Running head: KUCHENA CELESTINO SUPPLY CHAINS AND POLICIES
Kuchena Celestino Government Policies and Pharmaceutical Supply Chains
C. Kuchena
University of Zambia
GSB 8103
Dr. Abubaker Qutieshat
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In the view of Cresswell and Creswell (2018), there are three approaches to research: the
qualitative, quantitative, and mixed methods. The distinction between the three is not so much in
absolute terms but they lie on a continuum. Qualitative methods on one end and quantitative
methods on the other with mixed methods in between. A holistic way to differentiate these
methds looks at the underlying philosophical assumptions held by the researchers, the nature of
research strategies used in the research, and the specific methods and tools used to conduct these
strategies (Cresswell &Cresswell, 2018).
Quantitative research is mainly used to test objective theories by investigating the
relationship among variables. It looks to find out how variations in the independent or predictor
variables affect the dependent variables therefore it is deductive. The final write-up has a
determined structure entailing the introduction, literature and theory, methods, results, and
discussion. The mixed methods approach involves collecting both quantitative and qualitative
data. This is informed by the belief that that the combination of qualitative and quantitative data
elicits further awareness beyond that yielded by either the quantitative or qualitative data alone.
Further along the continuum lies qualitative research. This method seeks to discover and
understand the meaning individuals or groups assign to a social or human challenge. Choosing
this approach implies assuming an inductive style that focuses on how individuals create
meaning, and how circumstances shape this meaning from complexity. Consequently, the final
write-up has a flexible structure.
In summary, researchers should reflect on their ontological and epistemological
ssumptions that influence their study, the research design associated with this worldview, and the
particular methods or procedures of research that operationalize the approach into practice
(Cresswell & Cresswell, 2018). This study is mainly motivated by the belief that people make
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sense of the world as they perceive it and interact with other people in it (Berger & Luckmann,
1967). In addition, the study seeks to solve a “real-life” problem and therefore focuses on
practical policy recommendations. As a result, I will vacillate between the qualitative end of the
ontological spectrum to a midle-ground if the research processes demand so.
My perspective
According to Berger and Luckmann (1967), individuals form subjective meanings of
their experiences that are multiple and varied. Resultantly, researcher are led to look out for the
complexity of interpretations rather than reducing meanings into narrow categorizations. The
main objective of the research is to largely depend on the participants’ perception of the
circumstances under study. This study seeks to understand how individuals within organizations
that are part of the pharmaceutical supply chains interprete the challenges faced by their
organizations as they relate to government policies. This line of thinking requires a constructivist
approach to address how organizations interact with the environment. Furthermore, having
observed that organizational leaders’ views of the environment and subsequent organizational
response are reliant upon each leader’s worldview, the study will focus on the precise settings in
which these leaders live and work in order to comprehend the historical and cultural backgrounds
of the participants.
My training has largely been on the scientific approach but I have appreciated that some
conflicts arise in part due to differences in the worldview. I have come to understand that a
postpositivist and scientific approach to policy research masks the complexities surroundings
contextual differences. With this in mind, I am concerned with understanding how organizational
leaders of pharmaceutical wholesalers and manufacturers in Zimbabwe conceive of the
challenges they face as well as potential solutions. The challenges are those they feel are
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associated with government policies. They may have been brought about by policies being
implemented, or are avoidable if certain policies are implemented or both. This is an inductive
study that will seek to understand the opinions of the research participants and gain a pattern of
meaning.
Research Approach
In speaking about qualitative analysis, we are referring not to the quantifying of
qualitative data but rather to a nonmathematical process of interpretation, carried out for the
purpose of discovering concepts and relationships in raw data and then organizing these into a
theoretical explanatory scheme.Strauss & Corbin p.11Grounded theories, because they are drawn
from
data, are likely to offer insight, enhance understanding, and provide a meaningful guide
to action. Strauss & Corbin 1998p.12
To begin with, let us assure our readers that there is no need to
review all of the literature in the field beforehand, as is frequently done by analysts using
other research
approaches. It is impossible to know prior to the investigation what the salient problems
will be or what
theoretical concepts will emergeStrauss & Corbin 1998p.49
Qualitative research is more appropriate when the goal is to comprehend the contexts or
backgrounds in which participants in a study make sense of challenges and phenomena.
Sometimes, qualitative research is the viable option simply because quantitative tools and
statistical analyses just cannot fit the problem. Social interactions are challenging to fully
KUCHENA CELESTINO SUPPLY CHAINS AND POLICIES
appreciate with existing categories because this may not be sensitive to nuances such as gender,
race, economic status, and individual differences. A qualitative approach is ideal for such
research because of its evolving design, ability to elicit multiple realities, and usage of the
researcher as an instrument of data collection with a focus on participants’ views (Cresswell &
Poth, 2018). In contrast to ex-post explanations, qualitative methodology aims at findin
explanations directly in the field, by employing such methods as interviews or
observations. Qualitative research is well suited for the exploration of participation
from a holistic perspective because it places an “emphasis on people’s lived experience”
(Miles and Huberman, 1994, p. 10), masters complexity (Usunier, 1998) and leads to
new theoretical insights (Glaser and Strauss, 1967). For these reasons, qualitative
methodology constitutes an addition to the body of cross-cultural knowledge on
participation built through quantitative inquiry. This article demonstrates how a
qualitative
study using elements of the grounded theory approach can generate country-specifi
models of participation, allow comparison between countries, as well as enrich and
clarify the results of quantitative inquiry. It was further decided to work with a small
number of interviewees per
country, applying the principle of maximal differentiation as a sampling strategy
(Agar, 1996). Maximising differences means that within each country, the interviewees
are as different as possible in as many aspects as possible, e.g. in age, gender and
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functional area. Miles and Huberman (1994) argue that the data from a small number of
respondents sampled according to this strategy reveals patterns of common
understanding shared by the majority of the members of the wider population. Data
resulting from
interviews with no more than five managers turned out to be rich enough to detect
stable patterns and build a country-specific model of participation. Furthermore, asking
for personal experiences rather than
abstract statements also helped minimise the bias. Detailed attention was paid to the
“courtesy
bias” (Usunier, 1998, p. 121), the risk of shaping answers to please the interviewer.Szabo
2006
This study seeks to understand how organizations perceive the policy environment and
shape their responses. The ultimate goal is to theorize on the processes by which these
organizations make their reality and live in it. This research therefore demands usage of the
Grounded Theory Method (GTM).
Research Design
A research design refers to the plan for conducting a study (Cresswell & Poth, 2018).
Research designs are forms of inquiry across qualitative, quantitative, and mixed methods
approaches that guide procedures in a research study. Grounded theory is a qualitative research
design through which the researcher generates a wide-ranging account of a process, an action, or
circumstances based on the views of a large number of participants. This qualitative design was
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advanced in sociology in 1967 by two researchers, Barney Glaser and Anselm Strauss, having
observed that theories used in research were often ill-equiped for study participants (Cresswell &
Poth, 2018). Corbin and Strauss (2015) advocated for a postpositivistic approach to GTM. They
advised on following a structured method which culminated in a report similar to those of a
quantitative nature. This method is useful for novices who want an easier grasp of the method
but Charmaz (2014) offers a constructivist and therefore interpretive perspective on grounded
theory. This latter method resonates well with me because I intend to focus on gaining a full
comprension of how organizational leaders in the health supply chain construct reality and
respond to it.
Data will primarily be collected from interviews while repetitively comparing this data
with emerging concepts. This iterative process seeks to fill in gaps in the theory with data. This
is the grounding of theory. Strauss and Corbin focus on categories, codes, and codings and the
systematic procedures led by the continuous evaluation of data from the participants with
emerging classifications. In contrast, the contructivist approach emphasizes theory development
ensuing from a co-construction process reliant on researcher exchanges with participants.
Charmaz advocates for a social constructivist perspective that emphasizes assorted local and
multiple realities, and the complexities of specific worlds, views, and actions.
This constructivist grounded theory, according to Charmaz (2014), fits the interpretive
approach to qualitative research with flexible guidelines. This design stresses the views, values,
beliefs, feelings, assumptions, and ideologies of individuals rather than the methods of research
even though Charmaz (2014) delineates the acts of gathering rich data, coding the data,
memoing, and using theoretical sampling. This will be done in simple terminology because
complex phrases, diagrams, conceptual maps, and systematic approaches undermine grounded
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theory and are interpreted as an attempt to gain power. The study will rely on active codes
(Charmaz, 2014) for analysis.
Research Methods
The choice of methods depends on whether the intent is to specify the type of information
to be collected in advance of the study or to allow it to emerge from participants in the project.
interpret the themes or patterns that emerge from the data. If some phenomenon needs to be
explored and understood because little research has been done on it or because it involves an
understudied sample, then it merits a qualitative approach. Qualitative research is especially
useful when the researcher is uncertain of which variables to examine. Qualitative approaches
permit innovation and capacity to use researcher-designed frameworks. Furthermore, they
tolerate a more creative and literary-style of writing.
Grounded theory methods are guidelines that help researchers “(a) to study social and
social psychological processes, (b) to direct data collection, (c) to manage data analysis, and (d)
to develop an abstract theoretical framework that explains the studied process” (Chamarz, 2003).
In line with advice from Chamarz (2003), I have formed some questions regarding challenges in
the pharmaceutical supply chain and how they relate with government policies to interview some
organizational leaders within the pharmaceutical industry in Zimbabwe. The responses to these
questions will elicit participants’ concerns which in turn generate further questions. This iterative
process continues until saturation. Theoretical saturation was controlled in two
ways: the first criterion concerned the number of new codes per interview, whereas the
second was related to open questions about concepts and their relationships. Szabo2006
KUCHENA CELESTINO SUPPLY CHAINS AND POLICIES
Validation
In grounded theory, asking questions and constant comparison are the two main
procedures throughout the complete analysis process. Questions and comparisons
increase the likelihood that “analysts will discover both variation and general patterns”
(Strauss and Corbin, 1998, p. 85) and support the generation of abstract concepts.
Furthermore, these procedures ensure that validation of the findings is incorporated
into every step of the analysis (Strauss and Corbin, 1998). The current study utilised
the two procedures extensively. Moreover, questions and emerging concepts were
stored in “memos” to facilitate the analysis process. Using memos also helped detect
possible blind spots resulting from my own cultural conditioning. Further validation
was sought by presenting the emerging country-specific models of participation to
local research colleagues for their feedback.Szabo 2006
Research questions
1. How do pharmaceutical manufacturers and wholesalers in the medicine supply chain
view the main challenges affecting components of the pharmaceutical logistics cycle in
Zimbabwe?
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2. How do pharmaceutical manufacturers and wholesalers in the medicine supply chain
understand how the policies, rules or regulations affect each component of the
pharmaceutical logistics cycle in Zimbabwe?
3. In the minds of the pharmaceutical manufacturers and wholesalers, how does the
relationship between the policies, rules or regulations and the challenges affect the
pharmaceutical logistics cycle in Zimbabwe? How can the challenges be mitigated?
Gaps in supply chain research
A holistic approach to pharmaceutical supply chains that seeks to improve the public
benefit despite which sector (profit or not-for-profit) serves people is necessary. Some scholars
advise governments to implement policies that intentionally engage the private sector to cater to
local environments. Though policymakers, academics, consultants, and experts recognize the
importance of healthcare supply chain investments, a deep and structured understanding of the
main reasons for underperformance in healthcare supply chains is missing (Yadav, 2015).
Yadav, however, is looking at supply chains from a scientific approach which may miss
contextual implications.
From a review of literature, Mackintosh et al. (2018) observed that “deliver” frameworks
concentrate on logistics, while health system-based frameworks are inclined to neglect
procurement so they focused on how procurement can be used to improve pharmaceutical supply
chains. In short, most studies on supply chain management focus on the activities in the logistics
cycle but not the context in which these are implemented. In turn, Matanje Mwagomba et al.,
(2018) researched integrating HIV and NCD treatment programs focusing on reviewing policy
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documents. This study focused on harnessing lessons from HIV programs to incorporate NCD
programs. Tibandebage et al. (2016) noted that industrial policy literature is scant on
mechanisms to ensure ongoing engagement between government and manufacturers to enable
constant technological upgrading.
They advise that the dwindling pharmaceutical sector presents a fertile field for research
in policy renewal because of its perceived strategic importance. Gebre-Mariam et al. (2016)
summarised the debate on local pharmaceutical production in developing countries. From a
Smithean comparative advantage viewpoint (given as domestic resource costs), developing
countries should sacrifice pharmaceutical production and import cheaper finished products. In
contrast, accounting for the upstream and downstream linkages and benefits that accrue from a
holistic industrial development perspective then some proponents argue that essential medicines
are strategic products and local production guarantees self-reliance.
A country’s domestic consumption of pharmaceuticals is determined by its health care
expenditure and structure as intimated by Banda et al. (2016). This makes it worthwhile to
understand how the actors in the pharmaceutical chain view the current government expenditure
on health. While Banda (2013) looked at how pharmaceutical manufacturers utilized innovative
financing mechanisms to remain resilient, this did not seek to address how broad government
policies created the context in which the organizations operate. The BMI Report (2016)
concluded that the Zimbabwean pharmaceutical market is greatly weakened by the country’s
politico-economic crises and was not projected to make a significant recovery in the next five
years. How the actors in the pharmaceutical industry view this politico-economic stability’s
effects on the supply chains is worth studying. Consequently, a look into how the Zimbabwean
pharmaceutical supply chains are shaped by and in turn shape government policies is necessary.
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Zimbabwe underwent a political transition following the resignation of President Mugabe
in November 2017. The new government has dubbed itself the “New Dispensation” and vowed
to implement policies that aim for growth and comparatively different from the previous regime.
Furthermore, there have been terminations for long-serving senior personnel at the Ministry of
Health and Child Care and the National Pharmaceutical Company of Zimbabwe as well as a
switch from John Snow to Chemonics International as a development partner implementing
USAID projects. This makes Zimbabwe a context that can add to theories regarding policy
interactions and supply chain structure and performance.
This context makes Zimbabwe a worthwhile case study of how government policies are
affecting the medicine supply chains in light of a regime seeking to differentiate itself from a
previously failing one. This is imperative in Africa because the leading public health perception
dismisses how industrial and medical technology development in a country determines the
operation of health systems and global procurement has been touted as a solution assuming ready
availability of medicines from global value chains (Mackintosh et al., 2017).
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