Deconstructing free trade: An analysis of the implications of
the disruption on global medical supply chains during the
COVID-19 crisis.
Mohammad Masudur Rahaman
Communication for Development One-year master
15 credits Spring 2020
Abstract
The COVID-19 pandemic has disrupted global trade and caused many stakeholders to recognize how interconnected the international community is. However, due to nationalist sentiments and the uncertainty associated with the pandemic, most governments rushed to adopt protectionist measures aimed at protecting their essential supplies by imposing export restrictions on foodstuffs and diverse medical equipment and medications. Although most countries have managed to handle this crisis, it is evident that this isolationist effort would have worsened public health in both developing and developed countries if the COVID-19 pandemic had evolved to become a worse crisis than it is now. In particular, South Sudan, Bangladesh and Zimbabwe are vulnerable to the disruption of the global medical supply value chain which facilitates access to essential medications for their citizens. Nonetheless, the implications of the disruption of the global supply value chain may be felt in the distribution of the COVID-19 vaccine. In this regard, there is a need for revisiting the stance of the international community on free trade. There is growing evidence that free trade is essential in enabling countries to develop a diverse medical value chain that will enable them to be resilient in the event of a public health crisis. Organizations such as the Swedish Development International Agency (SIDA) must collaborate with the governments of the countries where they operate to ensure that they build diverse medical value chains. This will enhance their capacity to meet the healthcare needs of all their citizens, a key milestone in their quest for sustainable development. Moving forward, multilateral organizations and development agencies must cooperate to ensure that the needs and concerns of vulnerable populations are addressed as the international community moves to focus on the approval of emerging COVID-19 vaccines and their distribution.
Table of Contents
Abstract ... ii
Abbreviations ...v
Acknowledgements ... vi
CHAPTER ONE ...1
INTRODUCTION ... Fel! Bokmärket är inte definierat. Background ...2
Swedish International Development and Cooperation (SIDA) Healthcare Programs in Bangladesh, South Sudan Sand Zimbabwe ...4
Impact of COVID-19 on Global Health Supply Chain ...5
Developmental Aid Organizations Working in Health care in Developing Nations ...7
Significance of the study ...9
Research Questions ... 10
Main Research Questions ... 10
Data collection strategy ... 11
CHAPTER 2 ... 12
LITERATURE REVIEW ... 12
Global Medical Supply Chain ... 12
Current Situation ... 13
Challenges ... 14
Trade Policies and Regulations Adopted by Countries on Imports and Exports ... 16
The Distribution of the COVID-19 Vaccines ... 18
Positioning of research ... 20
CHAPTER THREE ... 21
THEORETICAL/CONCEPTUAL FRAMEWORK ... 21
Porter’s National Competitive Advantage Theory ... 21
Theory of political realism ... 22
CHAPTER 4 ... 23
RESEARCH METHODOLOGY ... 23
Research Strategy ... 23
Research Approach ... 23
Research methodology... 24
Data Collection Methods and Tools ... 24
Population and Sample Selection ... 25
Population Concentration ... 25 Sampling ... 25 Research Process ... 26 Data Analysis ... 26 Ethical Considerations ... 26 CHAPTER FIVE... 28
FINDINGS AND ANALYSIS ... 28
Findings and Discussion ... 28
CHAPTER SIX ... 36
CONCLUSIONS AND RECOMMENDATIONS ... 36
Conclusions ... 36
Recommendations ... 38
Areas for further research ... 40
Bibliography ... 41
APPENDIX 1: QUESTIONS ... 47
APPENDIX 2: Informed consent form... 52
What side effects or risks I can expect from being in the study? ... 53
Abbreviations
COVID-19 Coronavirus E.U European Union
SIDA Swedish International Development Agency U.N United Nations
UNCTAD United Nations Conference on Trade and Development W.T.O World Trade Organization
Acknowledgements
I am deeply grateful to my wife for the continuous support and encouragement throughout my studies, my parents and family for their moral support and kindness. I am also indebted to Erliza Lopez Pedersen, whose guidance and professionalism have played a pivotal role in enabling me to complete this thesis.
CHAPTER ONE
INTRODUCTION
The Swedish International Development and Cooperation Agency plays a pivotal role in supporting sustainable development programs in the countries where it operates. The mandate of this Swedish government agency is to contribute towards poverty eradication through capacity development, infrastructure funding and policy lobbying. In particular, it works to ensure that all people have access to affordable healthcare services in developing countries such as South Sudan, Zimbabwe and Bangladesh. The organization relies on global medical supply chains to be able to provide essential supplies and medical equipment to the communities it serves. Addressing emerging health challenges is an important part of SIDA’s mandate to improve the quality of human life and eradicate poverty.
However, the disruption caused by COVID-19 in the global medical supply value chain has adversely affected SIDA’s capacity to meet its commitments. The pandemic caused many countries to enact emergency bans on the export of essential medications and equipment. The post conflict era in South Sudan has presented challenges in the provision of health services due to a limited number of health workers and lack of access to health services. According to UNICEF (n. d), the gravity of the problem is aggravated by the fact that 75% of child deaths in South Sudan are caused by preventable diseases such as diarrhea, malaria and pneumonia. Similarly, Zimbabwe is faced with serious health challenges that have resulted in its being the most adversely affected by the HIV pandemic. Reliefweb (2016, n. p) besides grappling with a shortage of skilled professionals, there is also the challenge associated with limited infrastructure access which forces Zimbabweans to travel long distances to access healthcare services in clinics and hospitals. Shahen, Islam and Ahmed (2020, p.19) discussed that scarcity of drugs, insufficient medical equipment, and ambulance has combined with high population growth and acute poverty to undermine the quality of life of people in the country.
The COVID-19 pandemic has exposed the complex nature of free trade and its limitations in the face of a global health and humanitarian crisis. For example, it is evident that global medical value chains are vital in facilitating the innovation required to produce and distribute effective
medicines. The complexity of this issue is evidenced by the fact that the United States also struggled with access to essential medications and protective equipment, causing some stakeholders to push for a decoupling of its medical supply chain from China. However, this would be difficult in light of the massive investment required to be self-sufficient in the manufacture of health supplies. In addition, it could stifle the innovation and comparative advantages which is critical in achieving breakthroughs in the development of medications. Instead, there is a recognition that the most appropriate course of action is to reform the global medical value chain so that it is responsive to the needs of stakeholders and can contribute towards the achievement of shared prosperity. Improving public health outcomes is critical in poverty eradication and sustainable development because it affects the quality of life of individuals and their capacity to participate in income-generating activities. As such, the Swedish International Development and Cooperation Agency must lobby for the development of a robust global medical value chain because of Sweden’s influence as a member of the European Union and the organization’s influence over the international aid in the community.
Background
The COVID-19 pandemic poses a critical threat to human health and is expected to have a detrimental effect on the development of countries for a long time. Presently, SIDA is actively involved in initiatives aimed at reducing the spread of COVID-19 and mitigating its impact in both low-income and middle-income countries through either adjusting on-going healthcare programs or the provision of new support. By August 2020, SIDA had allocated SEK 1.25 billion to aid in the mitigation of the effects of COVID-19. Out of its on-going 2000 projects, 250 have been adopted to respond to meet new challenges. The organization has also added support to 85 new initiatives (Swedish International Development Cooperation Agency, n. d). COVID-19 has a disproportionate impact on the people who are already marginalized, highlighting the value of SIDA’s efforts.
The COVID-19 crisis has challenged the four basic principles of globalization as discussed by Ghez in his article on the implications of the COVID-19 pandemic on the international community. First, it has disrupted the freedom of movement for both goods and people. The
pandemic has lent credence to populist sentiments against free trade. Second, it has undermined the notion that the internet provides access to accurate information. The mushrooming of virus-induced fake news has undermined the transparency of online information (Ghez 2020, n. p). Third, political polarization has undermined the legitimacy of governments and public institutions to fulfill their roles during a global crisis. Fourth, the events that the world has witnessed in the recent past has undermined the belief that change is both linear and predictable. Furthermore, The Economist (2020, n. p) has made a persuasive argument that globalization was in trouble before the pandemic. However, this crisis has exacerbated the challenges that it is facing by entrenching a bias towards self-reliance. Furthermore, it has created an opportunity for nationalists to politicize both global travel and immigration. The shift towards in-ward looking may not only undermine the economy, but it could entrench geopolitical instability in contemporary society.
During this crisis, governments have taken deliberate actions aimed at blocking the export of what they considered essential items. In particular, the assault on the medical supply chain will entrench nationalism as countries seek to strengthen their public health systems. Nationalism has been used to justify the restrictions placed on the export of medical supplies. For example, India banned the export of medicines such as paracetamol, chloroquine and other healthcare equipment such as facemasks (Laker 2020, n. p). The United States threatened to nationalize some production systems and companies to ensure they only produced medical items for Americans. For instance, the Trump administration attempted to sequester the masks produced by 3M in its Singaporean factory. The policy interventions demonstrate the risks associated with global value chains.
However, global value chains make these strong-arming efforts difficult. For example, the ventilators that are made by Philips in the United States rely on components that are sourced from the European Union (Laker 2020, n. p). The attempts to force it to prioritize American consumers at the expense of legal, contractual obligations and in defiance of the EU threatened to initiate a raft of retaliatory measures. Efforts to adopt protectionist policies threaten to start a continuum that would undermine global value chains. Besides requiring countries with adequate bargaining power to negotiate with it each other, it may disadvantage developing economies
whose position on the value chain inhibits their leverage. The observation is particularly challenging for developing countries with limited medical supply chain capacities. According to Laker (2020, n. p), the five-fold rise in medical supplies during the pandemic has further demonstrated the challenges that poorer countries will face. Development organizations such as Swedish International Development and Cooperation (SIDA) rely on global value chains to be access the resources required to meet user needs.
Swedish International Development and Cooperation (SIDA) Healthcare Programs in Bangladesh, South Sudan Sand Zimbabwe
SIDA is a government agency working on behalf of the Swedish government to eradicate poverty in the world. Generally, the role of the agency is to global health situation by working with other actors across the world to develop and implement health interventions. It is bilateral development cooperation working in 35 countries in Europe, Latin America, Asia and Africa (Andersson 2009, p.341). SIDA's approach includes collaborating with government agencies, private organizations, and international agencies like the European Union (EU), United Nations (UN), and the World Bank to promote social dynamics of its focus regions. In mid-2020, SIDA announced its response plan for the COVID-19 crisis.
The program involves an allocation of SEK1.25 billion to counter the pandemic and its effects (Swedish International Development and Cooperation 2020, n. p). It is part of the agency's Agenda 2030 priorities which has seen more than 250 projects out of its 2000 initiatives adapted to meet the emerging challenges. Examples of the specific projects SIDA takes to combat COVID-19 health problem include one, funding small scale farmers and rural producers through the International Fund for Agricultural Development (IFAD) program to continue growing and selling crops and other products despite the COVID-19 restrictions ((Swedish International Development and Cooperation 2020a, n. p). Two, providing renewable energy to urban slum dwellers through organizations like Energy Sector Management Assistant (ESMAP). Three, restructuring its activities to mitigate the consequences of the pandemic on the education sector in low-income countries.
In Zimbabwe, SIDA's development program began in the 1980s after the country attained independence. The primary goal of the multinational agency in the country is to improve the
social and economic standards of Zimbabweans. Currently, SIDA's program totals SEK 1.5 billion for 2017-2021 initiatives (Swedish International Development and Cooperation 2020b, n. p). For a long time, Zimbabwe's healthcare system has been disrupted by political and economic disturbances. SIDA supports Zimbabwe through funding and working with UNICEF and UNFPA to improve the quality and access to healthcare. On COVID-19, the agency set aside SEK5 million to help the country adapt to climate change and increase food, nutrition, and clean water despite the hardships created by the pandemic.
Similarly, SIDA is involved in developmental projects in Bangladesh. The country has incredibly high rates of poverty and is also susceptible to disasters and violations of human rights. The agency's efforts focus on health, human rights, democracy, and climate change. SIDA works with institutions like the Urban Primary Health Care Service Delivery (UPHCSDP) to offer care to poor groups in urban centres (Swedish International Development and Cooperation 2020c, n. p). The program covers primary care delivery, family planning, and maternal and child healthcare. The current project runs between 2014 and 2020, covering SEK 1.9 billion for the period ("Our work in Bangladesh", 2020). SIDA has, so far, done an excellent job raising the standards of Bangladesh people.
Impact of COVID-19 on Global Health Supply Chain
Logistics is the backbone of any economy; it ensures uninterrupted flow of goods and services required to an economy or an industry to function normally. Globalization of business created an interdependent economy that drove many countries into immense economic development. Internationally, globalization is responsible for addressing issues like unemployment, education, and education. By minimizing unemployment, globalization addresses the issue of poverty and helps many countries achieve greater heights of economic performance (Carlsson-Szlezak et al., 2020, p.1). In effect, part of the efforts of the Swedish International Development and Cooperation (SIDA) is to empower communities in developing countries to be a part of the global economy. The Chinese economy is one of the world's leading economies in terms of production and consumption of goods and services. Thus, when it becomes an epicentre of the coronavirus outbreak, the rest of the world felt the impact as well.
The pandemic disrupted medical supply chain substantially. For instance, Sharma et al. (2020, p.248) note that before the global health crisis, China used to produce half of the world's masks. However, when the virus spread throughout the country, systems of manufacturing came to a halt slowing down the production of masks and other products. Although China is gradually getting back to operations following a significant reduction in the number of COVID-19 cases, the impact is still evident. There is still a long way to go to get back to normal operations in the manufacturing and export operations.
The COVID-19 pandemic has exposed the vulnerabilities of the supply chain and logistics in the healthcare sector. Sharma et al. (2020, p.249) documents that the pandemic continues to disrupt health supply chains by interfering with active pharmaceutical ingredients, shipping of medical supplies and equipment, procurement activities, and healthcare operations. Logistics in the medical supply chain is more than just the movement of health products and services; it also involves the movement of people between nations (Sharma et al 2020, p.249). COVID-19 has affected the movement of labourers working in pharmaceutical and healthcare technology firms, thus interfering with manufacturing activities.
At the peak of the health countries, almost every country adopted restrictive measures to control its spread. The measure involved enforcing policies curfew and partial and total closure of borders. This was an effort to restrict the movement of people and goods to contain the spread of the virus. The measures disrupted supply chain at the grass-root level. Actors in the medical supply chain would not operate as usual, including the limited operational time of pharmaceutical firms. For example, many of these companies operated round the clock to ensure a continuous supply of medical products. However, when COVID-19 hit, operations of most of them was reduced to less than ten hours a day.
Since the pandemic, the global health supply chain has registered multiple manufacturing challenges. Iyengar et al. (2020, p.1) point out that COVID-19 impacted countries that depended on China for their raw materials or final products. China is a significant supplier of active pharmaceutical ingredients to producers of generic drugs worldwide. The outbreak of the virus
halted the production of these ingredients by restricting Chinese to work at full capacity. The inability to meet the growing demand for antiviral agents has caused a massive global shortage of pharmaceutical ingredients and a consequential rise in costs. Iyengar et al. (2020, p.2) add, due to the shortage, countries like India have stopped exporting at least 26 active pharmaceutical ingredients amid fear of shortages within the country.
The infection increased the demand for ventilators. Iyengar et al. (2020, p.2) say ventilators are essential to the normal functioning of the lungs in the event of any respiratory diseases such as pneumonia. Since the COVID-19 is a respiratory illness, the demand for medical ventilators increased significantly, especially in severely affected regions. Before the COVID-19, there was minimal demand for ventilators since respiratory cases were not widespread. However, as the virus spread, the shortage of ventilators was experienced in the global health supply chain (Iyengar et al 2020, p.2). Countries like the United Kingdom directed a consortium of their manufacturers to produce enough ventilators for their markets, leaving lower- and lower-middle-income countries in trouble.
According to Swedish International Development Cooperation Agency (n. d), in South Sudan, SIDA has provided 256.3 million SEK towards humanitarian assistance and 238.7 million SEK for development cooperation. The interventions of SIDA have played an important role in saving lives in one of the poorest countries in the world. The continuation of war in the country has plunged 84% of the population (11 million people) living in extreme poverty (Swedish International Development Cooperation Agency, n. d). More than 8 million people in the area lack access to adequate food with the COVID-19 pandemic making the situation worse (Swedish International Development Cooperation Agency, n. d). Health centers in the country were destroyed during the armed conflicts and there is a lack of sufficient funding for the sector. A significant lack of trained midwives has caused a high maternal mortality rate. The Health Pooled Fund (HPF) which SIDA is a part of plays a pivotal role in providing basic maternal and pediatric care.
Developmental Aid Organizations Working in Health care in Developing Nations
The heightening health, social, and economic implications of COVID-19 has forced numerous global developmental institutions to adjust to new realities. People, especially those in poor and
developing countries with ineffective healthcare systems and economic structures, need extended support. For many countries in Africa, parts of Asia and parts of Latin America, COVID-19 is more than a health crisis. The disproportionate impact the pandemic has had on these countries has called for resilient systems that depend on highly coordinated and concerted efforts. As such, many regional and international humanitarian and developmental aid organizations have stepped up to facilitate a road to recovery for vulnerable countries.
Since COVID-19 was announced a global health problem, government organizations, bilateral and multilateral donors, development banks, philanthropic institutions, and other actors in the private sector have played a huge role in contributing towards mitigating the crisis. Devex's funding database reveals more than $20.5 trillion worth of donations in the forms of money, equipment, expertise and more have been committed to COVID-19 response so far (Cornish, 2020). The database that tracks COVID-19 response measures indicates that between January to November, various developmental aid organizations all around the world have responded to the pandemic through new programs, grants, contracts, and funding opportunities. The biggest beneficiaries of these response efforts are emerging markets and developing economies.
The biggest percentage of the response funds are directed at programs designed to prevent the spread of the virus and sustain communities from the effects of the crises. Up until early November, more than $192.3 billion have been channeled into 858 different programs (Cornish 2020, p.1). More than 747 grants have been supported by $2.1 worth of investments, mostly from governments and government agencies worldwide (Cornish, 2020). The global response plan has also seen more than $4.7 billion and $1.4 billion worth of investments channeled to 1,858 tenders and 908 contracts as business opportunities (Cornish 2020, p.1).
The International Monetary Fund (IMF) and the World Bank have been at the forefront in responding to the COVID-19 pandemic through its financial policies. Since the announcement of its response measures in March 2020, IMF has supported developing countries through emergency funding, augmenting existing lending programs, grants for debt relief, and new financing arrangement (Harjes et al 2020, p.4). Through its Rapid Financing Instrument (RFI) and Rapid Credit Facility (RCF) tools, IMF has set aside $50 billion to assist low income, and
emerging countries implement policies aimed at addressing the disease. An unprecedented number of countries have reached out to the organization for financial support through these programs.
Another organization that is at the front-line in responding to COVID-19 cases in developing countries in the United Nations (UN). In 25th March 2020, the organization launched a program to increase funding to help the world's most vulnerable nations scale up their efforts in fighting the pandemic (United Nations 2020, p.1). The $2 billion humanitarian response plan has so far benefited several countries in Africa and parts of Asia (United Nations 2020, p.1). The key areas of action include: first, supporting the health systems by enabling them to obtain the necessary equipment and medical supplies to combat the disease. Secondly, supporting household and businesses affected by the pandemic through income and food donations to unemployed and vulnerable populations. Thirdly, transforming societies to achieve sustainable development goals (SDGs) despite the pandemic.
The Organization for Economic Cooperation and Development (OECD) took a unique approach to tackle coronavirus by focusing on women and girls' wellbeing. The development aid organization says, when adopting policies and practices in the current crisis, there is a need to pay attention to gender inequality (OECD, 2020). There is a need for objective policies that balances the needs of both genders as opposed to exacerbating the inequality. The OECD Development Assistance Committee (DAC) through Network on Gender Equality in the response of COVID-19 is a collaborative effort of more than 30 bilateral donors with long-standing history on mainstream gender equality (Organization for Economic cooperation and development 2020, p.1). The program seeks to achieve long term gender equality goals even as the world recovers from the pandemic. The focus areas include supporting health systems, supporting girls' education and employment, ensuring social protection and economic recovery for women, and preventing violence and exploitation against women and girls.
Significance of the study
This study provides important insights about the role of international agencies in development and their utilization of global value chains to achieve their mandate. Communication for
development recognizes a multi stakeholder collaboration in facilitating development in different countries. Achieving positive outcomes in the mitigation of COVID’s effect on the society requires information sharing and coordination between all the stakeholders. This study will investigate the disruptive effect of the nationalization of medical supply chains on access to affordable care in developing countries in both the short-term and long-term. Besides creating a situation elsewhere the most vulnerable populations across the world are likely to receive vaccines the last, more importantly it may aggravate disparities in access to healthcare equipment and medications in developing countries as countries consistently seek to decouple their healthcare supply chains from others. Bieber (2018, p.520) observed that nationalism emphasizes membership to a nation and devalues any sense of shared investment in the collective well-being of the society. As such, nationalism undermines public support for the use of taxpayer funds to support sustainable development initiatives in other countries. Duara (2018, p.1) shared this view noting that nationalism undermines the capacity of a group of people to demonstrate empathy towards others.
Research Questions Main Research Questions
1. How has nationalism affected Swedish support for the Swedish International Cooperation and Development Agency?
1.1 How has the lack of global collaboration in addressing the COVID-19 pandemic affected the healthcare initiatives supported by the Swedish International Cooperation and Development Agency?
2. What are the implications of the nationalization of medical supply chains on access to COVID-19 equipment and medications in developing countries?
Research Design
The researcher adopted a qualitative research design for the project. In a qualitative research design, a researcher collects and analyzes non-numeric or non-statistical data, including texts, audio, or video, to understand the opinions, concepts, and experiences. It is the exact opposite of a quantitative research design, which involves collecting and analyzing statistical or numeric data. Essentially, qualitative design is used to gather in-depth insights into a research problem or generate new ideas. Because of this, the design has widespread application in theoretical fields such as history, sociology, anthropology, education, and health sciences, among others.
The principles of qualitative research design are consistent with basic research strategy; they both seek to introduce new knowledge or expand knowledge in a specific research problem. In this case, the examiner settled for qualitative design to gain insights into various stakeholders' perspectives on the topic. Sutton and Austin (2015, p.226) say the design helps a researcher access participants' thoughts and opinions towards an issue. Therefore, the design played a major role in appreciating different stakeholders' underlying thoughts on the impact of the COVID-19 crisis on the global medical supply chain.
Data collection strategy
The data collection will involve the identification of eight participants that will be invited to participate in an unstructured interview that fit the inclusion criteria. Three SIDA professionals working in Bangladesh, Zimbabwe and South Sudan were involved in this study. Furthermore, two journalists reporting on development news in Bangladesh and Zimbabwe were invited to take part in this study and a researcher on sustainable development in South Sudan was involved in the study. In addition, three citizens (one from Bangladesh, one from South Sudan and another from Zimbabwe) were part of this sample population.
CHAPTER 2
LITERATURE REVIEW
Global Medical Supply Chain
The global medical supply chain is among the prominent and rapidly growing sectors. The global healthcare supply chain is expected to hit $3 billion by 2025, rising at a market growth rate of 7.9 per cent between 2019 and 2025 (Iyengar et al 2020, p.1). The global medical supply chain industry is extensive. It includes a diverse range of segments, including pharmaceuticals, information technology, medical devices, and several other services, all of which are growing exponentially. As such, it is indispensable in enabling individual states to meet their healthcare goals. The rapid growth is primarily attributed to the increasing demand from patient’s worldwide (Iyengar et al 2020, p.1). Other include companies focused on curbing the rising health care costs, better patient care, and compliance with government regulations.
The scope of the medical supply chain varies between regions. While the supply chain appears to function efficiently in developed nations, it is significant in developing nations. According to Pisa and McCurdy (2019, p.2), a majority of lower- and lower-middle-income nations where disease burdens are high, health supply experiences a range of challenges. Usually, according to Pisa and McCurdy's (2019, p.1) report, the supply chain functions poorly resulting in falsified medications and stockouts. It is a concerning issue for two main reasons: first, the lower- and lower-middle-income countries will play a significant role in procuring health products. Secondly, the global health community has increasingly become concerned with the dysfunctional medical supply chain.
The performance of the health care sector depends mainly on the nature of the medical supply chain. Bialas et al. (2014, p.1) say the broader health care sector comprises of wholesalers, pharmaceuticals, medical supplies enterprises, distributors, insurance companies, government agencies, technology providers, and others. Bialas et al. (2014, p.1) further point out that logistics, purchasing and supply chain management are integral and highly interconnected to the health care industry. As such, many healthcare systems focus on lowering supply chain costs and
eliminating potential issues to improve their healthcare sectors. These efforts mark the difference between medical supply chain in industrial and developing nations.
The current global supply chain faces numerous problems. The main problems, according to Privett and Gonsalvez (2014, p.226) include lack of coordination, inventory management, demand information, and order management. The global health supply chain is fragmented and extremely uncoordinated, especially between countries. Privett and Gonsalvez (2014, p.227) attribute the problem to division in product types, funding organizations, and projects. Inventory management in the global medical supply chain is a complex challenge considering the inadequacy of information and unique contextual problems. Additionally, order management is also linked to a lack of reliable information and shipment reliability. Thus, it is often difficult to determine whether or not there is enough product in the system.
Current Situation
Although the pharmaceutical industry in some countries is recovering following the lift of lockdown measures, the industry's capacity has significantly been reduced. The impact of the lockdown measures is realized through human resources problems and increased logistic constraints. Dmitry and Das (2020, p.92) says the impact of the lockdown on individual companies and industries of affected markets depend on the duration of the lockdown. For instance, lockdown measures in major economies like India saw reduced international trade activities for weeks. The flow of essential medical products was affected worldwide. Further, the movement of workers in the health care industry was also affected. This had the unintended effect of aggravating the risks that vulnerable populations in low-income countries faced during the pandemic.
The lockdown came with restrictions on import and export activities. In March, India’s Directorate General of Foreign Trade enforced restrictive measures to limit the export of 13 pharmaceutical ingredients known as APIs and additional 13 formulations from the APIs (Sharma et al 2020, p.250). China produces and supplies more than 70 per cent of the APIs to India and the rest of the world (Singh et al 2020, p.250). When the two countries were on
lockdown, that is, export and import activities restricted, the movement of medical supplies, including the above ingredients came to a complete halt. The lockdown also caused a shortage of N95 masks, vital medical components for prevention of the spread of the virus (Mahajan & Tomar 2020, p.35). In many countries, even the healthcare staff ran out of shortage of surgical masks, thereby exposing them to the disease.
In addition to N95 masks, personal protective equipment (PPE) is another critical component for controlling the infection. The World Health Organization (WHO) (2020, n. p) defines PPE as garments designed to shield health care workers from the infection. PPEs consist of gloves, goggles, face protection, gowns, head cover, and rubber boots, among others. Vital PPE is currently in short supply despite the increasing demand due to inadequate machines used to manufacture them (Mahajan & Tomar, 2020, p.35). A significant number of machines and equipment are imported from China. Since the lockdown, and even after the recovery period, the supply of the machines has not been able to meet the demand needed to make enough PPE. The lack of a coordinated response to the COVID-19 pandemic had an adverse effect on bilateral trade. For example, when China was under complete lockdown, India was still operational because the virus was not widespread in the region. Lockdown measures in India came weeks later after COVID-19 had spread throughout Asia (Guan et al 2020, p.2). Thus, when India was experiencing full lockdown measures, China had lifted its lockdown policies and resumed operations. Therefore, India had to wait 12 more weeks to begin importing machines from China (Guan et al 2020, p.3). What that meant is that India has to double up its production of PPE suits from its capacity of 12,000 units to 30,000 units of production from April (Singh et al 2020, p.1). Moreover, the PPE manufacturers were forced to reach out to machine suppliers from China to meet the growing demand.
Challenges
The first challenge realized from the pandemic was panic buying behavior from various governments. Nations around the world are trying to purchase masks, PPE, ventilators, and other essential medical supplies to stock up in response to the disrupted supply chain. The increasing
producing to their full capacity (Liao & Fan 2020, p.1). At the same time, the shortage of raw materials due to the disrupted flow of goods between countries has seen the prices shoot up dramatically. Political pressure on the global medical supply chain is also at an all-time high. The combination of the above factors has undermined the capacity of the healthcare sector to meet the evolving needs of the society.
The market failure in the healthcare sector is characterized by an extremely high demand that meets limited supply. In this new failed market, distributors and sellers have established the power of determining numerous terms and conditions for buyers. First, strict payment terms with high financial risks involving more than the upfront payment of at least 50 per cent (Mahajan & Tomar 2020, p.35). Secondly, delayed deliveries due to the high amount of orders and prioritizing customers with highest paying terms (Mahajan & Tomar 2020, p.35). Thirdly, reduced access known and quality-assured producers and manufacturers. Fourthly, excessive mark-ups are resulting from hoarding stock to create a perceived shortage.
The new economic model gives developed nations an edge over the rest of the countries. Besson (2020, n. p) of the World Bank says the increased demand for medical supplies gives wealthiest economies an advantage in the global pharmaceutical industry. The growing panic buying patterns by developed nations reduces access to affordable and quality medicines and essential medical supplies for lower- and lower-middle-income countries (Mahajan & Tomar 2020, p.36). Besson (2020, n. p) relates the COVID-19 crisis to Ebola outbreak in 2014, arguing the lack of medical supplies and PPE contributed to an increased rate of infections and insufficient control of the epidemic. The researcher says a similar case could be reported with the current global health crisis in developing countries.
Another problem emerging from the affected medical supply chain is the proliferation of falsified and substandard medical products. A decreasing supply of medical products coupled with a worsening pandemic created a problem of a sudden increase in inferior medical products. In March, at the height of the COVID-19 pandemic, the World Health Organization published a medical report warning consumers, medical professionals, and healthcare authorities about the increasing number of substandard products claimed to cure, treat, or prevent coronavirus disease
(Mahajan & Tomar 2020, p.36). The delay in the diagnosis and treatment of the disease created a worrying case of health scams, some of which were fatal to patients.
Panic buying present opportunities for fraudsters to fill the gap between overwhelming demand and shortage of supply. The pandemic has made it incredibly easy for fraudsters to get away with and profit from falsified medical products. Some of the scammers include new suppliers who had previously been denied government authorization. The urgency of the problem and the inability to travel to fields of operations for quality audits to expose health systems to fake medical products. At the same time, while government regulators may be conscious of these risks, political pressure to deliver goods often lead to fast-tracked approval of products. According to Besson (2020, n. p) examples, of fraudulent cases include a European ordering $7.6 million worth of protective masks from a company in Singapore that were never delivered and the Netherlands government recalling millions of masks bought from China for being defective. The insights outlined in this section have demonstrated the vulnerabilities of developing countries in accessing Covid-19 health supplies. After lagging behind their counterparts during the initial response to the pandemic, they are now at risk of being left behind in access to vaccines. As such, this literature has demonstrated the need for aligning international trade and global supply chains with their health improvement initiatives.
Trade Policies and Regulations Adopted by Countries on Imports and Exports
The unprecedented global health crisis has disrupted international trade and global supply chains for essential and nonessential goods and services. The year began with the expectation that international trade in 2020 would play a pivotal role in advancing the 2030 Agenda for Sustainable Development. 2020 was to serve as the deadline for achieving an SDG target of increasing exports in developing countries. The pandemic changed everything from a global economic perspective. The sudden lockdown policies and other measures brought international trade to a halt (Agarwal & Chonzi 2020, p.6). However, since trade is vital to saving lives and livelihoods, many countries whose economy depend on international trade were forced to adopt new policies or modify their existing regulations to adjust to the new reality.
Measures taken to facilitate cross-border trade vary depending on countries. For instance, many countries have revamped their security management approaches. An example includes the adoption of policies to protect front-line workers at the borders. Regional countries trading with one another, such as those in Europe have initiated strategies for ensuring custom brokers, transport operators, freight forwarders, and border management officials practice precautionary measures (Hobbs 2020, p.171). The measures ensure safe handling of cargoes to minimize the risk of contracting the virus, sanitizing practices, and creating a training point for front-line staff to assess passengers for illness and isolation. Other practices for ensuring business continuity include instituting flexible working conditions and limiting the number of workers per shifts. Another approach to international trade includes increased border agency collaboration. Many countries operating with one another in a particular region including Asian market, European region, North and South Americas. For example, the European Commission (EC) approved guidelines for border management measures for protecting the health and ensuring the availability of goods and services. According to the guideline, member states should not restrict the circulation of all goods, including essential products such as medicines, perishable foodstuffs, and medical equipment. The commission turned the EU into a single market where there are no restrictions on the circulation of essential products, especially medicine and food. In Latin America, countries like Brazil introduced new legislation to simplify import activities of certain products. On 17th March 2020, the government adopted a policy for simplifying and fastening customs clearance processes (Vidya & Prabheesh 2020, p.2409). The legislation applies to goods designed to combat the spread of the deadly virus. The legislation makes it easy for products such as surgical masks, disinfectants, antiseptic gels, medicines, medical equipment and other essential products required by health care providers to go through expedited release. Importers are given priority to receive such goods without restrictions.
Similarly, Argentina has responded to the crisis by reducing trade restrictions to ensure sufficient supplies to the domestic markets. For instance, Canada has temporarily eliminated tariffs on a specific group of goods, while Argentina suspending its anti-dumping duties on imports (Gruszczynski 2020, p.339). China and the United States have also been forced to set aside their trade wars that have been going on for the past two years to beat the pandemic. Gruszczynski
(2020) writes that the two world's economic giants have reduced trade restrictions between each other. For instance, the United States has been forced to modify its policies to exclude a range of medical gear and equipment from the additional duties imposed previously under Section 301 (Gruszczynski 2020, p.339). China did the same by excluding duties on certain goods from the United States.
Uninterrupted shipping and opening ports is an area that many countries have focused on. De (2020, p.1) notes that 80 per cent of global trade volume is transported by commercial shipping that circulates raw materials, food, energy, and finished products around the world. For countries to remain operational despite the pandemic, they must maintain their ports open and ensure uninterrupted shipping activities. It is a measure China adopted to sustain its international trade. The ports remain operational round the clock without restrictions. For example, regular breaks such as weekend and public holidays operations shutting have been lifted. Through this, there is a continuous flow of goods into and out of the country. This explains why China seem to recover faster from the pandemic than the rest of the countries.
Other countries have adopted policies restricting the export of certain products. As mentioned earlier in the section, due to shortages of medical supplies, some countries restricted their export to protect its citizens. The disruption of the global medical supply chain forced some countries to implement policies that favour their citizens. For example, as mentioned by Sharma et al. (2020, p.250), in March, the Directorate General of Foreign Trade enforced restrictive measures to limit the export of 13 pharmaceutical ingredients known as APIs and additional13 formulations from the APIs. This came after experiencing a surge in the supply of essential pharmaceutical ingredients from China during the lockdown. The same concept has been applied to food products in many countries to ensure the sustainability of its people.
The Distribution of the COVID-19 Vaccines
Experts worry that the distribution of COVID-19 vaccines will present a variety of unprecedented challenges. Already, the global medical supply chain is extremely dysfunctional.
vaccines. Recently, there was a breakthrough in the fight against the virus when Pfizer and BioNTech discovered a working vaccine. Upon the announcement, several wealthy nations placed orders for vaccines for their citizens. With such a trend, some concerns developing nations may be locked out of access to the vaccines until at least four years later. Thus, to ensure equality, there is a need for an effective distribution mechanism.
Many scholars and supply chain management experts have come up with proposals for a good distribution network. Toner et al. (2020, n. p) has proposed an excellent distribution framework for distributing COVID-19 vaccine in the United States. The ethics-driven framework proposes a distribution approach in two tiers. The first tier should focus on three targets: first, the most essential in sustaining the COVID-19 response, such as health care workers (Toner et al 2020. n. p). Secondly, those at a greater risk of severe illness and death from the virus and their caregivers. This class of people encompasses the elderly and people with serious underlying medical conditions. Thirdly, people most critical in maintaining core functions in the country, including government officials. Tier 2 has four core considerations. They include people involved in broader health provisions, those who face barriers accessing care, and those at a heightened risk of infection because of where they live an where they work. (Toner et al., 2020) From an international perspective, the likes of WHO (2020), Gayle et al. (2020), National Academies of Sciences, Engineering, and Medicine (2020) have proposed frameworks for a fair and equitable allocation of COVID-19 vaccines. The goal of the proposal by WHO (2020, n. p) states, the vaccine must be a global public good that contributes to the promotion of equitable protection and promotion of everyone's wellbeing. It is founded on six fundamental principles— human wellbeing, equal respect, global equity, national equity, reciprocity, and legitimacy (WHO 2020, n. p). These frameworks are designed to ensure the equitable social and economic impact of all countries regardless of their socioeconomic status.
Gayle et al. (2020, n. p) and National Academies of Sciences, Engineering, and Medicine (2020) have a different approach. According to their proposals, the distribution and allocation of vaccines should per conducted in two phases. The initial phase ensures the allocation of the doses to all countries until the vaccines cover at least 20 per cent of their populations National Academies of Sciences, Engineering, and Medicine (2020, n. p). The purpose of the initial stage
is to ensure front-line workers and vulnerable people are vaccinated as the response to the pandemic continues. The follow-up phase expands the vaccine's coverage to the rest of the population. In the case of supply constraints, Gayle et al. (2020, n. p) advise that a weighted allocation approach in distributing vaccines to all the countries.
Positioning of research
COVID-19 has severely disrupted the global medical supply chain. According to the current body of empirical studies, the global health crisis has revealed the vulnerabilities of the global health supply chain. The disease caused a massive shortage of essential medical and pharmaceutical products by halting production from leading economies like China and India. The lack of sufficient disaster prevention stocks contributed to this problem, forcing governments to adopt knee-jerk reactions to secure their citizens at the expense of global collaboration. National and international measures to contain the spread of the virus, such as lockdown affected the global flow of goods and services. Thus, a considerable shortage of essential goods and services drove governments into panic buying behaviors which further worsened the situation. Low- and lower-income countries are the worst hit by the affected flow of goods and services. As a result, a number of regional and international developmental aid organizations continue to respond to the situation by addressing the gaps realized from the dysfunctional distribution system. However, a rise in anti-neoliberal globalism sentiment in most countries in the West is undermining the public goodwill and support which is essential for their success as taxpayer funded agencies. Moreover, countries also continue to ensure an effective supply chain by adopting policies and adjusting existing ones to revamp their international trade activities. However, there is much more that is still yet to be done in the effort of distributing and allocating COVID-19 vaccines because of the affected global health supply chain. This study demonstrates how the Swedish International Development Cooperation Agency is supporting development in Bangladesh, Zimbabwe and South Sudan.
CHAPTER THREE
THEORETICAL/CONCEPTUAL FRAMEWORK The Heckscher-Ohlin Theory (Factor Proportions Theory)
Eli Heckscher and Bertil Ohlin, Swedish economists, focused on how nations could gain achieve comparative advantage by utilizing factors which are in abundance in their areas. The relevance of this theory is highlighted by its focus on the factors which necessitate trade between different countries. This theory is based on the nation’s production factors such as land, labor and capital, which provide the funds which can be used to invest in plants and equipment (Findlay 2006, p.414). The cost of any factor is a function of supply and demand. The factors that are in great demand relative to supply are expensive while those in great supply relative to demand are likely to be cheap. The factor proportions theory postulates that nations produce and export the goods whose resources are in great supply because it results in cheaper production costs (Frederking 2010, p.4). In contrast, nations are forced to import goods whose required resources are in short supply, but higher demand. For instance, China and India have a large population which allows them to provide cheap labor to labor intensive industries such as textiles. As such, this theory demonstrates the importance of trade in facilitating access to medical supplies and equipment.
Porter’s National Competitive Advantage Theory
Michael Porter of Harvard Business School developed a model to explain the concept of national competitive advantage in 1990. His theory held that a nation’s competitiveness in a specific industry is determined by the capacity of the industry to innovate. The four determinants of comparative advantage are influenced by; the local market resources and capabilities, the conditions in the local market and the local suppliers and complementary industries and local firm characteristics (Aswathappa 2006, p.47). In considering the local market resources and capabilities, he appreciated the factor proportions theory. However, he added skilled labor, technology, infrastructure and education to the unique factors which can aid in bolstering the competitive advantage of a country. Furthermore, he noted the importance of a sophisticated home market in guaranteeing continuous innovation. The clustering of industries geographically enables some nations to have local suppliers and complimentary services (Cho, Mun & World
Scientific Publishing 2008, p.295).The local firm characteristics also have an influential effect on the competitiveness of local firms. In this context, it is imperative to note that the global pharmaceutical sector is dominated by a few companies such as GlaxoSmithKline, Pfizer, Novartis, Roche, Merck and Company and Johnson and Johnson. Since they are domiciled in the United States and Europe, other countries are dependent on trade with these regions to be able to access the healthcare supplies they need.
Theory of political realism
This theory is concerned with the concept of state power and the pursuit of national interest and the conflict between states. This is important in light of the fact that the policies adopted by different states during this crisis have largely been informed by their unique healthcare needs. Fundamentally, states are self-serving and acquisitive and predisposed to engage in a competition for power (McKeogh 1997, p.44). However, there is an expectation that an attempt by one state to obtain dominance over others would elicit collective opposition (Spegele 1996, p.155). There are some who hold the view that a dominant power could be an agent of stability. In this regard, there is an expectation that globalization is a strategy of contest for power A critique of this approach is that it fails to appreciate the fact that not everything in globalization comes down to acquisition, distribution and the exercise of power. Moreover, it fails to recognize the role of diverse stakeholders such as private sector bodies, sub-state authorities, macro-regional institutions and global agencies in shaping the evolution of globalization. In addition, some other structural inequalities cannot be simply linked to interstate competition because they have existed before. For example, class inequality, patriarchy and cultural hierarchy predate modern states.
CHAPTER 4
RESEARCH METHODOLOGY
Research Strategy
The examiner adopted a basic research strategy in place of an applied one. The difference between the two strategies is that the former seeks to determine new truths and test hypotheses while the latter seeks to improve methods, processes, or invent devices (Kaldewey & Schauz 2018, p.86). Thus, while applied strategy seeks to provide practical solutions to a particular issue, the basic research strategy aims to expand knowledge on a phenomenon. In this case, the purpose of the strategy selected was to determine how the COVID-19 pandemic has affected the global medical supply chain and the implications of the nationalization of the medical supply chain.
A basic research strategy played a significant role in arraying systematic and detailed insight into the topic under investigation and facilitated the extraction of scientific explanations and conclusions. Also known as fundamental or pure research, a basic research strategy focuses on acquiring new knowledge and expanding on existing information (Kaldewey & Schauz 2018, p.127). The appropriateness of the strategy to the research was its ability to establish a frontier of knowledge on the subject matter, contributing to the existing empirical work body. Through this, the research findings can contribute to breakthroughs in the global supply chain in the medical sector.
Research Approach
A research approach the researcher settled for includes a phenomenological method. It is a type of qualitative research design where an examiner considers participants' experiences on a specific issue or event through methods such as interviews, observation, and surveys. Other methods, like watching videos, reading, visiting places, can also be employed. Phenomenology was founded by Edmund Husserl and Martin Heidegger in the early 20th century. The approach primarily focuses on how participants feel about an issue, event, or activity. Therefore, a researcher will rely on the perspectives of individual participants to provide insights into their motivations.
The approach suits the project because of its nature and objectives. It is an exploratory investigation that seeks to gain insights into an emerging problem. Thus, like other types of qualitative approaches, the examiner does not start with a well-formed hypothesis. The research experience strengthened the researcher’s understanding of how the pandemic affected them as far as the global medical supply chain and what they think of the impact of nationalization of the medical supply chain. Advantages realized from the approach include the following. First, gaining an understanding of people's meanings. Secondly, adjust new ideas on the subject matter as they emerge. Thirdly, contribute to developing new theories on the phenomenon.
Research methodology
The study involved qualitative research due to the need to understand the perspectives of different stakeholders on this issue. Eight stakeholders in the development sector such as both present SIDA employees, journalists reporting on development initiatives, citizens of recipient countries dependent on international aid would be invited to participate in this study. These participants have an intimate understanding of the development sector. The inclusion criteria will ensure that only participants with a relevant experience of the subject are invited to take part in this study. According to Sutton and Austin (2015, p.226), qualitative research enable researchers to access the thoughts of participants towards the subject and the meaning that people assign to them. The exploratory research will facilitate an appreciation of the underlying opinions of people with the impact of the COVID-19 crisis on the global medical supply chain. The data collection process involved the use of semi-structured interviews to generate qualitative data through the use of open-ended questions. Jamshed (2014, p.87) observed that semi-structured interviews provide an opportunity for the interviewees to share information on their own terms.
Data Collection Methods and Tools
The data collection method used by the researcher in the project was an interview. The purpose of conducting an interview is to reflect people's emotions, opinions, thoughts, and experiences and explore issues with a deeper focus. Also, complex and unknown issues can be explored with an interviewer having the ability to observe nonverbal cues. However, its downside of the method includes the costs involved and possible bias on an interviewer's part.
The interview method is broad, and it encompasses structured, semi-structured, and instructed interviews. Structured interviews are extremely rigid in their operations and only allow an interviewer to ask certain types of predetermined questions. Semi-structured interviews are partly standardized and partly flexible (Sullivan-Bolyai et al 2014, p.287). In this method, an interviewer does not strictly follow a formalized list of questions. Instead, they can ask more open-ended questions allowing for a discussion instead of a straightforward question-answer format (Sullivan-Bolyai et al 2014, p.287).
The open-ended questions allowed the examiner to find more than they anticipated. Respondents accompanied their answers by sharing their motivations and displaying certain behaviors on the issue. It allowed the interviewer to detect hopes, fears, excitement, and other mental models in their responses.
Population and Sample Selection Population Concentration
The population in the context of research refers to a group of inhabitants to which information is intended. That being so, this investigation used key information applicable to all components of the medical supply chain worldwide. Information on the research applies to the entire global supply chain because of the inevitable impact of the ongoing COVID-19 pandemic that has disrupted operations in the medical industry and other sectors.
Sampling
The sample used in this study was arrived at using non-probability sampling. Allison and Dunkley (2014, p.1) describe non-probability as a sampling technique where a researcher selects samples based on subjective judgments. Although subject to bias, non-probability sampling should serve as a true representation of a research population. In particular, the researcher used a non-probability sampling method known as purposive sampling. The goal of purposive sampling is to focus on particular elements of a population of interest that will best enable a researcher to answer research questions effectively. A researcher selects participants based on their experiences and knowledge of the topic.
Research Process
After identifying and selecting participants for the researcher, the researcher contacted them in advance to prepare for the interview. The importance of contacting them was to disclose the project's details, including its purpose, benefits, and possible risks involved. This was in an aim to obtain their consent for participating in the investigation. The researcher contacted all the eight participants through emails and calls to arrange for a meeting for the actual interview. However, two had been already interviewed before the pandemic in another academic activity. On the day of the interview, after agreeing to participate, the participants were asked to sign the informed consent form. The interview took place over Zoom because it enables their recording. All the participants gave positive feedback regarding their participation in the project. After settling, the interview that lasted an average of an hour began. All the questions were covered, and their responses were recorded. The interviewer asked additional questions related to the topic to seek motivations, further clarifications, and respondents' opinions.
Data Analysis
The data collected was analyzed using content analysis. Content analysis is a type of data analysis method for qualitative research where a researcher categorizes data to classify, summarize, and tabulate the data (Elo et al 2014, p.2). The process covers three critical steps. First, developing and applying codes used to categorize data. The code is used to group data into themes or ideas where meaningful titles were assigned. The second step involved identifying themes, patterns, and relationships. A technique used to achieve was the word and phrase repetitions, where primary data was scanned for words and phrases commonly used by respondents. The third step involved summarizing data to link it to the research questions or objectives.
Ethical Considerations
was honesty and integrity. The researcher ensured the report is a true representation of the methods used, data collected, and results. The research is free from bias since the examiner maintained objectivity throughout. Also, the researcher avoided plagiarism and exploitation of other copyrighted materials. Where necessary, sources including journals, books, magazines, and other peer-reviewed materials used were appropriately cited and referenced.
The project also followed the rules of informed consent. The role of informed consent is to ensure individuals participate voluntarily in research with full knowledge of the benefits and relevant risks. The principle demands that a researcher avoid offering reasonable incentives like money or coercing participants to participate in the research (Connelly 2014, p.55). As mentioned earlier in the project, all participants were issued with informed consent forms outlining the purpose of the research, their rights, foreseeable risks, relevant benefits, the limit of confidentiality, and who they can contact with queries.
The third principle observed was the issue of privacy and confidentiality. Upholding participant's rights to privacy and confidentiality is a central tenet to a researcher's work (Arigo et al 2018, p.12). Appropriate measures were taken to ensure participants' privacy and confidentiality were maintained. For instance, the research did not demand personal information from respondents, including their names, age, or other personally-identifying information.
CHAPTER FIVE
FINDINGS AND ANALYSIS
Findings and Discussion
All the eight participants who were recruited to take part in this study accepted and cooperated throughout the data collection process. The three SIDA professionals in Bangladesh, Zimbabwe and South Sudan were aged 37 (male), 42 (female) and 33 (female) respectively. The two journalists reporting on development news in Bangladesh and Zimbabwe were 38 (male) and 29 (female) respectively. The Bangladesh citizen was a man aged 32 years, the South Sudanese citizen was a 27 year old male, while the Zimbabwe citizen was a woman aged 44 years. There were four men and four women who participated in this study. An alias was used to protect the identity of the participants.
Participant information
No Alias Age Gender Country Profession
1. Alex 42 female Zimbabwe SIDA policy analyst 2. Alice 33 female South Sudan SIDA program manager 3. Agnes 29 female Zimbabwe Journalist
4. Anne 44 female Zimbabwe citizen
5. Bernard 37 male Bangladesh SIDA Project Manager 6. Brian 38 male Bangladesh journalist
7. Bryon 27 male South Sudan citizen 8. Bean 32 male Bangladesh citizen
In this study, six of the participants indicated that they are directly involved in sustainable
development initiatives. The other two worked in adjacent roles that enabled them to have an intimate interaction with the sector. As such, all the participants were uniquely equipped to share
