Seven steps in the value chain of health products for equitable access and delivery in low- and middle-income countries.

The introduction of health products to low- and middle-income countries (LMICs) is hindered by several barriers. Even when these barriers are overcome, improper use of health products can have a negative effect on health outcomes. Health products may go unused due to a mismatch of product needs as well as a lack of public infrastructure, spare parts and consumables, or trained technicians. This study presents a comprehensive framework of the essential steps for effectively delivering quality health products to people in need based on our document reviews and case studies. We divide the value chain of health products into seven steps: 1) situation analysis, 2) research and development, 3) regulatory authorization, 4) selection and prioritization, 5) public procurement, 6) distribution and storage, and 7) health service delivery. We find that the practice of undertaking one step at a time leads to enormous costs in terms of time and resources, often with little success. Failed attempts sometimes necessitate starting over from the beginning. Therefore, it is important to attempt each step while looking ahead to the end through the entire chain of seven steps. More in-depth analysis and lessons from best practices for each of the seven steps may need to be investigated further to consider possible interventions.