Date of Award

January 2011

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Seth D. Dodds

Second Advisor

Jonathan N. Grauer

Subject Area(s)

Public policy, Surgery

Abstract

More than any other surgical subspecialty, orthopaedic surgery relies heavily on the use of implants and instruments, particularly in the provision of trauma related orthopaedic injuries, which are increasingly prevalent in low-income countries (LICs). The current international response to improving musculoskeletal care in LICs, is primarily geared towards increasing the donation of supplies used in orthopaedic surgical procedures. This study outlines the current response, and assesses the supply chain component of international aid efforts to improve fracture care. It then explores this component with a goal of determining how a sustainable source of functional implants can be delivered to skilled surgeons, to maximize the synergy of appropriate training and proper equipment towards delivering safe, simple and cost effective orthopaedic care in resource poor settings. There are two hypotheses: The first claims that the creation of a `coordinating unit' authorized to manage the supply donation process and the stakeholders involved, will improve the delivery of musculoskeletal care in LICs. The second claims that the implementation of a virtual and physical supply chain platform will improve the delivery of musculoskeletal care in LICs. The hypotheses propose that a correlation exists between optimization of the donation process and the achievement of improved delivery of musculoskeletal care. The research methodology is qualitative, consisting of interviews and observations, field research, literature reviews and case studies. Study findings reveal that conducting local needs assessments, helping recipients identify and

communicate demands, and confirming the presence of adequate local infrastructure and workforce capacity to receive and utilize donated equipment, are essential steps that should be executed prior to the deployment of donations, both within disaster and non- disaster contexts. In addition findings indicate that investment in logistical platforms and supply chains to manage donations, and establishment of a central coordinating unit to link stakeholders and information exchange, are highly instrumental in optimizing the provision of supplies and thus the delivery of orthopaedic care. The study results support the hypothesis that a `coordinating unit' can provide a standard approach towards assessing need, capacity, and resource inventory, and can coordinate stakeholders in a manner that maximizes the use of individual and corporate donations, and supports the surgical capabilities of surgeons and healthcare workers delivering musculoskeletal care in LICs.

Comments

This is an Open Access Thesis.

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