Evaluating the Synergistic Impact of Digital Logistics Systems (eLMIS) and Financial Auditing (APTS) on Essential Commodity Availability in Ethiopian Public Healthcare Facilities: A Multilevel Analysis of the 2024/2025 National Survey
Year: 2026
Type: preprint
Abstract: Background Chronic pharmaceutical stock outs hinder Universal Health Coverage in Ethiopia. To address this, the Ministry of Health introduced the electronic Logistics Management Information System for inventory visibility and Auditable Pharmaceutical Transactions and Services for financial management. However, no national study has tested their combined impact. This study evaluated the individual and synergistic effects of electronic Logistics Management Information System and Auditable Pharmaceutical Transactions and Services on essential commodity availability across Ethiopian public healthcare facilities. Methods We conducted a secondary analysis of the 2024/2025 Ethiopian Service Provision Assessment dataset utilizing 1245 public facilities nested within 125 clusters. The primary outcome was optimal essential commodity availability (zero stock outs and 100% tracer commodity presence). A two-level mixed-effects logistic regression model with an interaction term evaluated synergy, reporting Adjusted Odds Ratios with 95% Confidence Intervals. Results Overall optimal availability was 54.2% (95% CI; 51.4%–57.0%). Implementation rates were 41.2% for eLMIS, 38.2% for APTS and 26.5% for dual implementation. Facilities using eLMIS alone (AOR = 2.15; 95% CI: 1.52–3.04) and APTS alone (AOR = 1.82; 95% CI; 1.28–2.58) showed higher security. Dual implementation showed a profound synergistic effect (AOR = 4.32; 95% CI; 3.25–5.74, p < 0.001). Positive predictors included functional cold chains (AOR = 2.08), qualified staffing (AOR = 1.68), hub proximity (AOR = 1.58) and urban settings (AOR = 1.95). The model explained 66.2% of regional variance. Conclusion Dual implementation of electronic Logistics Management Information System and Auditable Pharmaceutical Transactions and Services creates a powerful synergistic impact on pharmaceutical availability. Synchronized national scale-up and cold chain investments are urgently needed to achieve supply chain resilience and Universal Health Coverage in Ethiopia.
Source: medRxiv
Institution: University of Gondar
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7221054566