Global Impacts of Healthcare Supply Chain Issues

“How can you do actually more with less, spending less money, but being able to deliver more in terms of access of health products to patients,” shared Karimi.

It may be inconvenient going to a store looking for a particular product and coming away empty-handed. But if the item you need is a healthcare product, the situation becomes dire and could be the difference between life and death. 

Amir Karimi, assistant professor of operations and analytics, studies how logistics and supply chain issues impact health care globally, particularly in low- and middle-income countries.

Listen to hear how small changes can lead to dramatic outcomes across the globe.

Stay connected with the UT San Antonio Carlos Alvarez College of Business to learn more about how we are empowering the next generation of business thinkers. Follow us on social media or visit us online at business.utsa.edu

Transcript

SPEAKER_01 0:00

How can you do actually more or less? Spending less money? Or perhaps you know being able to deliver more in terms of access of health products to patients?

SPEAKER_03 0:11

It may be inconvenient going to a store, looking for a particular product, and coming away empty-handed. But if the item you need is a healthcare product, the situation becomes dire and could be the difference between life and death. Welcome to another episode of Inside Alvarez Business, a podcast dedicated to bringing you the stories behind the research. I'm your host, Jonathan Halbesleiban, Dean of the Carlos Alvarez College of Business at the University of Texas at San Antonio. This season we're focusing on the business of healthcare. We're sharing the stories of our faculty, the real-world impact of their research, and what led them to study these important topics. Our guest today is Amir Karini, an assistant professor of operations and analytics in the Alvarez College of Business. Amir studies how logistics and supply chain issues impact healthcare globally, particularly in low and middle-income countries. Listen to hear how small changes can lead to dramatic outcomes across the globe. So, Amir, welcome again to Inside Alvarez Business. Looking forward to hearing the stories behind your research. So to get started, I'm always interested in how people got into their academic careers. I mean, that you know, as I mentioned at previous guests, like nobody grows up thinking I'm gonna be a professor. Like that's just not that's not very common. How did you get into your what inspired you to become an academic?

SPEAKER_01 1:30

Yeah, that that's an excellent question. I feel like so I grew up in Iran, and you know, I think the the way universities work in Iran are probably a little bit different than maybe um what Americans are used to. It's not necessarily that you're following your passion. I think it could be more so that maybe uh some trends you may follow. Like people, I think typically, like, so for first of all, there's like a nationwide entrance exam, which is very competitive because to get to the best schools, you need to study hard and whatnot. But then when it comes like to selecting where you want to go, like typically I think people just start with with engineering, let's say electrical, computer, mechanical, without even knowing actually what those subjects are all about.

SPEAKER_03 2:12

Oh, interesting.

SPEAKER_01 2:13

Okay, yeah. So they they could actually get into it and they may feel like oh, this is not actually something that I may even like. Right. So for me, I followed this typical, you know, pathway, entrance exam. So I ended up with something that was called industrial management. Okay, so not engineering. So I feel like actually, most probably Iranians that you find at schools in the US, like they've come from Iran. I think they most most of them have some engineering background. So I think mine, I guess, is a little bit different, has some similarities to industrial engineering, but I think there has bigger focus on business, I would say. Okay. So they cover like industrial psychology and some of these other topics. Okay. So then for me, there was a stage in time where I felt like it would actually be kind of cool to get a little bit of exposure to see what is also happening outside Iran, you know, and explore opportunities. So I think this field, like supply chain management, operations management, was the natural fit given my background.

SPEAKER_03 3:15

Okay.

SPEAKER_01 3:16

I think that's how I got into this field, but I did not really envision like the possibilities that lie ahead. Okay. So right now, I think I've found the niche topic that I really like.

SPEAKER_02 3:26

Yeah.

SPEAKER_01 3:26

I'm passionate about. I don't think I I knew about it actually. Okay. Uh, before getting into the field, like starting the PhD program.

SPEAKER_03 3:33

Oh, okay, that's really cool. So you kind of discovered it. Yes, like you you decided to pursue the PhD and then you sort of discovered the passion.

SPEAKER_01 3:41

That's exactly right. Yeah. And I thought actually a PhD maybe is it's kind of fail-proof because they're gonna fund me, you know, it's funded. Most PhD programs are funded in the US.

SPEAKER_02 3:51

Yeah.

SPEAKER_01 3:51

And if I end up not liking it, I mean I can just, I guess, always go back home. That that wasn't my vision, you know. Okay, great.

SPEAKER_03 3:59

So, and then, you know, and maybe this fits with the the you mentioned about the uh the passion and and discovering that, but a lot of you a lot of your work, or really guess all of your work has really been around the healthcare industry. And how did how did that become the area that you focused on?

SPEAKER_01 4:14

Yeah, excellent point. So, and again, I as I started exploring, which I think at Pierce 2 program does a lot of pressure on you to find a topic, and I was exploring different things, what is feasible and not. But like from very early on, I felt like pursuing the bottom line, it's not necessarily my passion, you know, and I can't force it. You know, it's if it works for other people, you know, which a lot of people in in in a business school may do, right? It was not something I wanted to follow. I wanted to do something that has a meaningful impact on people, you know, communities, societies. So the the focus of my research is actually low and middle income countries. So that's what um I can probably have the most impact, also given my background being from a low and middle-income country, Iran, right? And also health. Health is an aspect no one has has a, I guess, personal connection to people. If you feel healthy, unhealthy. I mean, that that's probably the the most important, I guess, part of our life that is taken for granted. Because yeah, it impacts everyone. Yes. Okay.

SPEAKER_03 5:14

Great. So yeah, I could so now I'm seeing I'm seeing thinking about your your work and seeing how those two things are intersecting, and that's really that's really interesting. That and in that you sort of discovered through your PhD program that I mean uh there's a personal connection, but kind of discovering that that is the connection and that is the passion. It's kind of what happened in in grad school. That's exactly was there were there people in particular that inspired that?

SPEAKER_01 5:38

So I think my advisor was open, which was good, like and encouraging, exploring maybe uncharted territories. Like the area I picked, I was I felt like it was something a little bit unusual. Um, and maybe we'll we'll get to this, I'm I'm sure, in a bit. But it's an area, you know, where first of all, I wanted to do empirical research using data. And there's actually not a whole ton of data available there. Yeah. Just because you know, weak infrastructure and data may not even be collected to begin with. Right. So actually, one of my advisors kind of cautioned against this that hey, this is not it may not be something that you can actually do some rigorous empirical work here. But I mean, like, I think the other aspect about a like being successful in a PhD program is perseverance. Like, if you just get discouraged by I don't know, one comment here and there, then you're kind of done. But if I think if you show perseverance, I feel like it may not always work, but at least you give it a chance. So I feel like in that case, it it did work out. You know, I did end up finding, you know, a couple data sources which led to one publication, and then like if a few others actually also followed, but now I'm at a stage where I actually see just a ton of opportunities, you know. I I just don't know we which I I have to prioritize now, you know.

SPEAKER_03 6:53

Yeah, yeah. Sort of open one door, but then and then that opens so many more.

SPEAKER_01 6:57

Exactly.

SPEAKER_03 6:57

Well, that's really cool. Let's talk a little bit more specifically about your research, because um, and and I I might want to come back to that data thing because I think that's really really interesting. You've got a topic that almost by definition makes the data a little bit trickier to come by. So a lot of your research examines the the notion of stockouts of in particular of healthcare products, and of course, especially in in developing countries. Can you help us understand what a stockout is and why that's so problematic?

SPEAKER_01 7:23

Yeah, excellent question. And I actually do talk about this in in the courses that I teach of at the Alvar's College of Business because I think it is a phenomenon that is very relatable. So I think it's something that we may have all come across. You know, if you go to HEB or Target, you'd be looking, I don't know, to get maybe a let's say a bag of popcorns or you know, some some ice cream or something, right? And if it happens to not be on the shelf, you could potentially end up leaving the store empty-handed, right? Yeah, yeah, which is inconvenience for sure in this case. So, but when we talk about health products, uh, so there are a whole set of other consequences that actually emerge now. So imagine a patient, a client walks into a health connect, a pharmacy, and they're seeking a particular type of health product, let's say in this ex in this case, contraceptives, maybe HIV medication, right? Antimalarials, and the product happens to not be on the shelf.

SPEAKER_03 8:19

Yeah.

SPEAKER_01 8:19

So that is the essence of the problem. It it's out of stock.

SPEAKER_03 8:23

Yeah, it's it's not just inconvenient, it's yes, perhaps quite problematic. Exactly. Yeah, yeah. Okay. And I guess in some ways it makes it kind of obvious why it's so problematic. And this apparently is a pretty common phenomenon. I mean, I know for a lot of folks, uh you know, we think about it and we think of it an inconvenience, but the the abundance, you know, uh for me, uh this guy's not really silly, but for me, it was uh lemon pudding. When I was in uh Alabama, it seemed like we would go to growth shopping and there was never lemon pudding, and we wanted to make a lemon meringue pie. And I was like, why can't we find lemon pudding? But it really wasn't that big of a deal. We can you know, we just had to go to a different store. That's not gonna be as likely for both a healthcare product and I suppose probably the context that you're working in.

SPEAKER_01 9:12

That's exactly right. So, like in this example, for example, you could have actually walked a few miles or something to to reach the health schon. Right, to find us there. And you may actually not even have any alternatives, you know. You may not be able to afford like spending that much time and money to come back again, or simply you know, you could just be discarded. You you were looking for something, you didn't find it, and you know, you may just not come back to it again.

SPEAKER_03 9:36

Yeah. Okay. So from the work that you've done, I mean, and you've you've kind of explored this from different angles. So, I mean, if if you had to kind of summarize uh what causes these things, and kind of because of that, what what kind of things can healthcare organizations be doing and thinking about to maybe try to avoid the problem?

SPEAKER_01 9:57

Yeah, that's an excellent question. And I think the answer is is not you know that straightforward because it all relies on supply chains. So let's think about the supply chains for for contraceptives. So the patients, the the client, you know, they may see the actual product at the clinic, but actually it takes a long journey until that product reaches that point, which is also the case for for any other product, no ice cream or popcorn or lemon pudding.

SPEAKER_03 10:23

Yeah, that was the problem.

SPEAKER_01 10:25

Yeah. So there is so, first of all, there's manufacturing of contraceptives, which for the most part does not actually take place in in LMICs. It's because I think that the process in in some cases could could be complex. I think condoms, those are a bit easier to to manufacture locally, but like when it gets to like vials or injectables, and when when the process becomes more complex, that is where you don't see actually local manufacturing of contraceptives. It needs to be manufactured somewhere, so that means it needs to be it needs to be shipped, yeah. Right? Who's gonna pay for it? That's again another tricky question. So in the past, like donors have taken responsibility for that, maybe USAID, the the global fund, but we see actually that being also vanished. Yes. So who's gonna pay for it again? That these are all factors that actually impact stockouts, right? Yeah, down like because down the road at the clinic may impact whether people are gonna have access to it or not. So procurement that is one factor, but even if you actually manage to pay for it and bring the supplies into a country, let's say the national warehouse, it is still a long journey until it reaches the patients. Okay. Because long distances, you know, let's say you're you're in the capital, for example, it's it's gonna take a long distance until that product actually reaches other stores. And add-to-add also a lack of road infrastructure.

SPEAKER_03 11:59

I was just gonna say the infrastructure, there's the distance, but yes, you know, distance in the United States might be different than distance in these countries, not just not the infrastructure, which I think is actually one of the differences.

SPEAKER_01 12:09

I feel like like here, maybe in Texas or anywhere else. I think if you travel from, let's say, the metro area, maybe to a rural area, I don't think you see a whole ton of difference in terms of like road infrastructure. It pretty much remains the same, you know. In terms of you see, you know, like still it has paint and the road signs and all that. That's not necessarily the case, actually, in in when we talk about low-income countries. So it could become a lot worse, it could become, you know, maybe unpaved roads, and these are all things that actually matter in terms of logistics and supply chain management.

SPEAKER_03 12:38

Yeah, yeah. So is there anything that you know some of these providers can be doing to help avoid uh the problem of stockouts?

SPEAKER_01 12:48

So that is a great question. So so I talked about procurement, the distribution part is tricky, but even when it comes to the clinic itself, so you need these are products that you actually need to manage on a day-to-day basis. Yeah, so let's say you're a nurse, you're a midwife, we're working at a clinic. So this is also something that I have observed in my research, which is kind of interesting. So as a nurse, it is not just your responsibility to actually care for the patients, patients arriving, maybe taking vital signs or administering maybe some IV medication. But interestingly, actually, these nurses are dual-tasked. They also need to be in charge of inventory management, which they may not actually know a whole lot about. Yeah, interesting. So, in in one of the research studies that recently completed, actually, we found that if you give these nurses the training they need to be able to more effectively manage inventory, it's gonna have a demonstrative impact on reducing stock-outs.

SPEAKER_03 13:47

Yeah. Yeah, it's interesting you bring that up because I made some notes in part because I think it's actually sort of worth sharing the impact. So uh, and please correct me if I'm wrong. But that that frontline training, you translated that to saving 4.25 maternal and newborn lives per 100,000 women of reproductive age. And so just my like napkin calculation, because this was a study in Indonesia, my napkin calculation that would be 1,600 lives saved just by training the frontline nurses. And then interestingly, it more than doubled if you did the training in person. Yes, that's really fascinating. Yeah, I mean that I'd like to think that that would be enough to convince people that you ought to do this. Yeah, I'm guessing that's not enough to convince people. I mean, it's still not happening necessarily, but right.

SPEAKER_01 14:34

Because again, I think it goes back to I feel like resources, like, and this is actually one one of I guess the key messages of the paper is that yeah, if you could do the the training to, you know, to everyone, even if we don't know that there is an impact. I mean, why does it hurt? Right, let's just do it. If there's no funding constraint, but unfortunately, you know, again, in any context, I think funding is going to be a constraint, but especially when we're talking about low-income settings, right? There are a whole host of other priorities, right? Why should I spend money on some training that they didn't even know what the impact of it is, right? So I think this is where I think the research also sheds some light. So it is about how can you do actually more with less with spending less money, but perhaps you know being able to deliver more in terms of access of health products to patients. So what you mentioned is exactly right. We did see that if if you do the training on site inside a health clinic where a trainer actually goes to the actual place where where the nurse is working, I think the impact is is about five times or something greater than if you gathered a bunch of nurses into a classroom and gave them the training there. So I think that also shows the impact of some sort of experiential learning. Yeah. We also emphasize a lot in our classrooms and in teaching as well.

SPEAKER_03 15:54

Yeah. Well, and I imagine that that might, I mean, and maybe your studies haven't gotten to this point, but it seems to me, just so I'm thinking from an industrial psychologist's perspective, but being able to see, I mean, it's one thing to kind of grasp the concepts, but and and maybe even see examples of it. But when you see it like on your shelves, that that seems like that would have a very powerful impact. You know, you can get a better, a little bit better sense of you know the quantity and what it looks like on your shelf versus that same quantity might look very different in a different setting.

SPEAKER_01 16:24

Yes, you're exactly right. So I think you're talking about tailoring the training actually to what each health clinic may need. Because the clinic, you know, the storage area may look very different, you know, depending on the clinic. So if if you tailor the training to a specific setting where the health worker is actually working, yeah, rather than some generic environment, it's like a classroom of some sort that you know looks nothing like where I do my work. Right, right. That's where you you see the most benefit.

SPEAKER_03 16:51

Okay. That's really interesting. So let's let's actually go back to something we mentioned before about in terms of the data, because to me, I was like I said, I hadn't thought about it until you said it, but really it's it's one of those unique research problems that we sometimes see where the very nature of the problem makes it hard to study, in the sense that I mean, if you've got a system that's just plagued with stockouts, they they probably have some other challenges in terms of you know, there's probably not somebody keeping very close track of when those stockouts happened and how long it took to get the stuff back. How do you study that?

SPEAKER_01 17:27

Yeah, I think it is it is tricky. So in in some instances, there have been surveys that were conducted, and these are massive surveys. So think of it a national survey that takes actually two years to complete. There's these surveyors that go to each health clinic and they have this long list of items in terms of questions, right? And it's not actually just stock outs. Stock out is only like a tiny proportion of all the questions they ask because there are a whole host of other things that are also happening. Yeah, like do you have access to electricity here? Is there clean water at the clinic or not? You know, I don't know, like what is patient satisfaction here? How does that look like? So stock out is actually only one of them. So this was one way that I did study stock out through one of these surveys.

SPEAKER_02 18:10

Okay.

SPEAKER_01 18:10

These massive surveys, which was, I don't think funding it was maybe it was actually the funding that is provided by USARD, but USARD does provide a a lot of or did actually provide a lot of help in terms of administering these these surveys. So I I hope this can continue in in the future as well. And we're not gonna lose access to to all of these valuable data.

SPEAKER_03 18:32

Yeah, I hope I hope so too. I wish I could say I was optimistic, but I hope I hope I hope so too, because I I can see that, yeah, that would be something the the data collection certainly would be something that would be one of the, you know, I don't want to say the first to go, but you know, certainly wouldn't be as high a priority as actually providing the aid, for example. So far you've you've studied I I know several different countries, and I know you your focus has been on kind of the the the lower income countries. Are there lessons that can be learned from that that could help improve things in the United States?

SPEAKER_01 19:04

I think the core of issue also goes back to probably I I feel like disparities in terms of disparities to to access. So I'm just gonna mention a couple of numbers. So something like unmet need for contraceptives, which is the the percentage of people who need access to contraceptives but but are not using it for whatever reason. In some countries in sub-Saharan Africa, it could be up to 40 percent. So in the US, it's actually North America maybe it's around six percent.

SPEAKER_03 19:35

Oh wow, that's quite a difference.

SPEAKER_01 19:36

Yeah, but but even within, so that is actually the average number, but in the US still, and also within like low-income countries, there's another, you know, level of disparity. You know, not everyone is gonna have equal access. Right, right. So that and that is what I have also seen in my research as well, that like stocks, for example, is not something that is happening like proportionally or equally everywhere in the country. They're places that are gonna suffer a lot more. I feel like that is probably going to be a factor to consider anywhere you go. Like in the US, for example, maternal mortality, the US actually has one of the higher maternal mortality rates among the industrialized nations. I think it is twice or or three times as as high as those countries in in Europe or or Canada. But but even in the US, so who's suffering most actually from these maternal mortalities? It is African American women. Like that number goes like five times higher than the average for those individuals. So I think looking at the disparities, I feel like that could be another important takeaway in terms of improving access. Like these are essentially marginalized communities, neglected, whatever terminology you want to use.

SPEAKER_03 20:59

Yeah. Yeah. No, that makes sense. So in some ways, that that could give us a little bit of hope here in the US that, you know, it's as you're learning things about things that are happening in other countries, there is that that parallel. You know, I think about work I've done in the past with rural hospitals and some of the challenges they have. I I've never looked at stockouts, but I imagine they're higher in some of those rural hospitals as well. And part two, because some of the stuff expires, so they're they're not gonna want to keep a ton of it if they, you know, they don't want to want to keep what they need. And so, but then that puts them at higher risk of a stock out. So that would be interesting to kind of translate some of that and and see see how that works. So through the pandemic, stockouts were kind of a big problem everywhere. You know, the the the toilet paper stuff and all of that. Is has that opened up some different possibilities for you in terms of research or or maybe not, because it's you've been kind of focused on the the one context?

SPEAKER_01 21:52

Yeah, I think for sure, probably it made the field of supply chain management a lot more relevant. I think now you know, like. Mentioned shortages. I can just bring up this this toilet paper example because I'm sure like majority of people experienced it maybe firsthand or heard about it one way or another, or the shortages of the PPEs, the personal protective equipment for nurses who are fighting the pandemic. So I think it for sure has made it easier for for me to talk about my research and also like has elevated I feel like the field of supply chain management a little bit. But in terms of research, this is something I actually have thought a lot about, and uh I have had thoughts about what is the impact of pandemic on different outcomes. I don't have like I guess a working paper or something at the moment, because I think whenever you're doing academic research, I feel like the expectation is that you're expected to uncover something maybe surprising or you did not expect, right? So if I come out and say that yeah, the pandemic did lead to an increase in stockouts, I feel like oh yeah, yeah, I think they're not gonna be super enthusiastic, I guess, about it, unless I it covers something. If it did reduce stockouts, maybe, you know, that is something. Right, exactly.

SPEAKER_03 23:11

Yeah. I though I I do think there's still some there, maybe there would be some interesting and maybe even counterintuitive things looking at the the how they happened. It'd be different than the healthcare thing, though. So, you know, like why in the world was it that people were stockpiling toilet paper? So I guess maybe like like the psychological components, maybe there's some counterintuitive or interesting things there. But I see your point that everybody pretty much knew they happened.

SPEAKER_01 23:35

Exactly. And so but one point that's I think interesting that I've also thought about probably looking at productivity. I think that could be something interesting to to study. It's not exactly my my topic of interest, but I mean, think of like the COVID pandemic, and it's a debilitating disease, and it once once you catch it, you know, you could catch it again, right? And I've actually read a lot of like health journals that talk about this. It is not just the flu because it impacts you know your body in so many different ways. The the nervous system, like when you lose your sense of smell, or when you have brain fog and all these, these are like all signs that this disease is impacting your body in different ways. Yeah, so I would actually be curious to see like how many days of I don't know, productivity had just been lost, or people were now struggling with long COVID, yeah, and are also being dismissed by doctors because they don't even know you know what the solution to that is.

SPEAKER_03 24:35

Yeah, yeah.

SPEAKER_01 24:35

I think that would be an interesting research question to see.

SPEAKER_03 24:38

You know, that that kind of reminds me and sort of a related possibility too that might come up sort of from time to time, but I think and I think it's mostly resolved now, but you know, there was a period a couple maybe two years ago where there was this massive shortage of ADHD drugs.

SPEAKER_01 24:53

Oh.

SPEAKER_03 24:54

And so that that could actually be interesting to kind of take a look at. Did what did we see differences in productivity or learning for students, that type of thing? I don't know if it was enough of a shortage to have that impact or not, but uh that that I can see how trying translating the stockouts to productivity could be really interesting.

SPEAKER_01 25:14

I need to look that up. ADHD trucks.

SPEAKER_03 25:16

Yeah, yeah. I think it was like maybe two years ago. Okay, well, let's see. So uh a recent paper that you published in production and operations management took a bigger picture angle, and you explored how female decision makers that were serving either as health ministers in a country or in their their governing body, like a parliament, impacted procurement of contraceptives. What was the inspiration for that study? Because it's it's kind of a little bit different angle from what you were you were do looking at before.

SPEAKER_01 25:45

Yes, it is, and it is more of a big picture kind of. So it's not looking at availability of contraceptives at the connect level, so it's it's looking at actually national procurement of contraceptives uh like at the high level. Yeah, yeah. And so I'm gonna actually give out a couple of numbers. So these are things I've uh read you know across different reports and uh and articles. I believe 80% of the frontline health workforce, nurses and doctors, midwives, are women. So 80%, like think of that. That that's a massive number, right? Yeah, so these are the people that are actually delivering care and like all of that essential stuff. They did that during COVID-19, which was an emergency crisis, but they're also doing it in non-emergency time on a day-to-day basis, yeah, even if we don't hear about them. But when it comes to who's actually making decisions, making policies in terms of health, yeah, it's only, I think, about 15 or 20 percent or something on average. In some countries it's gonna be less, some some countries are gonna be more. I mean, like if you want to think about parity, like if 50% of the population is is female, I mean, 50-50% in terms of decision making, that would make more sense. But especially if you if you have 80% of the frontline health workers, those are the people who have actually the knowledge, they have first hand experience in terms of dealing with patients, right? So there's something you know that is not quite right.

SPEAKER_03 27:16

Yeah, yeah, yeah. Doesn't line up.

SPEAKER_01 27:19

Yeah, exactly. So then the question becomes so what happens actually if if you have more female decision makers making these types of decisions related to health? Are they gonna make decisions that are gonna benefit women more? Are they gonna be, you know, impartial, or what are you gonna do?

SPEAKER_03 27:36

Yeah, okay. And what do you find?

SPEAKER_01 27:39

And what we find, we we actually confirm what I just said that when you have more women as health ministers, when you have a woman health minister in a country, and we have ways of dealing, you know, with different sorts of sorts of biases in the analysis. When when you have more women as health ministers, they do increase the procurement of contraceptives. If I remember correctly, I think is about by 60 percent. So we're gonna order 60 more contraceptives. Okay. And so when you have female health ministers, but on top of that, you also have women as parliamentarians. These are also going to help the minister actually achieve their goals because the the the parliamentarians are also in charge of allocating budget and all of that.

SPEAKER_03 28:27

Yeah, yeah, you might have aspirations to procure more, but if you don't have the money, exactly, that's not gonna happen.

SPEAKER_01 28:32

So when you have both of these elements, the executive legislative branch together, represented by more women, then there's even a greater increase in contraceptive procurement.

SPEAKER_03 28:42

Okay, that's really interesting. That's that's really interesting. And and certainly uh gives us food for thought as we kind of just think about representation across the country and across the world, and the impact that that that can have. So well, what's up next for you? What are you particularly excited about that you're working on that that you're okay sharing?

SPEAKER_01 29:00

Yeah, so we were trying to do a follow-up study with the Indonesia one, and the Indonesia study, by the way, was one uh where I did collaborate with an organization, it's called John Snow Inc., and it's been really fruitful. So it has taken actually a little bit of time, I think, to like collect the data and all of that, because this was something I started when I was a PhD student, like back in 2017 or 18 or something. So data collection took some time, then coming up with a research design because this was also done all in collaboration with JSI. Okay, so they're co-authors on the paper, so lots of back and forth, you know, until we arrived at a good angle research question. They also had interest in. So the paper seems to be converging now. How many years is it? I guess it's like seven something years, right? Yeah, yeah. Seven, eight years or something.

SPEAKER_02 29:53

Yeah, yeah. Wow.

SPEAKER_01 29:55

But there's a follow-up study there, and again, the study was about training. What happens if you deliver training to these frontline health workers such that they become more effective in managing inventory? So the question here in this follow-up study, which I'll be collaborating with JSI again, is okay. So training is great, but it's still, you know, capital intensive. So in Indonesia, it was only about, I think, 10% of the entire cohort of health facilities in the country that were trained.

SPEAKER_02 30:25

Okay.

SPEAKER_01 30:25

So 90% were left untrained, even though if you could have trained them, you know, it would have been beneficial.

SPEAKER_00 30:31

Yeah, yeah.

SPEAKER_01 30:32

So I'm trying to come up with some sort of machine learning artificial intelligence model to see if we can transfer the benefits from those that were trained to the ones that were untrained, actually. Is there a way, like without delivering additional training, is there a way to transfer those benefits or not? So that is, I guess, my my next focus.

SPEAKER_03 30:54

Yeah. Well, that's really cool. It's in a way, it sounds a little futuristic. It may not be as it's futuristic as is in my imagination, but yeah, yeah. For some reason, I'm thinking like beams transferring to people or something like this. But yeah, but that that does seem like a really great thought, just to given you're right. I mean, training is capital intensive. So if you've got a way that you can you know make that a more efficient process and reach more people, we already know what the impact could could potentially be.

SPEAKER_01 31:22

Yeah, and what's cool actually, the organization is already very supportive and seems like willing to engage in this project. So I'm gonna meet meet with them and then see you know what is next.

SPEAKER_03 31:31

Okay, very good, very good. Well, you know, having talked with you a little bit out in other settings, I know you are an incredibly busy guy. So I'm curious what kind of stuff outside of the Carlos Salvare College of Business do you do you spend time with?

SPEAKER_01 31:44

Yeah, fun question. So we my wife and I, we love gardening. So uh we live in the southtown part of San Antonio, it is right south of downtown. And so when we purchased this house, there's a lot of grass, Bermuda grass here and there, which I don't think does a lot of whole lot of benefit like to creatures and whatnot, you know.

SPEAKER_02 32:10

Yeah, yeah.

SPEAKER_01 32:10

Bees and birds, they're not gonna benefit from that. So but we did transform both our front yard, backyard into essentially native landscaping. Cool. We did a lot of work on our own, so purchasing the plants, planting them, water and all of that. And now I think we do have a beautiful garden that it does actually invite a lot of different creatures, you know. In Texas, we are a state where there's some numbers there. I think it is the most number of like migrating birds that pass through or something. They along that passage, exactly. So it's funny, like some of these birds that so I I graduated from Minnesota. Yeah, some of the birds that we actually had to go like some far forest with binoculars or something, try to look for them uh in in Minnesota, and then we actually find them in our backyard.

SPEAKER_03 33:06

Yeah, well, and you had to look for them like that one week a year where it was warm enough.

SPEAKER_01 33:10

Yeah, right.

SPEAKER_03 33:12

Well, that that's really cool. So you're yeah, you you're getting attracting all kinds of interesting uh creatures, and then that makes it more interesting of a yard. That's really cool.

SPEAKER_01 33:21

And I think that is also a good, I guess it's a good side gig because you're busy, you know, with research and and whatnot. If you want to take a little break, just go to a yard and maybe relax a bit.

SPEAKER_03 33:32

Yeah, absolutely. My wife is similar, she she enjoys that kind of stuff too. More more than I do. I mean, I help when I can, but uh it certainly is relaxing to her too, and I can see why. And that that's great that you're also able to do that along with your wife. So that's that's terrific. Well, Amir, it has been such a joy talking with you here today. Obviously, we as we mentioned right at the start, we all interface with the healthcare system. Health health is an issue for all of us. So I'm glad to know that we've got amazing researchers like you that are tackling these important issues, and in your case, not even just here, but globally. And you know, I feel like I hope you feel like you're you're actually making a difference with the work that you're doing, because I certainly think you are. So thank you for being here today. And again, more importantly, thank you for the great work that you're doing to improve all of our lives. Thank you.

SPEAKER_01 34:17

Thank you for having me.

SPEAKER_03 34:20

Thank you for listening to the Inside Alvarez Business Podcast. Special thanks to our producer, Brittany Johnson, and for the support of Wendy Frost and Melissa Lackey to help make this podcast possible. Stay connected with the Carlos Alvarez College of Business at the University of Texas in San Antonio to learn more about how we are empowering the next generation of business thinkers and conducting groundbreaking research to ensure their success. Follow us on social media or visit us online at business.edu. Until next time, I'm Jonathan Halbuslevin. Thank you for listening.