Harwin de Vries: "Enhancing Health Product Availability in the Presence of Severe Cash Constraints in Kenya

Access to essential medicines and other health products remains a challenge in low- and middle-income countries, particularly in rural areas. Community health entrepreneurs (CHEs) play a key role in bridging this gap by selling health products in small rural stores. However, CHEs frequently experience stock-outs due to cash constraints. How to address this problem in the context of rural areas in low- and middle-income countries is currently unclear. We address this by conducting a mixed-methods study. We perform a large-scale, partially randomized field experiment that tests two interventions with 458 CHEs in Kenya in collaboration with social enterprise Healthy Entrepreneurs (HE). The first involves setting up stock-hubs — small consignment stock locations where CHEs can replenish their inventory on-the-spot. The second is a cashflow game designed to help CHEs internalize the high potential return of reinvesting revenues in their business. We also conduct interviews with CHEs and HE staff members. Our results show that the stock-hubs can successfully address cash constraints and contribute to improving the availability of health products, but the cost of accessing the products at the hub must be low and the stock-hub coordinator must meet certain criteria. The cashflow game successfully addressed cash constraints for CHEs that had low historical sales performance. This study is one of the first field experiments that provides insights into addressing cash constraints in areas with high resupply costs and long resupply intervals.

Harwin de Vries is Associate Professor at the Technology and Operations Management department at RSM. His research focuses on health & humanitarian logistics, with a particular focus on disaster relief logistics and access to essential medicines and health services in LMICs.