To ensure that health centres have access to essential medical products such

To ensure that health centres have access to essential medical products such as medicine to meet the needs of patients, a well-functioning supply chain is necessary, which includes procurement, appropriate warehousing and efficient transportation (Yadav, Stapelton, & Van Wassenhove, 2011). Also, because the health care industry is undergoing major revolutions as far as supply chain management is concerned in both developed and developing countries (Bartlett, 2009; Su, Chou, Hsu, & Ho, 2009), supply chain management is therefore important for quality healthcare delivery. This arises from the fact that healthcare is so dependent on the availability of drugs and other medical supplies at the right time and in the right quantities for the management of patients. Lack of the medical supplies at the point of need can lead to an unnecessary loss of lives which could otherwise have been prevented. It is in this regard this study aims at determining the supply chain management practices of healthcare facilities and its effect on the performance of the facilities.The supply chain concept is theorized from the formation of a value chain network consisting of individual functional entities committed to providing resources and information to achieve the objectives of efficient management of suppliers as well as the flow of parts (Lau & Lee, 2000). Therefore, supply chain management (SCM) is recognised as a modern concept that leads in achieving benefits of both operational and strategic nature (Al-Mudimigh, Zairi & Ahmed, 2004). SCM involves not only the integration of key business processes within the organization but also the integration of these processes throughout the entire supply chain (Croxton, Garcia-Dastugue, Lambert, & Rogers, 2001). SCM could further be described as the chain linking each element of the manufacturing and supply process from raw materials and ending with the user, encompassing several organizational boundaries (Scott & Westbrook, 1991; New & Payne 1995). According to this broad description, SCM includes the entire value chain and addresses material and supply management from the extraction of raw materials to its end of useful life (Tan, 2001).The healthcare supply chain is composed of three major players at various stages, namely, producers, purchasers, and healthcare providers. Producers include pharmaceutical companies, medical surgical products companies, device manufacturers, and manufacturers of capital equipment and information systems. Purchasers include grouped purchasing organizations (GPOs), pharmaceutical wholesalers, medical surgical distributors, independent contracted distributors, and product representatives from manufacturers. Providers include hospitals, systems of hospitals, integrated delivery networks (IDNs), and alternate site facilities (Toba et al, 2008).Effective supply chain management is important to building and sustaining competitive advantage in product and services of organisations. According to D’Amours, Ronnqvist, and Weintraub (2008), companies resort to supply chain practices to improve their performance. Due to this supply chain management is applied by companies across the globe due to its demonstrated results such as delivery time reduction, improved financial performance, greater customer satisfaction, building trust among suppliers, and others. Gunasekaran and Ngai (2004); Sufian (2010) indicate that the performance of supply chain is influenced by managing and integrating key element of information into their supply chain. To achieve effective supply chain integration, the firms need to implement information technology (Handfield & Nichols, 2002; Sufian (2010). Brandyberry et al. (1999) suggests that by using technology of information, the firms could managing the flow and impact of numerous supply chains dimension, such as quality, cost, flexibility, delivery, and profit. Byrd and Davidson (2003) also observe that information technology impact the supply chain effectiveness.Supply chains are critical in defining the ultimate cost and accessibility of medicines. A well-functioning health supply chain provides broad geographic access to affordable, high-quality products. In addition, good supply chains operate with efficiency, adaptability, and financial integrity. SCM also ensures product availability as a measure of supply chain performance (WHO/HAI, 2008). Given that importance of SCM to the health sector, it is thus important to understand the extent implementation of supply chains management principles to ensuring performance of healthcare facility in terms of efficiencies of operation, quality of healthcare service delivery and patients’ satisfaction using Tema Metropolis for the study.1.2 Statement of the Problem The Ghana public health sector runs a three-tier system of managing health commodities. Suppliers, the medical stores (Central Medical Store, Regional Medical Store and Service Delivery Points) and the transportation system form the supply chain. Ghana Health Service logistics system is centralized and the healthcare delivery system is decentralized. Supply chain management in the health system is crucial. The importance of strategic supply chain management in the Ghana Health Service system cannot be overemphasized. Poulin (2007) argues that logistics accounts for a sizeable portion of a hospital’s operating budget. Poulin (2007) has observed that 30% to 46% of hospital expenses are invested in various logistical activities and that almost half of the costs associated with supply chain processes could be eliminated through the use of best practices. Supply Chain Management (SCM) practices therefore can play a major role in the availability of the pharmaceutical and non-pharmaceuticals. This in turn can impact on the performance of the healthcare institutions. Supply chain management practices and innovation have been found to positively influence supply chain performance as well as the overall performance of the organizations (Ling & Ling, 2012). Although many healthcare organizations have recognized the importance of adopting supply chain management practices, the application of techniques, methods and best practices originally developed in an industrial setting clearly is often problematic. Organizations even with most efficient internal processes do not facilitate supply chain management across borders. Also, the healthcare supply chain is frequently described as highly fragmented and relatively inefficient (Schneller & Smeltzer, 2006). A major problem with the traditional healthcare supply chain is that each stage of the supply chain operates independently, leading to misaligned incentives and conflicting goals that prevent the supply chain from operating as a system. Collaboration is minimized and other players resort to traditional methods of operations that may not be cost effective (Muturi, 2010).In developing countries like Ghana, government have invested heavily in building hospitals, polyclinics, and CHPS compounds and also introduced the National Health Insurance Scheme (NHIS) with the ultimate objective of providing accessible, affordable and quality healthcare’s services to public. However, in spite of these improvements, the healthcare industry still have challenges in ensuring efficient supply of medicine to health centres. There are instances where medicines and health commodities are not available at the Central Medical Stores and the Regional Medical Stores. In another situation, medical products are available at the Central Medical Stores and the Regional Medical Stores but are not available at the point of healthcare delivery. Bossert et al., (2004) study on the health logistics systems in Ghana revealed that worse performance was related to procurement, inventory control, storage, logistics management information systems, training, and client contact. Bossert et al., (2004), logistics systems can be effectively decentralized for some logistics functions while others should remain centralized. This challenges of effective medical supply chain practices has led non-availability of essential medical products in healthcare facilities. Patients are often made purchase medical products from private pharmaceutical shops before treatment. This can add to the usual delays in health centres across and therefore hamper the efficiency of operation of health centres in the country. This raises pertinent issues regarding the extent of implementation of supply chain management practices to ensure efficient supply of medical products to the healthcare centres in the country. It is in this vein, the current study is conducted to examine the effect of medical supply chain management practices on the performance of public health facilities in Ghana using Tema Metropolis for the study.1.3 Objectives of the studyThe main objective of the study is to examine the role supply chain management (SCM) practices in ensuring efficient delivery of medical products to healthcare facilities in Tema Metropolis. To achieve the main objective, the specific objectives are:i. To determine the extent of application of medical supply chain management practices by healthcare facilities in Tema Metropolis.ii. To examine the relationship between medical SCM practices and performance of healthcare facility in Tema Metropolisiii. To identify the challenges of effective medical SCM practices to ensuring effective delivery of medical products to healthcare facilities in Tema Metropolis. 1.4 Research Questions The study finds answers to the following research questions:i. What is the extent of application of medical supply chain management by healthcare facilities in Tema Metropolis?ii. What is the relationship between medical SCM practices and performance of healthcare facility in Tema Metropolis? iii. What are challenges of effective medical SCM practices to ensuring effective delivery of medical products to healthcare facilities in Tema Metropolis?1.5 Research HypothesesH1: the extent of application of supplier relationship management component of SCM practice has significant effect on the performance of public healthcare facilities in Tema Metropolis.H2: the extent of application of the customer relationship management component of SCM practice has significant effect on the performance of public healthcare facilities in Tema Metropolis.H3: the extent of information sharing in SCM practice has significant effect on the performance of public healthcare facilities in Tema Metropolis.1.6 Significance of the studyThe health commodity supply chain in the public sector in Ghana is constituted by the Central Medical Store, and a network of Regional Medical Stores (RMS) in each of the ten administrative regions of the country. Drugs and supplies, including contraceptives, are managed through this supply chain to health facilities throughout the country. Therefore, extent of implement of SCM practices will ensure efficient delivery of medical products to health facilities in the country. The findings of the study will provide information about the extent of application of SCM practices to ensuring availability of medical products to healthcare centres. This information will be useful in assessing the performance of public health facilities in the Tema Metropolis. The findings of the study will provide information for policy makers such as the government or the Ministry of Health (MoH) to ensure implementation of pragmatic policies aimed at achieving effective supply chain management in the health sector. The finding will help enhance the collaboration and relationship between the government and its main actors in the medical supply chain process such as producers and suppliers so that manufactures and suppliers of medical products do not stop supplying products to government. This will further ensure availability of medical products and equipment to public health facility to enhance the quality of healthcare service delivery to clients or patients. On the whole, the findings of the study will ensure effective functioning of the health sectors as a whole and also ensure government provides accessible, affordable, and quality health service through the National Health Insurance Scheme.The finding of the study will also provide information regarding the factors hampering effective application of SCM practices to ensure efficient delivery of medical products for appropriate measures to be taken to address the challengesThe study may also be useful to scholars and academicians. It will provide useful information to potential and current scholars on supply chain management particularly in the health sector. Therefore, the findings of the study will add information to the extant literature on supply chain management for future studies.1.7 Research MethodologyIn terms of the choice of research method, this study adopted a cross-sectional survey and mixed method and quantitative method. The quantitative methodology was adopted because, it provides findings which are objective and devoid of the opinion of the researcher. The choice of a survey for the research design helps to provide a quantitative or numeric descript ion of trends, attitudes, or op in ions of a population (Creswell, 2009). A questionnaire was used as primary data collection instrument. The questionnaire contained close-ended type of quest ions. The close-ended quest ions helped to provide numeric information (quantitative data). The study targeted employees of public health centres in Tema Metropolis. The employees included personnel in the Municipal Health Directorate, health administrators, doctors, nurse, pharmacies, and medical logistic managers. Therefore, Both management and non-management staff of public health centres were included. The data analysis involved both descriptive and inferential statistical tools. Data analysis was done using SPSS.CHATER TWOLITERATURE REVIEW2.1 Introduction This chapter reviews literature on the concept of supply chain management, its objectives, and SCM practices. It also looks at the concept of competitive advantage, and the relationship between SCM and competitive advantage. The chapter ends with the design of a conceptual framework.2.2 Supply Chain Management (SCM)A supply chain is network of actors that transform raw materials into distributed products. But, as the name states, the supply chain has traditionally been considered as a chain of actors. Furthermore, the supply chains were considered to be a form of long-term upstream co-operation. In the early 1990’s, supply chains were still perceived as linear companies’ linear chains (Kemppainen & Vepsalainen, 2003). Supply chain as a concept, has been understood, not as chain but as a network. Christopher (1998, p. 15) describes supply chain as follows: “The supply chain is the network of organisations that are involved