage areas of 29 governmental veterinary clinics were assessed through physical observation using 20 criteria. The study found that the majority (27; 93.1%) of the facilities were protected from direct sunlight−19 (65.5%) stores had separate storage and dispensing areas. However, none of the stores had fire safety equipment or wall thermometers. Only 14 (48.3%) facilities had separate storage areas for expired and damaged products and a very limited number of stores (20.7%) had pallets and shelves. In only a few stores were products stacked at least 20 cm away from the walls (17.2%), 10 cm off the floor (10.3%), and on racks over 2.5 m in length (17.2%). Overall, the average performance of district government veterinary clinics that met the criteria for acceptable storage conditions was 48.3% ( Supplementary material 4 ).

Of the 29 surveyed government district veterinary health clinics, no facility met the criteria for good storage conditions, and seven had a storage condition performance of 25% or below ( Figure 3 ).

Figure 3 . Performance of storage conditions at government district veterinary clinics.

Storage conditions in private veterinary drug wholesalers

The stores of 8 private veterinary drug wholesalers were assessed through physical observation using 20 criteria. The study found that products were protected from direct sunlight in all stores. In all the stores visited, palettes and shelves were accessible, and dispensing and storage areas were separated. The majority (75%) of the facilities had separate storage rooms for damaged and expired goods, and during the physical inspection, all stores looked free from harmful insects and rodents. Only four facilities (50%) had separate and specialized storage areas for flammable products and chemicals. Products were stacked at least 20 cm away from walls, 10 cm from the floor, and on racks that were 2.5 m in length in the majority of stores (87.5%) inspected. Overall, the average performance of private veterinary drug wholesalers that complied with the acceptable storage criteria was 86.25% ( Supplementary material 5 ). Of the eight private drug wholesalers surveyed, six met the criteria for good storage conditions with an average percentage >80% ( Figure 4 ).

Figure 4 . Performance of storage conditions at private veterinary drug wholesalers.

The overall adherence to storage conditions in the district government veterinary clinics and private veterinary drug wholesalers was, on average, 48.3 and 86.25%, respectively ( Figure 5 ).

Figure 5 . Average adherence to acceptable storage conditions by facility type.

Assessment of veterinary pharmaceutical warehousing activities

The warehousing activities (receiving, storing, and issuing) of the surveyed facilities were analyzed using descriptive statistics, and the grand mean and standard deviation of the target variables were computed ( Table 5 ).

Table 5 . The grand mean and standard deviation of the target variables.

Receiving activities

The majority of respondents had a “neutral” response to their facility's pharmaceutical receiving activities, with a mean value of 3.31 and an SD of 0.64. The individual response for each item in the receiving activities is shown in Table 6 .

Table 6 . Respondent's perception of each item in the receiving activities of the facility.

Storing activities

The majority of respondents were found to “disagree” with their facility's pharmaceutical storing activities, with a mean value of 2.53 and an SD of 0.89. The individual response to each item in the storing activities is shown in Table 7 .

Table 7 . Respondent's perception of each item in the storing activities of the facility.

Issuing activity

The study found that the majority of respondents agreed on their facility's pharmaceutical issuing activities, with a mean value of 4.07 and an SD of 0.44. The individual response to each item in the issuing activities is shown in Table 8 .

Table 8 . Respondent's perception of each item in the issuing activities of the facility.

Assessment of human and materials resource management practices of the facilities

The current study found that the majority of respondents “disagreed” with the facilities' human and material resource management practices, with a mean value of 2.40 and an SD of 0.61 ( Supplementary material 6 ). The socio-demographic data collected for this study indicated that the majority (71; 94.7%) of employees had non-veterinary pharmacy professional qualifications, and only 4 (5.3%) were veterinary pharmacy professionals ( Figure 2 ). The study also found that 43 (57.3%) participants had not received or participated in any on-the-job training sessions ( Table 9 ).

Table 9 . Summary of training history of respondents.

When the respondents were asked about training, all of them indicated their desire to take training in the future, and they pointed out the types of training they required ( Figure 6 ).

Figure 6 . Training desirability among respondents.

Results of qualitative data

In this study, qualitative data was collected using a face-to-face interview to identify and explore the challenges faced by government district veterinary clinics and private veterinary drug wholesalers in managing their veterinary supplies warehouses.

Socio-demographic characteristics of key informants

A total of 14 KIs were interviewed for this study. The majority of them (5; 35.7%) were District Livestock and Fishery Resource Development heads, 4 (28.6%) were Animal Health Department coordinators, and the remaining were from private veterinary drug wholesalers ( Figure 7 ). Concerning their educational qualifications, 5 (35.7%) had a doctorate in Veterinary Medicine, 5 (35.7%) had a bachelor's degree in Veterinary Science, 2 (21.4%) had a diploma in Advanced Animal Health, and 2 (21.4%) had a degree in Veterinary Pharmacy.

Figure 7 . Socio-demographic characteristics of key informants. DLFRD, District Livestock and Fishery Resource Development; AH dept, Animal Health Department; Vet, veterinary.

The assessment of the challenges linked to the veterinary pharmaceutical warehouse management practices

As perceived by the KIs, the surveyed facilities face enormous challenges related to veterinary pharmaceutical warehouse management practices. Based on the characteristics of the data, the challenges were divided into three major thematic areas. These were infrastructure challenges, human and material resource challenges, and challenges related to the sale and purchase of veterinary drugs.

Theme one: challenges associated with infrastructure

This theme focuses on challenges raised regarding the warehouse and storage areas of veterinary pharmaceutical products. Key informants reported that the lack of adequate storage space is a challenge in almost all facilities. Most KIs mentioned that “the layout of our pharmaceutical warehouse is not designed based on the standard of drug storage and lacks storage space to accommodate all the stock appropriately” (heads, District Livestock and Fishery Resource Development and coordinators, Animal Health Department).

This statement was supported by one other KI who said:

The main challenge in our district is the inadequacy of drug storerooms. As you have seen, our drugstore is very narrow and old, and we do not have enough pallets and shelves. Our drug store is not free from leakage of water, dust, or direct sunlight. We have no warehouse built for this purpose. To store drugs, we assign empty buildings or offices. It is not as per the standards (Coordinator, District Animal Health, BVSc, 3 years of experience).

Another KI stated:

Due to a shortage of adequate storage space, we are forced to store different products, like flammable chemicals, laboratory reagents, expired products, and even non-functional equipment, together with unexpired pharmaceutical products, in the same storage area. This makes it impossible to track the product accurately. But we have no option (Head, District Livestock And Fishery Resource Development, MSc, 5 years of experience).

One more KI emphasized:

The drug storage area is our major challenge. During a meeting at the district and regional level, I wrote a letter and forwarded questions to district leaders and to other higher governmental bodies. But still, this problem is not solved. This is due to budget constraints and the lack of awareness and attention of district leaders and other higher governmental bodies in this sector. Some even think that veterinary drugs do not need special warehouses and storage areas because they consider veterinary drugs to be like other materials (Head, District Livestock And Fishery Resource Development, DVM, 3 years of experience).

On infrastructure, almost all respondents from the private drug wholesalers emphasized that issues related to building rent are their major challenges. “There is a time-to-time rent cost increment, and it isn't easy to search for standard buildings that fit with the directives of VDFACA. So, it creates a big challenge for our business” (Owners and Technical Managers, Private Wholesalers).

Theme two: challenges associated with human and material resources

Human resource.

Most key informants mentioned that the shortage of qualified staff to perform activities like drug storage, issuing, and dispensing is a challenge. A KI remarked, “In our woreda, most of the district clinic drug stores and dispensers are run by non-pharmacy professionals.” One KI stated:

This is the only district clinic in this woreda, and we have 37 clinics at the kebele level. Conversely, we have only one district drug store control person. He performs many activities. He works as an accountant by giving receipts to customers. At the same time, he dispenses drugs. He also works as a drug store employee, issuing drugs to professionals coming from each kebele. There is a high workload among the available professionals. There was no compensation for work overload, and there were no educational opportunities. So, how can we be effective in drug handling and management? (District livestock and fishery resource development heads and animal health department coordinators, Coordinator, Animal Health Department, BVSc, 7 years of experience).

This KI also confirmed that “there is no job description used for district drug dispensary and drug store personnel.”

Training related challenges

All KI interviewed from district clinics mentioned that their main challenge in pharmaceutical warehouse management was the lack of equipment and materials such as fire extinguishers, ventilation, wall thermometers, computers, cold chain materials/ice boxes, and vehicles used for drug transportation (heads, District Livestock and Fishery Resource Development and coordinators, Animal Health Department).

This statement was emphasized by another KI:

Our district is grouped under the desert area, so the drug store needs ventilation and a wall thermometer to control the temperature daily, but as you see, our wall thermometer and the ventilation have not been functional for the last 2 months. Non-functional equipment is not timely renewed (Coordinator, District Animal Health Department, DVM, 5 years of experience).

Yet another KI added:

We have no vehicle for transporting drugs from our supplier and distributing drugs to our kebele clinics. Drugs are transported in public vehicles like Bajaj, motorcycles, or even by human carriage. This exposes drugs to external factors like direct sunlight, which reduces the quality of the drug (Head, District Livestock and Fishery Resource Development, BVSc, 9 years of experience).

All the KI mentioned that they need system software and standardized manuals. One KI admitted that these manuals “facilitate our warehousing activities, but still no one uses them.” Another KI added, “our activities are not electronic. This is due to budget constraints and a lack of computers. Our staff is not also trained in this regard.” (heads, District Livestock and Fishery Resource Development and coordinators, Animal Health Department).

Theme three: challenges associated with the sale or purchase of veterinary drugs

KIs were interviewed about the challenges faced in the sale and purchase of pharmaceuticals, and all highlighted that availability, affordability, financial resources, and regulatory-related challenges were their major issues.

Availability and affordability of veterinary drugs

According to the KIs, the availability and ability to obtain essential veterinary drugs at an affordable cost are their biggest challenges. In particular, the KIs from drug wholesalers indicated that there was an inadequate supply of veterinary drugs. For instance, one KI said, “Importers are not able to supply the drugs needed by our customers. Even now, it is difficult to afford the drugs available on the market. The lack of availability of essential veterinary drugs is our major challenge in our commercial endeavors.” Another KI added: “As an example, when we see pen-strep, it has not been available on the market for the last 2 months, and its cost has increased from 170 to 650 ETB per vial” (Technical Manager and Owner, Veterinary pharmaceutical warehouse, 2 years of experience).

All the KIs from the district clinics also emphasized this statement by saying that:

Drug availability is our major challenge. We have had no pen-strep for the last 4 months. This is very essential for treating the majority of animal diseases. The Amhara region veterinary drug and input supply agency is the main supplier for all districts in the region, but the agency cannot supply as per our requisition.

One KI strongly highlighted,

We frequently face a shortage of animal drugs. We do not get some items on the market because of the current shortage of hard currency in our country, and due to this, it is difficult to deliver full services to the community (heads, District Livestock and Fishery Resource Development and coordinators, Animal Health Department).

Regulatory-related challenges

Most KIs from district clinics mentioned that “government regulatory bodies like VDFACA and other regional and zonal agricultural and livestock offices do not support us in the fulfillment of pharmaceutical warehouses except for some irregular training they deliver.” Another KI added by saying, “We expect more from VDFACA in addition to facilitating training to realize the quality of veterinary drugs. But still, their effort in this regard is very low” (heads, District Livestock and Fishery Resource Development and coordinators, Animal Health Department).

All the KIs from the drug wholesalers emphasized that “The lack of a regulatory and service chain between regional and federal regulatory bodies of VDFACA is a challenge. Making contracts with our employees (technical managers and assistant storekeepers) and even renewing our license requires a trip to the central FDFACA.” On this issue, all the respondents appeared quite emotional and exasperated and asked, “Why is the Amhara regional branch of the VDFACA unable to perform these tasks? This creates a big challenge for our services.”

Most of the KIs also highlighted that “Disposing of expired and unusable pharmaceutical products is our challenge. There are teams or committee members organized from different sectors, but the team is not working actively. We don't have policies and guidelines to manage these waste products” (heads, District Livestock and Fishery Resource Development and coordinators, Animal Health Department). One KI from the government district clinic emphasized, “I have worked in this district for over 15 years, including the last 5 years as the district livestock resource coordinator. In our drug store, there are many expired vaccines, drugs, and chemicals that were in our clinics and collected from kebele clinics starting 10 years ago and are still lying in our store. We always write a letter to the district managers, but they are still not committed to implementing this” (Coordinator, Animal Health Department, BVSc, 16 years of experience).

Budget-related challenges

Most KIs from the district clinics mentioned that: “Inadequate allocations of budgets are the major challenge for us to fulfill regulations relating to premises, including infrastructure, buildings, and human and material resources, which are essential for achieving good practices in pharmaceutical warehouse management and providing basic service at the facility level.” A majority of them support the argument that “even within the sector, budget allocation is not fair since the livestock sector has merged with agriculture. Most of the budget is allocated for the agricultural and livestock production wings rather than the maintenance of livestock health” (heads, District Livestock and Fishery Resource Development and coordinators, Animal Health Department).

To maintain the quality and efficacy of pharmaceutical products, good warehouse management is central and requires attention among other pharmaceutical supply chain activities. To provide effective health services, whether in animal or human health aspects, a pharmaceutical warehouse and store should be properly installed, and drugs should be properly managed and handled ( 11 , 14 ). Without proper pharmaceutical storage management, the entire healthcare system will fail. In the livestock sector, high-income countries have established systems for assessing and monitoring the quality of veterinary products available in the market and at service delivery sites, whereas most low- and middle-income countries still struggle to monitor the proper use of veterinary medications ( 4 ).

Literature suggests that pharmaceuticals should be clearly organized and arranged with each zone of the store to make it much easier for store personnel to control stock, take periodic stock inventories, pick orders, and time will not be wasted ( 42 , 43 ). The current study found that in the majority (26; 70.3%) of surveyed facilities, mixed-type veterinary drug arrangement methods were used. This finding is higher than the finding of the study conducted on the pharmaceutical storage of public health centers at North Shoa Zone, which showed that in 29.3% of facilities, products were arranged in mixed types. The observed difference could be due to the availability of adequate storage space and sufficient shelves and pallets in the medical health sector. In that study, shelves were sufficiently available in 27 (65.9%) facilities out of 41 health facilities ( 44 ), whereas the availability of pallets and shelves in the current study was only about 60.35% on average from the surveyed 37 facilities.

Implementing automated systems is essential for managing warehouse operations and enables warehouse managers to complete their responsibilities more quickly, precisely, affordably, and flexibly (3, 41, 42). The present study found that none of the facilities had system software or electronic data interchange technology, 23 (62.2%) facilities handled pharmaceutical-related information, and everything was paper-based. This contradicted the findings of a study conducted at private medical drug wholesalers in Gondar, Ethiopia, which showed that 80% of the surveyed facilities' pharmaceutical warehouse management practices used the Professional Electronic Data System (PEDS) ( 11 ).

This difference might be due to the type of health facilities studied and the fact that the amount of stock managed in the medical pharmacy store may be huge, making it difficult to manage that huge stock manually. The non-use of system software in veterinary health facilities may be due to financial constraints on computer access and a lack of trained professionals. The quantitative result of this study indicated that the activities being carried out in the surveyed facilities were manual and paper-based. This was also supported by the qualitative result, in which budget-related constraints, computer access, and a lack of trained staff were the major challenges to automating their warehousing practices. Therefore, these findings establish that veterinary pharmaceutical stock arrangements and pharmaceutical-related information are not handled in an organized way.

Even if using a bin card is a time-consuming and laborious task, implementing this professional tool enables store managers to accomplish their activities in a rapid, effective, and cost-effective manner ( 11 ). However, this study revealed that bin cards were not utilized in any of the surveyed facilities. This finding contradicts the results of a study conducted on inventory management of laboratory commodities in Gambela regional state and Jimma zone, Southwest Ethiopia, which found that utilization of bin cards was 58.8 and 69.9%, respectively ( 45 , 46 ). Additionally, the result is also contrary to the findings of the study conducted in public health centers on pharmaceutical store management practices in Addis Ababa and the North Shoa Zone, which indicated that bin card utilization was 48.9 and 54%, respectively ( 30 , 44 ).

The quantitative result of the current study showed that the performance of bin card utilization in the surveyed veterinary health facilities was very low. The qualitative result also supported this finding with KIs noting the presence of a professional awareness gap on the use of bin cards; low ownership and attention given by higher managerial units; less commitment of the district veterinary drug and input supply officer; a lack of trained and qualified store personnel; and a lack of supportive supervision by regulatory bodies and district leaders. This indicated poor implementation of veterinary supplies stock-keeping practices in the surveyed veterinary health facilities.

The standard operational procedure simplifies the warehouse's operations by providing specific step-by-step instructions for each activity and ensuring the quality of the activities performed in the warehouse uses the same measurable standards every time ( 47 ). However, the present study found that 22 (59.5%) facilities had no standardized written manual. It was lower than the results of the study conducted in public health centers and hospitals in Dessie Town, Ethiopia, which showed that 80% of the facilities had standard guidelines for managing commodities in their stores ( 48 ). The observed difference might be due to differences in study facilities. The finding of this study was to deduce if in the majority of veterinary health facilities, warehouse practices are performed randomly or as per standards.

Scientific evidence recommends that expired or damaged stocks should be immediately removed from the usable inventory and sent to a separate place according to the established guidelines. This is because pharmaceutical waste could be dangerous and may pollute the environment habituated by the general public or wildlife, or even be diverted to the marketplace for illegal resale ( 49 , 50 ). However, the present study found that the majority (32; 86.5%) of surveyed veterinary health facilities did not dispose of expired products promptly, and 31 (83.8%) facilities did not have documented policies and guidelines for managing veterinary drug waste. The disposal practices found in the current study were poor compared to the study conducted in the North Shoa Zone, which showed 63.4% of health facilities disposed of pharmaceutical waste. In a study conducted in Addis Ababa, 66.7% of the health centers disposed of pharmaceutical waste within a year, and the availability of waste disposal documents was 100% ( 44 , 51 ). The observed difference could be due to differences in study settings, as currently, the human health sector is implementing an integrated pharmaceutical logistics system throughout health facilities and using the pharmaceutical waste rate as one of the key performance indicators for pharmaceutical logistics. According to the quantitative result of the current study, the expired and waste product disposal practices in the veterinary health sector were poor. This was also strengthened by the results obtained from the face-to-face interview, as the majority of KIs stated that most facilities do not have policies or guidelines to manage waste products. Some government district clinics have not disposed of expired products for the past 10 years.

Storage conditions of the facilities

Storage conditions are regarded as the cornerstone of warehouse management practices. Any defect in the storage area may result in obsolescence, deterioration, spoilage, pilferage, or breakage of stock due to excessive overstocking. Furthermore, the poisonous degradation of products can be hazardous to humans and the environment ( 30 , 52 ). The present study revealed that the average percentage of storage conditions in government district veterinary clinics and private veterinary drug wholesalers is 48.3 and 86.25%, respectively. This observed difference in storage performance between governmental and private entities could be because private veterinary drug wholesalers might be subject to inspections by government regulatory bodies. Furthermore, they also face strict control for the layout and fulfillment of the warehouse premises before their license is issued. According to this study's finding, the government district veterinary clinics did not meet the criteria for acceptable storage conditions, which was below the acceptable range (80%).

This finding is consistent with the study results conducted on assessing pharmaceutical store management practices in public hospitals in Addis Ababa, which showed an average adherence to proper storage conditions at 47.1% ( 30 ). The similarity of the findings could be that both were governmental facilities, so regulatory bodies and management units may not pay attention. However, the result was lower than the results of the study conducted on inventory management for laboratory commodities from health facilities in Gambela regional state and Jimma zone, Ethiopia, which indicated that the overall adherence to the criteria for proper storage conditions was 68.2 and 70.6%, respectively ( 45 , 53 ). The current study generally indicated the storage conditions in governmental district veterinary clinics were poor and below the acceptable limit (≥80%). This could be due to a lack of adequate storage space. The qualitative result also supports this because most of the KIs invited for interviews stated that the main challenge in their districts was the inadequacy of drug storerooms and the lack of standardized design and layout.

On the other hand, private veterinary drug wholesalers met the criteria for acceptable storage conditions, with an overall performance of 86.25%, which is considerably good (≥80%) ( 40 ). The percentage of storage conditions in private veterinary pharmaceutical wholesalers found in this study was higher than those of a study conducted on pharmaceutical warehouse management practices among private medical pharmaceutical wholesalers in Gondar, Ethiopia, which found that the facilities' storage performance was 68.75%. The difference could be due to the commitment of the concerned regulatory bodies to inspecting, controlling, providing feedback, and supervising the facilities.

Warehousing activities of the facilities

Receiving, storing, and issuing/shipping goods are the key operational tasks carried out in the warehouse, and proper practice of all the tasks is vital to warehouse management ( 54 ). Scientific studies suggest that warehouse management practices may differ across different sectors. It depends on various variables, such as material turnover and demand specifications, the type of materials used, the organizational unit's operational scope, and its size ( 55 ). Researchers recommend that if the tasks of receiving in a warehouse are not operated properly, they make up roughly 10% of operating expenditures in any distribution center ( 56 ). Regarding the receiving activities, the present study found that the majority of respondents had “neutral” responses to the performance of pharmaceutical receiving activities at the facility level, with a computed mean value of 3.31 that falls within the range of 2.61–3.4 and an SD of 0.64. From the analysis, it can be deduced that the current pharmaceutical receiving activity of the veterinary health facilities, which includes the availability of a pre-notification area for incoming pharmaceutical products, procedures for the cross-checking and identification of the documents and products received, procedures for the notification of discrepancies to the suppliers for the returning and receiving of products, and the safety of the receiving space for the movement of products handling equipment, is moderately satisfied. The SD of 0.64 indicates that there were no extremes in respondents' positive or negative scores. As stated in the literature, receiving activities should get strict attention, as they make up roughly 10% of operating expenditures in any distribution center. However, the qualitative result of this study indicated that governmental bodies did not pay attention to the sector, especially for the fulfillment of infrastructure and storage premises ( 56 ).

Regarding the storing activities, the majority of respondents “disagreed” with their facility's performance of pharmaceutical storing operations, with a computed mean value of 2.53 that falls within the range of 1.81–2.60 and an SD of 0.89. This indicated the current pharmaceutical storage activity of the veterinary health facilities, which includes the availability of adequate storage areas to store the inspected products, the arrangement of drugs in the storage area as clearly identified with their categories, the availability of clearly recorded and traceable locations for storing products, and the fact that products are stored according to the manufacturer's storage specifications at all times, were unsatisfactory. The standard deviation of 0.89 indicates that there are no extremes in respondents' positive or negative scores. Researchers suggest that storing activities cost ~15% of warehouse operating costs ( 56 ). However, the qualitative findings of this study show that the storage activities of the facilities are not based on standards.

Regarding issuing activities, this study found that the majority of respondents were “in agreement” with a computed mean value of 4.07 that falls within the range of 3.4–4.2 and an SD of 0.44 for the performance of the facility's pharmaceutical issuing activities. From the analysis, it can be deduced that the pharmaceutical issuing activity of the veterinary health facilities in terms of products is picked based on the printed order picking format; products are picked in the order of the FEFO principle; records are updated when goods are issued from their storage areas; and the availability of enough areas for product packing, labeling, and dispatching is “satisfactory.” An SD of 0.44 indicates that the majority of respondents had similar reflections.

Human and material resources management practices

In pharmaceutical warehouse management practices, the personnel who work there and handle the materials have a direct role in managing the stock and all other warehouse operations ( 53 ). Researchers also suggested that effective pharmaceutical warehouse management is determined by the professional's qualification level, training and capacity building, and the accessibility of sufficient material and equipment (which are crucial because they guard against future harm to the workers and the warehouse) ( 11 , 54 ). The present study found that the availability of qualified and sufficient numbers of staff to manage warehouse operations and the availability of equipment and materials used for facilitating warehouse activities at the surveyed facilities were unsatisfactory, with a computed mean value of 2.40 falling within the range of 1.81–2.60, and an SD of 0.61. This finding establishes that the human and material resource management practices, which comprise the availability of a sufficient number of staff, awareness of staff on veterinary pharmaceutical warehouse management principles, availability of job descriptions for their respected duties, availability of sufficient materials and equipment like personal protective materials, store safety materials like fire extinguishers, ladders and pallet jacks, hand trucks, etc. to facilitate warehouse activities, and the delivery of timely maintenance support and replacement for the equipment in the warehouses when it is not working satisfactorily. The SD of 0.61 indicates that the majority of respondents had similar reflections.

Evidence also suggests that the level of exposure to pharmaceutical warehouse management practices and other related supply chain activities is different for different professionals. Medicine storage is one of the most important responsibilities that can be best handled by a pharmacist ( 57 ). Accordingly, the veterinary pharmacy professional has direct exposure to the related tasks compared to non-pharmacy animal health professionals. The present study found that most of the veterinary pharmaceutical warehouse management activities were performed by non-pharmacy professionals (71, 94.7%); on the other hand, the involvement of veterinary pharmacy professionals in pharmaceutical warehouse practice was only about 4 (5.3%). This is in line with the result of the study conducted on the assessment of inventory and store management practices of pharmaceuticals in public health centers and hospitals in Dessie Town, Ethiopia, which showed only two institutions (20%) completely controlled and operated their stores by pharmacists ( 48 ). However, this was lower than the result of the study conducted in India, where 60% of the health centers were operated by pharmacists ( 58 ). This observed difference could be due to the difference in the study population.

The observed difference might also be due to the availability of educated human resources and the absence of job descriptions. As stated in the literature, a review conducted on veterinary drug management, handling, utilization, resistance, and side effects confirmed that low educational levels and a lack of graduates in veterinary medicine who are aware of pharmaceutical warehouse management were the major problems in veterinary drug handling and management ( 14 ). The absence of a job description for veterinary pharmacy professionals was supported by a qualitative result, as key informants confirmed that there is no job description used for district drug dispensaries and drug store personnel.

Different scholars suggest that employing qualified warehouse personnel and providing necessary training is crucial in improving the productivity of warehousing operations ( 10 , 53 ). However, the present study revealed that more than half (57.3%) of the study participants had not received on-the-job training in veterinary drug management, handling, and other related activities. The findings are somewhat consistent with a study carried out on the veterinary drug supply chain in Uganda, which found that nearly 90% of drug retailers and veterinary drug practitioners did not receive specialized training in veterinary medicine handling and storage management. The findings are also consistent with another study conducted on the assessment of veterinary drug handling, management, and supply chain in Ethiopia's Afar Pastoral Region, which found that ~63.9% of respondents lacked sufficient knowledge on safe handling and management of veterinary drugs ( 21 , 24 ).

Strengths and limitations of the study

This study was the first in the country to assess the status of veterinary pharmaceutical warehouse management practices and will serve as a baseline for future research. Furthermore, the strength of this study was that it used both quantitative and qualitative approaches in assessing existing practices and the challenges of veterinary supplies warehouse management practices. However, due to insufficient previous studies conducted in veterinary pharmaceutical warehouse management practices in the study area and abroad, it was difficult to compare the results with those conducted in similar settings. Besides, due to time constraints, geographic distance, and financial limitations, this study did not cover all the facilities available in the study area.

Conclusion and recommendations

This study revealed that most of the surveyed facilities in the study area did not prioritize the management practices of veterinary supply warehouses. The study specifically found that the warehouse management practices at government district veterinary clinics and private drug wholesalers were unsatisfactory. This was evident because 23 (59.5%) facilities lacked standard operating procedures for warehouse activities, and no veterinary health facilities utilized bin cards and system software. Furthermore, the majority of facilities (32; 86.5%) did not have guidelines for drug disposal and failed to dispose of expired drugs on time. The storage conditions at government district veterinary clinics were poor, with 48.3% meeting below the minimum requirements for good storage conditions. In contrast, the storage conditions at private veterinary drug wholesalers were good, with 86.25% meeting the necessary standards.

On warehousing activities, the storing activities and human and material resource management practices of the surveyed facilities were not satisfactory. Key informants highlighted several challenges that hindered effective veterinary supplies warehouse management, such as inadequate infrastructure, lack of qualified and trained staff, insufficient storage safety and security equipment, issues with pharmaceutical product availability and affordability, weak regulatory framework, and budget constraints at the facility level. Overall, the study found that warehouse management practices in the surveyed facilities were significantly poor. To enhance the management practices of veterinary pharmaceutical warehouses, various entities, including the District Veterinary Health Service offices, zonal Agricultural and Veterinary Health Services offices, Amhara Region Livestock and Fishery Resource Development office, Veterinary Drug and Feed Administration Control Authority, and veterinary professionals must make concerted efforts.

Data availability statement

The original contributions presented in the study are included in the article/ Supplementary material , further inquiries can be directed to the corresponding author.

Ethics statement

The study was conducted after obtaining approval and clearance letters from the University of Gondar, School of Pharmacy with Ref No. S/A/P/67/2014. To collect data from the selected facilities letters of permission were obtained from the Amhara region livestock and fishery resource development office and the Ethiopian veterinary drug and feed control administration authority, Amhara regional branch. The participants were asked and provided their oral informed consent to participate in this study.

Author contributions

AW: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Software, Validation, Writing—original draft. TS: Project administration, Supervision, Visualization, Writing—review & editing. AE: Project administration, Supervision, Visualization, Writing—review & editing. YT: Data curation, Validation, Visualizations, Supervision, Writing—review & editing. BW: Project administration, Supervision, Visualization, Writing—review & editing.

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Acknowledgments

We would like to acknowledge the contribution made by the University of Gondar, College of Veterinary Medicine and Animal Sciences and the School of Pharmacy for sponsoring study leave and paying student support fees. The authors also express gratitude to the study participants who work in the district veterinary clinics and private veterinary pharmaceutical wholesalers for their appreciated assistance during the period of data collection. My great thanks are also extended to the social and administrative pharmacy staff, the school of pharmacy, the college of medicine, and the college of veterinary medicine and animal science at the University of Gondar for their professional support.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

The reviewer AB declared a shared affiliation with the authors to the handling editor at the time of review.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fvets.2024.1336660/full#supplementary-material

Abbreviations

AHS, Animal health service; AMR, Antimicrobial resistance; EAA, Ethiopian Agricultural Authority; EMA, European medicine agency; FEFO, first expire first out first in principles; WM, warehouse management; PFSA, pharmaceutical fund and supply agency; SCM, supply chain management; SOP, Standard operational procedures; VDFACA, Veterinary drug and feed administration control authority; VP, Veterinary pharmaceuticals.

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Keywords: veterinary pharmaceuticals, veterinary clinics, veterinary drug wholesalers, warehouse management practices, Amhara region, Ethiopia

Citation: Wondie Mekonen A, Sintayehu T, Endeshaw Woldeyohanins A, Tefera Mekasha Y and Weldegerima Atsbeha B (2024) Assessment of veterinary pharmaceutical warehouse management practices and its associated challenges in four selected zones and Bahir Dar city of Amhara regional state, Ethiopia. Front. Vet. Sci. 11:1336660. doi: 10.3389/fvets.2024.1336660

Received: 11 November 2023; Accepted: 09 April 2024; Published: 07 May 2024.

Reviewed by:

Copyright © 2024 Wondie Mekonen, Sintayehu, Endeshaw Woldeyohanins, Tefera Mekasha and Weldegerima Atsbeha. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Abibo Wondie Mekonen, abibowondie@gmail.com ; abibo.wondie@uog.edu.et

• Open access
• Published: 01 May 2024

Health system lessons from the global fund-supported procurement and supply chain investments in Zimbabwe: a mixed methods study

• Abaleng Lesego 1 ,
• Lawrence P. O. Were 1 , 2 ,
• Tsion Tsegaye 1 ,
• Rafiu Idris 3 ,
• Linden Morrison 3 ,
• Tatjana Peterson 3 ,
• Sheza Elhussein 3 ,
• Esther Antonio 4 ,
• Godfrey Magwindiri 4 ,
• Ivan Dumba 5 ,
• Cleyland Mtambirwa 5 ,
• Newman Madzikwa 5 ,
• Raiva Simbi 5 ,
• Misheck Ndlovu 6 &
• Tom Achoki 1  

BMC Health Services Research volume  24 , Article number:  557 ( 2024 ) Cite this article

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Metrics details

The Global Fund partnered with the Zimbabwean government to provide end-to-end support to strengthen the procurement and supply chain within the health system. This was accomplished through a series of strategic investments that included infrastructure and fleet improvement, training of personnel, modern equipment acquisition and warehouse optimisation. This assessment sought to determine the effects of the project on the health system.

This study employed a mixed methods design combining quantitative and qualitative research methods. The quantitative part entailed a descriptive analysis of procurement and supply chain data from the Zimbabwe healthcare system covering 2018 – 2021. The qualitative part comprised key informant interviews using a structured interview guide. Informants included health system stakeholders privy to the Global Fund-supported initiatives in Zimbabwe. The data collected through the interviews were transcribed in full and subjected to thematic content analysis.

Approximately 90% of public health facilities were covered by the procurement and distribution system. Timeliness of order fulfillment (within 90 days) at the facility level improved from an average of 42% to over 90% within the 4-year implementation period. Stockout rates for HIV drugs and test kits declined by 14% and 49% respectively. Population coverage for HIV treatment for both adults and children remained consistently high despite the increasing prevalence of people living with HIV. The value of expired commodities was reduced by 93% over the 4-year period.

Majority of the system stakeholders interviewed agreed that support from Global Fund was instrumental in improving the country's procurement and supply chain capacity. Key areas include improved infrastructure and equipment, data and information systems, health workforce and financing. Many of the participants also cited the Global Fund-supported warehouse optimization as critical to improving inventory management practices.

It is imperative for governments and donors keen to strengthen health systems to pay close attention to the procurement and distribution of medicines and health commodities. There is need to collaborate through joint planning and implementation to optimize the available resources. Organizational autonomy and sharing of best practices in management while strengthening accountability systems are fundamentally important in the efforts to build institutional capacity.

Peer Review reports

The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), together with its Zimbabwean national and international stakeholders have continued to invest in health system strengthening to improve public health in the country. These investments have been guided by systemwide strategic assessments to understand the fundamental challenges facing the Zimbabwean health system [ 1 , 2 , 3 , 4 ].

Given the strategic importance of access to essential medicines, vaccines, and other health technologies as a strategic pillar of any health system [ 4 , 5 ], the Global Fund supported the Ministry of Health and Child Care (MOHCC) through the United Nations Development Program (UNDP) to undertake a comprehensive assessment of the national procurement and supply chain management (PSCM) system in 2013 [ 6 ]. This assessment aimed to develop a strategic vision and costed action plan for improvement. This covered both upstream and downstream aspects of PSCM. The strategic purpose was to help the MOHCC launch a coordinated approach to invest in PSCM improvements and enhance coordination and cooperation in managing all health commodities across the health system [ 3 , 6 , 7 ].

Subsequently, the Global Fund supported several initiatives aimed at the realization of the improvements proposed by the comprehensive assessment undertaken by UNDP [ 6 ]. These initiatives primarily encompassed end-to-end supply chain assistance in critical areas, including demand quantification and forecasting, warehousing capacity development, fleet improvement, distribution systems, and waste management systems. Other support aspects focused on warehouse optimization, data and information management systems, and personnel training [ 7 , 8 ]. In general, warehouse optimization is the process of improving the efficiency and effectiveness of warehouse operations. It involved refining workflows, leveraging technology, enhancing spatial utilization, and ensuring precise inventory management [ 6 , 7 ].

More specifically, the Global Fund provided funds for the construction of warehouses for the National Pharmaceutical Company of Zimbabwe (NATPHARM) to facilitate the smooth handling of health commodities. Additionally, this support extended to water supplies (in terms of sinking boreholes) for various warehouses, water tanks, and booster pumps for the other branches. Global Fund also supported NATPHARM in constructing two incinerators in the two main cities, Harare, and Bulawayo to handle pharmaceutical waste effectively [ 9 , 10 ].

Through Global Fund support, NATPHARM also received modern warehouse equipment such as forklifts, pallet jacks and rolling ladders, and data and information management system support for better visibility and effective handling of health commodities. The support further extended to optimising the Harare branch warehouse with modern receiving and transit capabilities to serve other feeder locations and the procurement of modern delivery trucks to facilitate the distribution of commodities. Global Fund support also extended to personnel training and retention for the effective functioning of NATPHARM and the broader procurement and supply system [ 3 , 6 , 9 ].

Focusing on quality assurance and safety of medicines and other health commodities, Global Fund supported the Medicines Control Authority of Zimbabwe (MCAZ) to develop capacity in quality testing of all commodities procured through grants. MCAZ was also supported with the installation of solar panels that allowed for an uninterrupted power supply to facilitate smooth operations at the organization. The Global Fund support was also critical in the upgrading of the biology and chemistry laboratories to attain WHO prequalification standards [ 8 , 9 , 11 ]. Similarly, there was direct support from the Global Fund to facilitate pharmacovigilance activities, such as adverse drug reactions reporting using electronic systems. All these measures were meant to ensure that the medicines and health commodities consumed in the Zimbabwean health system were safe and quality-assured [ 4 , 5 , 9 , 11 ].

The overarching project by the Global Fund to support the Zimbabwean government was designed and implemented in response to the nationally identified gaps and opportunities that were established through various research and consultative efforts [ 3 , 4 , 6 , 8 ]. The project was kickstarted in the first quarter of 2019 and continued through 2021, with various project components being implemented in a phased approach to achieve the national targets [ 3 , 4 , 7 , 10 , 11 ]. To ensure effective coordination, accountability, and avoidance of duplicative efforts, the project was designed and implemented in close coordination with other partners represented in the National Health Development Partners Coordination Forum (HDPCF), Health Sector Technical Working Group (HSTWG), and the Global Fund Country Coordination Mechanism (CCM), among others [ 3 , 4 , 6 , 8 , 10 ]. There was regular reporting to the respective coordination mechanisms to track progress as well as troubleshoot any implementation issues as they arose [ 6 , 9 ].

Overall, the gaps identified through the various assessments commissioned by the Global Fund included a lack of effective coordination, poor inventory and order management, human resource constraints, and warehousing and storage inefficiencies [ 12 , 13 ]. Therefore, the focus of the Global Fund support was to retool the Zimbabwean PSCM system to be efficient, cost-effective and responsive to the population's health needs, particularly in the face of global epidemics and pandemics such as HIV/AIDS and COVID-19 [ 14 , 15 , 16 , 17 , 18 ].

In an attempt to resolve these issues, healthcare systems around the world are working on streamlining their supply chains through various health system strengthening measures [ 19 , 20 , 21 , 22 ]. Therefore, the objective of this analysis was to assess the overall effects of the Global Fund-supported investments in the Zimbabwean PSCM system and document the lessons learned to inform future programming efforts to strengthen healthcare systems.

The assessment covered a period of 2018 -2021 and employed both qualitative and quantitative research methods. Figure 1 . illustrates the convergent mixed methods study design that was applied. In this study design, both the qualitative and quantitative data collection and analyses are implemented simultaneously, and the insights merged to provide a fuller picture [ 23 ].

Convergent mixed methods design

The quantitative part of the study entailed collecting and analysing administrative data covering priority indicators that are routinely reported on the Zimbabwe PSCM. Meanwhile, the qualitative part comprised of key informant interviews (KII) focusing on stakeholders within the healthcare system to give perspective to the observed data trends. Insight from the two parts of the analysis were merged and subjected to comparative assessment and interpretation to ensure that a consistent picture emerged [ 23 , 24 ]. More details on the methods are provided in later sections.

Analytical framework

The overall analytical approach espoused in this assessment was anchored on the logical relationships of the building blocks of the health system as described by the World Health Organization (WHO) health system framework [ 5 ]. Figure 2 shows the analytical framework, which illustrates the results chain cascading from the Global Fund-supported initiatives to the expected improvements in intermediate and long-term outcomes related to PSCM, including the availability of medicines, reduced wastage, and overall improvements in population-level coverage [ 4 , 5 ].

Analytic framework

Overall, the framework graphically displays the results Global Fund intended to achieve through its support to the Zimbabwean PSCM. The "theory of change" that underlies the Global Fund’s strategy is revealed through the arrows in the diagram that identify “causal” linkages through which various intermediate results interact to make progress toward the overall goal of improving health system performance [ 3 , 5 ].

Quantitative research

The quantitative research entailed a detailed descriptive analysis of the operational data that was routinely reported across the Zimbabwe PSCM system. Table 1 . shows some of the key performance indicators (KPI) that were considered in our analysis.

Data collection, management and analysis

The data used in this analysis were obtained from the routinely reported operational data that included the NATPHARM-operated warehouses and healthcare facilities in the country. The data were extracted from the various data management systems operated by the different institutions, cleaned, and collated into a comprehensive dataset in the form of a spreadsheet covering the period of the assessment. The database was examined for completeness and accuracy by cross-referencing the corresponding progress reports for specific periods. Trends of priority indicators were compared over time, as they related to Global Fund support to the PSCM space.

Qualitative research

The qualitative assessment entailed KIIs with health system stakeholders who were knowledgeable and intimately involved in the Global Fund-supported initiatives and its intended beneficiaries. This included provincial and district management teams, hospital and clinic personnel, and other stakeholders in the Zimbabwe health system. Informed consent was obtained from each study participant involved in the study. The data collection protocol ensured that all study participants fully understood the objectives of the study and consented verbally to provide the required information.

As previously stated, the literature review helped map and identify critical organisations involved in the PSCM space, and more specifically, those involved in the procurement and health system strengthening activities supported by the Global Fund. A full list of those organisations is provided on Table  2 .

Sampling techniques

Convenience purposive sampling was used to select key informants and in-depth interviews [ 23 ]. Our sample was supplemented using snowball sampling methods (also called chain sampling). The initial respondents referred other potential respondents until no new information was forthcoming or achieved saturation. Efforts were made to be all-inclusive, involving various stakeholder groups and organisations intimately linked to the operations of the Zimbabwe PSCM landscape.

This comprised of KIIs using a structured interview guide that covered various thematic areas relevant to the assessment to obtain a comprehensive perspective of the impact of the Global Fund-supported initiatives in the country. In its development, testing and validation, the key informant guide was pretested and adapted to ensure suitability for the task. In view of the restrictions imposed to prevent the spread of COVID-19 infections at the time of the study, some KIIs were conducted online using multimedia channels such as Zoom, Skype, and telephonically.

Three research assistants supported the two project leaders in conducting the KIIs. After each interview, all notes taken by the research assistant were checked by the two project leaders to ensure completeness and readability to minimise recording errors. In addition, a tape recorder was used for interviews to assist with reference post data collection. All the recordings were stored in a pin-protected cloud storage which was only accessible by the two project evaluation leaders. Qualitative data obtained from the KIIs were transcribed in full and then manually analysed applying thematic content analysis. Where there was a divergence of opinion, an agreement was established through discussion with three members of the project evaluation team. In thematic analysis, data from interview transcripts were grouped into similar concepts. This approach was appropriate for semi-structured expert interviews as it is used to code text with a predefined coding system that can then be refined and completed with new themes emerging [ 23 , 24 ]. Our initial coding system was defined during the desk review stage and continuously updated in the successive phases of data collection employing a deductive approach of qualitative research. The emerging themes were not preconceived (desk review) but emerged from the data during the coding process, while the global themes were the highest-order themes that emerged from the data and were broad enough to capture the essence of the entire dataset [ 23 ]. The codes are presented in a tabular format in the results section below.

This section presents both the quantitative and qualitative research results from the study. The quantitative results comprise of trends of the priority operational PSCM indicators for the relevant period. The qualitative results present the perspectives of the key health stakeholders involved in the Zimbabwe healthcare system.

Quantitative results

Table 3 shows that the total warehouse capacity across the Zimbabwean health system increased by 37.8% between 2018 and 2021.

Of the 1500 public health facilities in Zimbabwe coverage by the PSCM system was consistently high between the years 2018 and 2021, averaging 94%, and increasing by 13.6% over the same period. However, order fulfillment rate within 90 days, for 1410 reporting health facilities was consistently below 50% from 2018 to 2020, despite the reported high coverage for the health facilities by the PSCM in the country. Notably, this indicator showed remarkable improvement to 91% in 2021, from an average of 42% from the previous three years. More specifically, the order fill rate for Tenofovir 300mg/ lamivudine 300mg/efavirenz 600mg (TLE 600mg) improved despite the significant drop observed in 2020. However, when comparing 2018 and 2021, the order fill rate for this specific HIV drug increased by around 36.5%, while the stockout rates for the same drug at the central stores declined by about 14.5% over the same period.

Table 3 further shows a 44% drop of order fill rates for the Determine HIV Test Kit between 2018 and 2020 for the 1410 reporting health facilities, only to recover in the year 2021, where order fill rates improved to 83%. At the same time, the stockout rates for the Determine HIV Test Kit at the central stores declined by 49% between 2018 and 2021.

Figure  3 shows the estimated average population coverage for HIV treatment for adults and children, from 2018 to 2020, at 92% and 71%, respectively. The figure shows that there was limited variation in the population level coverage over the years, despite the estimated increase in the number of people living with HIV over the same period. The national target for this indicator is 95%.

Adult and paediatric HIV treatment population coverage

Figure  4 shows the proportion of the value of the expired stock in the 7 warehouses, over three years, between 2019 and 2021, which demonstrates a declining trend over time. The highest expiry was in quarter 4 2019 at 1.9%, compared with the lowest in quarter 3 2021 at 0.1%. This represents a 93% reduction in value of expired stock.

Percentage value of expired stock

Figure  5 shows the combined stock-taking variance valued in United States Dollar terms across 7 warehouses over a three-year period. The stock variance shows a declining trend over the three-year period to negligible values at the end of 2021.

Stock-taking variance

Figure  6 shows the temporal trend of the number of days that it took NATPHARM to resolve the stock variances across the different warehouses in the country. Overall, there is a decline from the average of 8 days from the December 2018 stocktake (with Harare warehouse as an outliner at 25 days), to an average of 1 day in the December 2021 stocktake, where all warehouses converge.

Duration to resolve stock variance

Table 4 shows the funding levels in USD$ to support the diagnostic capacity for Covid-19, comprising of the polymerase chain reaction test (PCR) and rapid diagnostic tests (RDT). The table further shows the PSCM related costs, the total test done, and positive cases identified over the two-year period. The total funding between 2020 and 2021 increased by 290%, with testing levels increasing by 490% over the same period. The average Covid-19 positivity rate in 2020 was 6.4% while the positivity rate for 2021, was 3.1%, indicating a greater than 50% drop.

Qualitative results

Most of the participants interviewed acknowledged that the Global Fund support to NATPHARM and the broader Zimbabwean health system had been central in improving the overall performance of the health system through improved availability of essential medicines and other health commodities. This was largely achieved by ramping up the various components of the PSCM value chain and related operations, leading to efficiency, effectiveness and reliability.

Table 5 shows the codes, emerging and global themes from the thematic content analysis. The emerging themes revolved around the lack of infrastructure and equipment curtailing warehouse operations before the Global Fund support. Data gaps and poor product visibility were also emerging themes, as were the effects of the old fleet on the overall supply and distribution system. Similarly, issues of infrastructure, capacity, and personnel training gaps emerged as crucial themes hindering quality assurance within the PSCM. Global themes also largely focused on infrastructural inadequacy leading to underperformance. Improvements leading to better handling of commodities; data and information systems, enhancing visibility and supporting accuracy in forecasts; improvements in the distribution systems enabled by newer fleets also featured as global themes. Similarly, better trained and motivated personnel, able to perform critical functions; capacity to ensure the quality and safety of medicines and other health commodities; and the need for effective multistakeholder partnerships to improve effectiveness and sustainability of health systems, were key themes.

NATPHARM operations

According to the NATPHARM management, warehouse improvement and optimisation exercise resulted in better visibility and improved efficiency in the operations related to the commodity handling across the entire value chain. More specifically, the processes related to stock taking improved markedly over time according to the reports presented by various organizations that had been commissioned to undertake the stock audits.

“ …. warehouse optimisation supported implementing an inventory management system which conformed with bin location and variant codes, according to different donors. The result was improved, faster and more accurate stock takes, a sharp reduction of variances and more streamlined order processing ” Participant, NATPHARM.

Further, it was reported by various participants that order processing and deliveries had improved to be timely and on schedule as a result of the improved visibility and efficiency harnessed across the PSCM. Similarly, there was consensus that receiving processes and documentation had significantly improved through the support offered by Global Fund particularly towards warehouse optimization. The improvements in the data management systems and related trainings were also cited as contributory to the overall trend that was observed.

“ Reporting quality has greatly improved and is now timely, accurate and complete. This helps in accurate forecasting of demand, which in turn avoids unnecessary wastage and expiries” Participant MOHCC.

There was consensus from the majority of participants interviewed that the fleet improvements had improved the availability of essential commodities vital for the effective management of high burden diseases; HIV/AIDS, Malaria and Tuberculosis in Zimbabwe. According to participants from a local health facility, this was evidenced by low stockout rates for the key commodities needed to manage these three conditions effectively. The new fleet was reported to facilitate deliveries from various warehouses to the recipient health facilities on a regular basis. This level of distributional access coupled with better demand forecasting as a result of improved data use, was noted as critical in the improved availability of medicines and health commodities at the health facility levels.

Further, respondents in the leadership of NATPHARM revealed that the Global Fund support had benefited the overall financial position of the organisation by tapping into efficiencies harnessed through the various measures that have been implemented. Some of the support measures that resulted in efficiency improvements include, the warehouse optimization, pharmaceutical waste management and fleet improvements, which ultimately reduced operational costs.

For example, it was noted that running a newer fleet of vehicles led to lower maintenance and fuelling costs than previously was the case, when deliveries were done using older vehicles. Similarly, it was noted that pharmaceutical waste resulting from expired medicines and other health commodities was expensive to store and dispose, particularly when engaging third party organizations. However, this additional cost was reportedly in the decline, as a result of the investment in the incinerators for waste management.

“ The provision of incinerators for waste management has resulted in huge savings in terms of the cost of waste destruction. It has also resulted in significant compliance with environmental health regulations.”, Participant, NATPHARM.

MCAZ operations

Majority of the participants agreed that the Global Fund support to MCAZ strengthened its overall capacity to handle the requisite safety and quality assurance needs to effectively support the procurement functions for medicines and other health commodities within the country and regionally. The installation of solar panels to provide uninterrupted electricity power supply for the operations of the organization was cited as a huge advantage allowing for improved performance, in a country where power supply is unreliable. Similarly, other participants cited, the support for MCAZ laboratories to obtain the WHO prequalification status, as a major step towards effectiveness and sustainability for the organization; citing the fact that MCAZ is offering quality assurance services regionally at a fee.

“ We [MCAZ] now have the capacity to conduct the safety and quality assurance tests needed to support the procurement of commodities in the country and the region. We [MCAZ] even recently won the tender to support the regional procurement activities ”, Participant, MCAZ.

Based on the results framework provided in Fig.  3 , there is clear evidence that the Global Fund-supported initiatives resulted in positive improvements in the overall performance of the Zimbabwean PSCM system. However, it is important to recognise some of the assessment’s limitations in interpreting these findings. First, the results reported are for a limited observation period and a limited set of indicators, which are largely confined to the national level analysis, missing out on granular subnational and commodity-specific analysis that could be more informative. Secondly, this study was not conceptualised before the onset of the intervention reported here (i.e., Global Fund-supported initiatives), and therefore, no specific steps were taken to develop an appropriate prospective research design and data collection strategy to support a more rigorous assessment. Therefore, the study relied on secondary PSCM data that were sparse and covered a limited period. Third, the study could be subject to confounding relationships with other concurrent interventions being implemented by other health system stakeholders that have direct or indirect effects on the PSCM system, complicating impact attribution to specific interventions. Forth, the analysis focused only on a narrow subset of medicines and commodities related to HIV/AIDS and COVID-19. However, despite these limitations, every effort has been made to use the most up-to-date and complete information available, including validation using official reports and collaborative reported data with key informant interviews.

The estimated population coverage for HIV treatment for both adults and children remained consistently high despite the increasing prevalence in the country. It was estimated that adults living with HIV increased by 10% from a baseline of 2018, to reach 1.3M in 2020, while children living with HIV increased by 24%, from a baseline of 2018, to reach 75 000 in 2020 [ 3 , 4 , 9 ]. As a key last mile population outcome, it can be rightly assumed that high HIV treatment coverage in the Zimbabwean system emanated from strengthened inventory management functionality and improved delivery of orders supported by a modern fleet of vehicles, which allowed for meeting the supply target of four quarterly rounds [ 3 , 8 ]. Population coverage is an important performance measure for a health system. It unites two important concepts; need and utilisation of an intervention to improve health [ 25 ]. In our case, the intervention is HIV treatment and the population in need is those living with HIV needing treatment; and the proportion with access and able to use the treatment they need, represents population coverage. This is a fundamentally important consideration as various health systems, including low- and middle-income countries, are making universal health coverage (UHC) efforts. There is no question, that improved access to essential medicines and other health technologies is a fundamental cornerstone towards UHC [ 1 , 5 , 26 ].

Other intermediate indicators that are critical for progress towards improved availability of medicines and other health commodities and hence UHC, also showed significant improvements that could be attributed to Global Fund-supported initiatives. For example, reduced wastage and decreasing value of expired health commodities reported, point towards improving efficiency across the value chain. As noted earlier, efficiency is one of the fundamental expectations of an effective health system outlined in the WHO health system framework [ 3 , 5 ]. The diminishing value of expiries could be ascribed to various factors, including the improved workflow processes and data accuracy at NATPHARM. This improvement which is associated with better visibility of commodities across the value chain could be attributed to investments made by Global Fund such as the enterprise resource planning platform, coupled with concomitant training and supervision.

Through Global Fund’s assistance to NATPHARM, automation of tasks such as stock management, ordering, and other operational activities was central and contributory to driving the observed improvements in the handling of commodities; reduction of wastage and expiries and improving availability. Similarly, better inventory management and warehouse optimization activities such as decongestion resulted in quicker, timely, more accurate, and well-documented stock takes, improving overall commodity management.

Variances between stock on hand and physical counts were used to determine whether facilities are conducting period checks on their stocks and therefore calculating monthly consumption of commodities accurately. As such the variance across commodities should be zero. Low variance indicates that the stocks at hand are generally similar and do not vary widely from the physical stock counts, while high variance indicates that the respective values have greater variability and are more widely dispersed from one another. There is clear evidence pointing towards the reduction in stock variances when comparing stock on hand and physical counts across the different warehouses in the country over time. This trend can be attributed to better visibility of commodities at the warehouses and training of personnel which was supported by the Global Fund [ 2 , 9 ]. Similarly, the number of days it took the NATPHARM personnel to resolve stock variances showed a dramatic reduction, from an average of 8 days to 1 day in a span of 3 years. This observed trend could also further support the claim that overall, the Global Fund supported initiatives produced the desired results.

With the advent of Covid-19, the effects of the Global Fund support on the PSCM became evident considering the robust response the country was able to mount particularly in terms of diagnostics [ 9 ]. The country was able to rapidly roll out COVID-19 testing, reaching many people between 2020 and 2021. Similarly, the Covid-19 positivity rates declined from 6.4% to about 3.1% over the same period. High positivity rates may indicate that the health system is only testing the sickest patients who seek medical attention and is not casting a wide enough net to know how much of the virus is spreading within its communities. A low rate of positivity on the other hand, can be seen as a sign that a health system has sufficient testing capacity for the size of the Covid-19 outbreak and is testing enough of its population to make informed decisions about reopening the economy. The WHO guidance is that countries which have conducted extensive testing for COVID-19, should remain at 5% or lower positivity rate for at least 14 days.

Safe pharmaceutical waste management and disposal is a primary consideration of any effective health system in completing the PSCM loop [ 27 ]. The Global Fund supported the investment in MOHCC operated incinerators. These investments could largely be associated with reduction in the cost of storage, handling and disposal of the expired stock, particularly when considering that certain space was rented from third parties which often charged a premium. Safe pharmaceutical waste disposal also became more priority with the increased supplies that resulted from the efforts to tackle the Covid-19 pandemic.

Despite signs of progress, there was temporary faltering of indicators- namely, order fill and stockout rates; associated with key commodities for effective management of HIV in the year 2020, warranting an explanation. The drop in Tenofovir/Lamivudine/Efavirenz (TLE 600mg) in 2020 could be linked to several factors. In the year 2019, the Zimbabwe MOHCC adopted new treatment regimens containing Dolutegravir. This means, newly HIV positive clients were started on Dolutegravir regimen as standard of care rather than the previous first line treatment which then surged Tenofovir/Lamivudine/Dolutegravir 50mg order fill rate, while having the opposite effect on the old regimen. Lastly, the effects of COVID-19 pandemic cannot be underestimated as the global supply chain systems were logged with delays which caused disruptions and inefficiencies in health systems in many countries [ 28 ]. In the same period, Determine HIV Test Kit rebounded from stocking out in central stores because of strengthened warehouse optimization activities, including better inventory management, purposeful stock taking, and approval processes contributed to the lowering of stockout rates.

The Global Fund-supported initiatives were also instrumental in building capacity by training key personnel for the effective implementation of activities related to the procurement and supply chain management function [ 8 , 29 , 30 ]. Better quantification and forecasting capabilities (due to data availability through e-LMIS and personnel training), improved warehousing capacity to hold a wide portfolio of products, and direct delivery to facilities through a modern fleet could have contributed to the high population coverage reported [ 26 , 30 , 31 ]. According to the WHO health system framework, effective leadership is required to coordinate all the functions of the health system in order to achieve the desired outcomes [ 5 ]. Therefore, it is sensible to conclude that, the reported health system improvements could not have happened without effective leadership and well-trained staff tasked with coordination and management across the PSCM value chain. It can be further inferred that the training and capacity development measures offered to the NATPHARM personnel were consequential in supporting the broader health system to meet its overall objectives, including improving PSCM performance [ 2 , 7 , 29 ].

Similarly, adequate infrastructure, equipment, data, and information management systems are crucial ingredients for a well-functioning health system, according to the WHO health system framework [ 4 , 5 , 9 ]. The Global Fund-supported initiatives were central in supporting these aspects of the health system through improved warehousing capacity, of modern equipment, installation of solar panels, fleet improvement and deployment of an electronic-logistic management information system (e-LMIS). The cumulative benefits of these investments include optimised procurement and distribution of commodities leading to a reduction in stockout rates and timely order refills to meet the population health needs [ 9 ].

Based on these findings, it would be reasonable to conclude that the Global Fund-supported initiatives in Zimbabwe contributed positively to strengthening the health system, particularly through the improved performance of the various indicators linked to the PSCM system at national and regional warehouses, as well as health facilities. Considering the prevailing health needs in the country, the implementation of this project and the manner of investments provide a basis and playbook for further support to make progress. This is particularly true considering the various competing priorities in the Zimbabwean healthcare system amidst resource constraints [ 3 , 6 , 8 ]. This was largely underpinned on the overarching focus on UHC and the critical role that an effective PSCM plays towards that very objective [ 3 , 12 , 13 , 14 ].

The Global Fund-supported project in Zimbabwe worked through the existing national coordination mechanisms where various key stakeholders, including MOHCC and NATPHARM, were involved in all key strategic planning and implementation decisions, ensuring country leadership and ownership. It was clear from the outset that this approach required sound partnership, transparency, and accountability among all the involved stakeholders, to deliberate and find common ground, guided by the overarching objective to make progress towards UHC.

The question of securing the gains and ensuring sustainability is fundamental for donor supported health programs in low- and middle- income countries. To make progress, it is imperative for health system stakeholders, including governments and donor organizations that are keen to sustainably strengthen health systems to pay close attention to critical areas like the procurement and distribution of health commodities. It is critical to collaborate with key stakeholders through joint planning and implementation to optimize the available resources. Organizational autonomy coupled with strong data driven accountability systems and the sharing of best management practices are fundamentally important in this discourse.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request and once written permission is obtained from NATPHARM.

Abbreviations

Country Coordination Mechanism

Health Development Partners Coordination Forum

Health Sector Technical Working Group

Key Informant Interview

Medicines Control Authority of Zimbabwe

Ministry of Health and Child Care

National Pharmaceutical Company of Zimbabwe

Polymerase Chain Reaction

Procurement and Supply Chain Management

Rapid Diagnostic Tests

Tenofovir Lamivudine Efavirenz

Universal Health Coverage

United Nations Development Program

World Health Organization

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Acknowledgements

The authors would like to thank the participants from the different organizations in Zimbabwe that provided feedback during the study. They are also grateful to the management of the various organizations that allowed their staff to participate and provided premises and other resources that were used during the interviews. Gratitude to Sarah Gurrib who proofread the manuscript and offered useful comments.

The study was funded by the Global Fund to Fight AIDs, Tuberculosis and Malaria. The funder had no role in the study design, data collection, data analysis, data interpretation, or writing of the article. All authors had full access to study data and had final responsibility for the decision to submit for publication.

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Contributions

Tom Achoki (TA), Rafiu Idris (RI), Lawrence Were (LW) and Abaleng Lesego (AL) conceptualized and designed the study. AL, TA, and Godfrey Magwindiri (GM) collected and analyzed data. TA and AL drafted the manuscript. Tsion Tsegaye (TT), Linden Morrison (LM), Tatjana Peterson (TP), Sheza Elhussein (SE), Esther Antonio(EA), Ivan Dumba (ID), Cleyland Mtambirwa (CM), Newman Madzikwa(NM), Raiva Simbi (RS), Misheck Ndlovu (MN) and LW did the critical revisions of the manuscript. All authors read and approved the final manuscript.

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Ethics approval and consent to participate.

Ethical approval including the consent procedure for participants was obtained from the Ethics Committee of the MOHCC Department of Research and NATPHARM, Harare Zimbabwe. The conduct and methods of this study adhered to the tenets outlined in the Declaration of Helsinki. Informed consent was obtained from each study participant involved in the study. The data collection protocol ensured that all study participants fully understood the objectives of the study and consented in writing to provide the required information. Before the interview commenced, the participants also consented verbally and confirmed that they had understood the objectives of the study and that they could opt out of the interview at any time without prejudice. No sensitive or personally identifying information was collected regarding the study participants.

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Competing Interests

RI, LM, TP and SE declare that they are fulltime employees at the Global Fund to Fight AIDs, Tuberculosis and Malaria. EA and GM declare that they are fulltime employees at PricewaterhouseCoopers. ID, CM, NM and RS are fulltime employees at National Pharmaceutical Company of Zimbabwe. The rest of the authors declare that they have no competing interests.

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Lesego, A., Were, L.P.O., Tsegaye, T. et al. Health system lessons from the global fund-supported procurement and supply chain investments in Zimbabwe: a mixed methods study. BMC Health Serv Res 24 , 557 (2024). https://doi.org/10.1186/s12913-024-11028-6

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In the recent years, the database community has witnessed the emergence of a new technology, namely data warehousing . A data warehouse is a global repository that stores pre-processed queries on data which resides in multiple, possibly heterogeneous, operational or legacy sources. The information stored in the data warehouse can be easily and efficiently accessed for making effective decisions. The On-Line Analytical Processing (OLAP) tools access data from the data warehouse for complex data analysis, such as multidimensional data analysis, and decision support activities. Current research has lead to new developments in all aspects of data warehousing, however, there are still a number of problems that need to be solved for making data warehousing effective. In this paper, we discuss recent developments in data warehouse modelling, view maintenance, and parallel query processing. A number of technical issues for exploratory research are presented and possible solutions are discussed.

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Dept. of Computer Science Telecommunications, University of Missouri-Kansas City, Kansas City, MO, 64110, USA

Sunil Samtani & Vijay Kumar

Advanced Computing Research Centre, School of Computer and Information Science, University of South Australia, Mawson Lakes, 5095, Australia

Mukesh Mohania

Department of Social Informatics, Kyoto University, Kyoto, 606-8501, Japan

Yahiko Kambayashi

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Graduate School of Informatics, Dept. of Social Informatics, Kyoto University, 606-8501, Yoshida Sakyo Kyoto, Japan

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School of Applied Science, Nanyang Technological University, N4-2A-12, Nanyang Avenue, 639798, Singapore

Ee-Peng Lim

School of Computer and Information Science The Levels Campus, University of South Australia, Mawson Lakes, 5095, S.A., Australia

Mukesh Kumar Mohania

Faculty of Science, Dept. of Information Sciences, Ochanomizu University, 2-1-1 Otsuka, Bunkyo-ku, 112-8610, Tokyo, Japan

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Samtani, S., Mohania, M., Kumar, V., Kambayashi, Y. (1999). Recent Advances and Research Problems in Data Warehousing. In: Kambayashi, Y., Lee, D.L., Lim, EP., Mohania, M.K., Masunaga, Y. (eds) Advances in Database Technologies. ER 1998. Lecture Notes in Computer Science, vol 1552. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-49121-7_7

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Changing Partisan Coalitions in a Politically Divided Nation

5. party identification among religious groups and religiously unaffiliated voters, table of contents.

• What this report tells us – and what it doesn’t
• Partisans and partisan leaners in the U.S. electorate
• Party identification and ideology
• Education and partisanship
• Education, race and partisanship
• Partisanship by race and gender
• Partisanship across educational and gender groups by race and ethnicity
• Gender and partisanship
• Parents are more Republican than voters without children
• Partisanship among men and women within age groups
• Race, age and partisanship
• The partisanship of generational cohorts
• Religion, race and ethnicity, and partisanship
• Party identification among atheists, agnostics and ‘nothing in particular’
• Partisanship and religious service attendance
• Partisanship by income groups
• The relationship between income and partisanship differs by education
• Union members remain more Democratic than Republican
• Homeowners are more Republican than renters
• Partisanship of military veterans
• Demographic differences in partisanship by community type
• Race and ethnicity
• Age and the U.S. electorate
• Education by race and ethnicity
• Religious affiliation
• Ideological composition of voters
• Acknowledgments
• Overview of survey methodologies
• The 2023 American Trends Panel profile survey methodology
• Measuring party identification across survey modes
• Adjusting telephone survey trends
• Appendix B: Religious category definitions
• Appendix C: Age cohort definitions

The relationship between partisanship and voters’ religious affiliation continues to be strong – especially when it comes to whether they belong to any organized religion at all.

The gap between voters who identify with an organized religion and those who do not has grown much wider in recent years.

Protestants mostly align with the Republican Party. Protestants remain the largest single religious group in the United States. As they have for most of the past 15 years, a majority of Protestant registered voters (59%) associate with the GOP, though as recently as 2009 they were split nearly equally between the two parties.

Partisan identity among Catholics had been closely divided, but the GOP now has a modest advantage among Catholics. About half of Catholic voters identify as Republicans or lean toward the Republican Party, compared with 44% who identify as Democrats or lean Democratic.

Members of the Church of Jesus Christ of Latter-day Saints remain overwhelmingly Republican. Three-quarters of voters in this group, widely known as Mormons, identify as Republicans or lean Republican. Only about a quarter (23%) associate with the Democratic Party.

Jewish voters continue to mostly align with the Democrats. About seven-in-ten Jewish voters (69%) associate with the Democratic Party, while 29% affiliate with the Republican Party. The share of Jewish voters who align with the Democrats has increased 8 percentage points since 2020.

Muslims associate with Democrats over Republicans by a wide margin. Currently, 66% of Muslim voters say they are Democrats or independents who lean Democratic, compared with 32% who are Republicans or lean Republican. (Data for Muslim voters is not available for earlier years because of small sample sizes.)

Democrats maintain a wide advantage among religiously unaffiliated voters. Religious “nones” have become more Democratic over the past few decades as their size in the U.S. population overall and in the electorate has grown significantly. While 70% of religiously unaffiliated voters align with the Democratic Party, just 27% identify as Republicans or lean Republican.

Related: Religious “nones” in America: Who they are and what they believe

Over the past few decades, White evangelical Protestant voters have moved increasingly toward the GOP.

• Today, 85% of White evangelical voters identify with or lean toward the GOP; just 14% align with the Democrats.

• Over the past three decades, there has been a 20 percentage point rise in the share of White evangelicals who associate with the GOP – and a 20-point decline in the share identifying as or leaning Democratic. 

Over the past 15 years, the GOP also has made gains among White nonevangelical and White Catholic voters.

About six-in-ten White nonevangelicals (58%) and White Catholics (61%) align with the GOP.    Voters in both groups were equally divided between the two parties in 2009.

Partisanship among Hispanic voters varies widely among Catholics and Protestants.

• 60% of Hispanic Catholic voters identify as Democrats or lean Democratic, but that share has declined over the past 15 years.
• Hispanic Protestant voters are evenly divided: 49% associate with the Republican Party, while 45% identify as Democrats or lean Democratic.

A large majority of Black Protestants identify with the Democrats (84%), but that share is down 9 points from where it was 15 years ago (93%).

Atheists and agnostics, who make up relatively small shares of all religiously unaffiliated voters, are heavily Democratic.

Among those who identify their religion as “nothing in particular” – and who comprise a majority of all religious “nones” – Democrats hold a smaller advantage in party identification.

• More than eight-in-ten atheists (84%) align with the Democratic Party, as do 78% of agnostics.
• 62% of voters who describe themselves as “nothing in particular” identify as Democrats or lean Democratic, while 34% align with the GOP.

Voters who regularly attend religious services are more likely to identify with or lean toward the Republican Party than voters who attend less regularly.

In 2023, 62% of registered voters who attended religious services once a month or more aligned with Republicans, compared with 41% of those who attend services less often.

This pattern has been evident for many years. However, the share of voters who identify as Republicans or lean Republican has edged up in recent years.

For White, Hispanic and Asian voters, regular attendance at religious services is linked to an increase in association with the Republican Party.

However, this is not the case among Black voters.

Only about one-in-ten Black voters who are regular attenders (13%) and a similar share (11%) of those who attend less often identify as Republicans or Republican leaners.

Higher GOP association among regular attenders of religious services is seen across most denominations.

For example, among Catholic voters who attend services monthly or more often, 61% identify as Republicans or lean toward the Republican Party.

Among less frequent attenders, 47% align with the GOP.

Black Protestants are an exception to this pattern: Black Protestant voters who attend religious services monthly or more often are no more likely to associate with the Republican Party than less frequent attenders.

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Key facts about hispanic eligible voters in 2024, key facts about black eligible voters in 2024, key facts about asian american eligible voters in 2024, republican gains in 2022 midterms driven mostly by turnout advantage, most popular, report materials.

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