As humanitarian organizations are struggling to reach an increasing number of beneficiaries, humanitarian-business partnerships, such as the use of logistics service providers (LSPs), promise to improve effectivity and efficiency of humanitarian assistance. Blockchain-based smart contracts which ensure automation, transparency, and efficiency promise to facilitate partnerships, particularly if trust is low. In this paper, blockchain-based smart contracts are critically examined for their application to humanitarian supply chains (HSCs). We identify various adoption barriers which we categorize into organizational, technological, and environmental. As the use of blockchain-based smart contracts in HSCs is in its early stages, we propose future research propositions and directions that can provide insights into overcoming barriers and challenges of adopting the technology in the humanitarian sector.
Objective: This exploratory study examines how distributed ledger technologies could be used within the plasma derivatives supply chain. The plasma derivatives are used increasingly in the pharmaceutical market and the supply chain is global. However, there are significant risks relating to the governance of the supply. The risks include unclear origin of plasma and the propagation of contaminated or poor-quality blood to the pharmaceutical production process. From an ethical perspective, the risk is that vulnerable individuals are exploited in the donation process. Finally, the plasma supply chain currently depends on only a few exporters of plasma, which presents a supply chain risk. Design: The blockchain technology is piloted in other areas of pharmaceutical supply chains and in this study we examine those solutions and conceptualize how a similar solution can be applied to the plasma supply chain. We identify risks within the plasma supply chain and discuss how blockchain-based solutions can mitigate those risks. Results: Drawing on existing literature within the pharmaceutical blockchain arena, we introduce a solution to verify the origin of plasma. We also model how the blockchain technology can be used to tackle ethical and supply chain risks. Conclusions: Blockchain can have a role in mitigating plasma supply chain risks. The area is, however, novel and requires more research.
Blockchain technology is swiftly entering the fields of humanitarian and development aid. While it has the potential to revolutionize the aid sector, e.g., through pairing smart contracts with forecast-based financing, it also has the potential to perpetuate societal problems and add new risks. This essay outlines the use cases of Blockchain technology for the humanitarian and development sectors and reflects on potentials and pitfalls that come with the adaptation of this new technology.
Liver disease is a significant problem in Pakistan. In a country of approximately 200 million people, 5% (10 million) are infected with hepatitis C virus, and more than 2 million are in need of liver transplantation to save their life.1,2 Pakistan's first liver transplant was performed in 2003 in an international collaborative effort at the Sind Institute of Urology and Transplantation in Karachi. Activities in liver transplantation had been on a hiatus until 2011 when a team of local doctors performed a deceased donor liver transplant in Lahore. From 2012 onward, a number of centers undertook the challenges in developing living donor liver transplant programs across the country. The provinces of Punjab and Sind have been in the forefront of liver transplant activity in Pakistan (Figure 1).FIGURE 1: Centers with liver transplant activity across Pakistan until February 28, 2017.MEDICAL AND SURGICAL CHALLENGES Certain factors have been highlighted as potential obstacles to successful liver transplant activity in Pakistan.3 In the recent past, there has been a significant progress in assessing the burden of need while improving public awareness and readiness of medical facilities. However, a significant gap remains in supply and demands and is linked to funds, technical competence, skill transfer, and sustainability through incentivization and outcome assessment. The most critical factor in developing high-volume transplant programs across the country remains a lack of skilled workforce. Other than in 2 centers run by local teams, transplant numbers in centers that work with international collaboration remain very low (Table 1). Security concerns and visa delays make frequent travel by international teams a difficult proposition. Moreover, the parachuting approach of international transplant teams at various centers for short periods leads to interruptions in the continuity of care. Thus, the presence of efficient local transplant teams is critical in developing successful and sustainable transplant programs (Table 1). Until February 28, 2017, a total of 539 liver transplants have been performed in Pakistan, and approximately 95% of these were performed in the 2 centers run by local teams.TABLE 1: Transplant activity across various centers in the country up to February 18, 2017HEALTH ECONOMICS AND INSURANCE PATTERNS With the exception of a few countries, healthcare in the developed world is the government's responsibility.4 In contrast, healthcare financing in Pakistan is predominantly out of pocket.5 Although the healthcare system in Pakistan has evolved to a well-planned, district-based network of health facilities, the present system is finding it difficult to cope with growing pressure from an ever increasing population and awareness in people regarding their civil rights.4 Living donor liver transplantation is different from deceased donor liver transplantation in that, although requiring highly skilled surgical, medical, and intensive care facilities and infrastructure, it can be successfully accomplished by focusing resources and expertise in a single hospital rather than attempting to develop an entire transplantation infrastructure.6 Insurance coverage has not gained widespread acceptance in Pakistan owing to various sociopolitical and financial reasons. It has been shown that information asymmetry, adverse selection, moral hazard, and fraud raise concerns for the sustainability of insurance programs in developing countries.7 A living donor liver transplant in Pakistan costs between US $35 000 and US $45 000. Most of our patients are self-funded; however, in recent years, there has been increased support from government and philanthropic organizations. Financial restrictions continue to be the biggest hurdle in making liver transplant accessible to patients in need. RECIPIENT AND DONOR OUTCOMES Most transplant programs are still in their infancy in Pakistan, and published outcomes have therefore been limited. Nevertheless, 1-year survival rates of 87% have been demonstrated by one of the busiest transplant centers in Pakistan.3 Grade 3 or above Clavien-Dindo complications were seen in 52% patients, with 23% patients experiencing biliary complications. With regard to donor outcomes, an overall morbidity of 17% has been reported with a biliary complication rate of 3%.8 Based on personal communication, one donor mortality has been reported from one of the institutes in the Sind province resulting in a donor mortality of 0.2% in the country (Gambat Institute of Medical Sciences, oral communication, November 30, 2016). Until February 28, 2017, we have performed 408 LDLTs in our center. Estimates of 1- and 4-year overall survival are 83% and 77%, respectively. Overall, 21.4% of patients had a biliary complication, and there was no donor mortality. With a limited availability of deceased donors, auxiliary, swap, and domino transplants have also been performed to increase the donor pool. We have also accepted donors with hepatitis B core antibody positivity and Gilbert syndrome. ETHICS The Human Organ and Transplantation Authority regulates legal and ethical aspects of liver transplantation in Pakistan. The donors have to be legally (spouse, brother/sister-in-law) or blood related to the patient to be eligible for donation. This has been mandated based on previous reports of commercialization in kidney donations in the country.9 The decentralization of Human Organ and Transplantation Authority with the 18th amendment under the constitution of Pakistan has moved various ministries including the Ministry of Health from a central to a provincial control.10 Those changes have resulted into 5 autonomous provincial bodies regulating transplant activity, allowing a more stringent legal and regulatory process at the provincial level. At the same time, the current decentralized approach challenges the implementation of a future national transplant registry that may monitor transplantation activity and outcomes countrywide. FUTURE DIRECTIONS It is expected that transplant activity will continue to rise in the near future in Pakistan based on the tremendous burden of chronic liver disease and hepatocellular carcinoma. With structured training programs in place, current limitations in surgical/medical workforce are expected to improve. The self-sufficiency in regard to transplant infrastructure will reduce the reliance on international collaborations while providing a continuity of care for the ever increasing numbers of cirrhotic patients. Financial constraints will play a major role in expanding private sector transplant centers. The government will have to consider innovative ideas including private-public sector partnerships and proper incentivization of transplant personnel to make liver transplantation available to the underprivileged in Pakistan. The implementation of a National Transplant Registry is inevitable to ensure transparency in various steps of organ donation and outcome reporting while providing transplant services of international credibility.
Shantanu Bhattacharya, Sameer Hasija, Luk N. Van Wassenhove
We analyze the efficacy of different asset transfer mechanisms and provide policy recommendations for the design of humanitarian supply chains. As a part of their preparedness effort, humanitarian organizations often make decisions on resource investments ex ante because doing so allows for rapid response if an adverse event occurs. However, programs typically operate under funding constraints and donor earmarks with autonomous decision‐making authority resting with the local entities, which makes the design of efficient humanitarian supply chains a challenging problem. We formulate this problem in an agency setting with two independent aid programs, where different asset transfer mechanisms are considered and where investments in resources are of two types: primary resources that are needed for providing the aid and infrastructural investments that improve the operation of the aid program in using the primary resources. The primary resources are acquired from earmarked donations. We show that allowing aid programs the flexibility of transferring primary resources improves the efficiency of the system by yielding greater social welfare than when this flexibility does not exist. More importantly, we show that a central entity that can acquire primary resources from one program and sell them to the other program can further improve system efficiency by providing a mechanism that facilitates the transfer of primary resources and eliminates losses from gaming. This outcome is achieved without depriving the individual aid programs of their decision‐making autonomy while maintaining the constraints under which they operate. We find that outcomes with centralized resource transfer but decentralized infrastructural investments by the aid programs are the same as with a completely centralized system (where both resource transfer and infrastructural investments are centralized).