Evaluating the Synergistic Impact of Digital Logistics Systems (eLMIS) and Financial Auditing (APTS) on Essential Commodity Availability in Ethiopian Public Healthcare Facilities: A Multilevel Analysis of the 2024/2025 National Survey
- 1Teda Health Science College
Abstract
BackgroundChronic pharmaceutical stock outs hinder Universal Health Coverage in Ethiopia. To address this, the Ministry of Health introduced the electronic Logistics Management Information System for inventory visibility and Auditable Pharmaceutical Transactions and Services for financial management. However, no national study has tested their combined impact. This study evaluated the individual and synergistic effects of electronic Logistics Management Information System and Auditable Pharmaceutical Transactions and Services on essential commodity availability across Ethiopian public healthcare facilities.
MethodsWe conducted a secondary analysis of the 2024/2025 Ethiopian Service Provision Assessment dataset utilizing 1245 public facilities nested within 125 clusters. The primary outcome was optimal essential commodity availability (zero stock outs and 100% tracer commodity presence). A two-level mixed-effects logistic regression model with an interaction term evaluated synergy, reporting Adjusted Odds Ratios with 95% Confidence Intervals.
ResultsOverall optimal availability was 54.2% (95% CI; 51.4%-57.0%). Implementation rates were 41.2% for eLMIS, 38.2% for APTS and 26.5% for dual implementation. Facilities using eLMIS alone (AOR = 2.15; 95% CI: 1.52-3.04) and APTS alone (AOR = 1.82; 95% CI; 1.28-2.58) showed higher security. Dual implementation showed a profound synergistic effect (AOR = 4.32; 95% CI; 3.25-5.74, p < 0.001). Positive predictors included functional cold chains (AOR = 2.08), qualified staffing (AOR = 1.68), hub proximity (AOR = 1.58) and urban settings (AOR = 1.95). The model explained 66.2% of regional variance.
ConclusionDual implementation of electronic Logistics Management Information System and Auditable Pharmaceutical Transactions and Services creates a powerful synergistic impact on pharmaceutical availability. Synchronized national scale-up and cold chain investments are urgently needed to achieve supply chain resilience and Universal Health Coverage in Ethiopia.
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BibTeX
@misc{gelaw2026evaluating,
title = {{Evaluating the Synergistic Impact of Digital Logistics Systems (eLMIS) and Financial Auditing (APTS) on Essential Commodity Availability in Ethiopian Public Healthcare Facilities: A Multilevel Analysis of the 2024/2025 National Survey}},
author = {y. D. Gelaw and A. M. Gebiru},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.05.26364822},
url = {https://www.medrxiv.org/content/10.64898/2026.10.05.26364822v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Evaluating the Synergistic Impact of Digital Logistics Systems (eLMIS) and Financial Auditing (APTS) on Essential Commodity Availability in Ethiopian Public Healthcare Facilities: A Multilevel Analysis of the 2024/2025 National Survey
AU - y. D. Gelaw
AU - A. M. Gebiru
PY - 2026
DA - 2026/10/05
PB - medRxiv
DO - 10.64898/2026.10.05.26364822
UR - https://www.medrxiv.org/content/10.64898/2026.10.05.26364822v1
AB - BackgroundChronic pharmaceutical stock outs hinder Universal Health Coverage in Ethiopia. To address this, the Ministry of Health introduced the electronic Logistics Management Information System for inventory visibility and Auditable Pharmaceutical Transactions and Services for financial management. However, no national study has tested their combined impact. This study evaluated the individual and synergistic effects of electronic Logistics Management Information System and Auditable Pharmaceutical Transactions and Services on essential commodity availability across Ethiopian public healthcare facilities. MethodsWe conducted a secondary analysis of the 2024/2025 Ethiopian Service Provision Assessment dataset utilizing 1245 public facilities nested within 125 clusters. The primary outcome was optimal essential commodity availability (zero stock outs and 100% tracer commodity presence). A two-level mixed-effects logistic regression model with an interaction term evaluated synergy, reporting Adjusted Odds Ratios with 95% Confidence Intervals. ResultsOverall optimal availability was 54.2% (95% CI; 51.4%-57.0%). Implementation rates were 41.2% for eLMIS, 38.2% for APTS and 26.5% for dual implementation. Facilities using eLMIS alone (AOR = 2.15; 95% CI: 1.52-3.04) and APTS alone (AOR = 1.82; 95% CI; 1.28-2.58) showed higher security. Dual implementation showed a profound synergistic effect (AOR = 4.32; 95% CI; 3.25-5.74, p < 0.001). Positive predictors included functional cold chains (AOR = 2.08), qualified staffing (AOR = 1.68), hub proximity (AOR = 1.58) and urban settings (AOR = 1.95). The model explained 66.2% of regional variance. ConclusionDual implementation of electronic Logistics Management Information System and Auditable Pharmaceutical Transactions and Services creates a powerful synergistic impact on pharmaceutical availability. Synchronized national scale-up and cold chain investments are urgently needed to achieve supply chain resilience and Universal Health Coverage in Ethiopia.
ER -