The Role of Logistics Management Information Systems in Sustaining Healthcare Infrastructure in Rural Kazakhstan

Abstract

Purpose: This study aims to investigate the role of Logistics Management Information Systems (LMIS) in supporting healthcare infrastructure in rural Kazakhstan, and to identify the benefits and challenges of implementing LMIS in these settings. Methodology: A mixed-methods approach was used, combining both qualitative and quantitative data. A survey of healthcare professionals was conducted to gather data on current practices and challenges, while interviews with stakeholders provided additional insights into the potential benefits and limitations of LMIS. A literature review on LMIS in healthcare was also conducted to inform the study. Results: The study found that Logistics Management Information Systems (LMIS) can improve rural healthcare by enhancing resource allocation, patient care, and decision-making. However, challenges include infrastructure limitations, training needs, data privacy concerns, and financial constraints. Addressing these challenges can unlock LMIS's potential to transform rural healthcare. Conclusion: This study demonstrates the potential of LMIS to improve healthcare access and quality in rural Kazakhstan. While there are implementation challenges, these can be addressed through targeted investments in infrastructure, training, and data security. The findings of this study have important implications for policymakers, healthcare professionals, and other stakeholders seeking to improve healthcare outcomes in rural areas.

1. Introduction

Rural areas in Kazakhstan face significant challenges in healthcare delivery, including inadequate medical facilities, a shortage of healthcare professionals, and limited access to advanced medical technologies (Turgambayeva et al., 2021). These challenges contribute to disparities in health outcomes between urban and rural populations, with rural residents experiencing higher rates of morbidity and mortality (Richman et al., 2019).

Modernizing healthcare infrastructure and improving logistics management are essential to bridging this gap and ensuring timely and effective medical care for rural residents (LUXON, 2015). Logistics management is a critical component of healthcare delivery, as it involves the planning, coordination, and execution of the movement and storage of medical supplies, equipment, and personnel (Ageron et al., 2018).

Effective logistics management can improve healthcare outcomes by ensuring that medical supplies and equipment are available when and where they are needed, and that healthcare professionals are deployed efficiently. However, logistics management in rural Kazakhstan is often inadequate, with shortages of medical supplies, equipment, and personnel common in rural areas (Richman et al., 2019).

The challenges facing healthcare logistics in rural Kazakhstan are complex and multifaceted, and require a comprehensive approach to address them. This study aims to explore the role of Logistics Management Information Systems (LMIS) in improving healthcare logistics in rural Kazakhstan, and to identify the benefits and challenges of implementing LMIS in these settings. Access to quality healthcare services is essential for ensuring the health and well-being of the population. However, many challenges and obstacles make it difficult to effectively manage and modernize the social healthcare infrastructure in rural areas in the Republic of Kazakhstan (Richman et al., 2019).

One of the main problems is the availability of medical services. Rural areas are often characterized by distance from medical facilities and a lack of qualified medical professionals. Many people in rural areas must travel long distances to receive medical care, which poses serious difficulties, especially in emergency situations.

Financial accessibility of medical services remains a problem for many rural residents. High costs of medical equipment, medications, and medical personnel can increase the cost of services to the public, making them unaffordable for many low-income families.

The quality of medical care in rural areas often remains low due to insufficient infrastructure, lack of equipment, and lack of trained personnel. This can lead to underdiagnosis, insufficient treatment, and an increase in the spread of infectious diseases.

To effectively manage the modernization ofsocial health infrastructure in rural areas, it is necessary to adopt an integrated approach. This approach must include not only government agencies and medical institutions but also the active participation of the local population, public organizations, and the private sector.

Programs aimed at improving the medical infrastructure, ensuring the availability of qualified medical personnel, and introducing modern technologies and treatment methods must be developed and implemented. Financial sustainability and efficient use of resources are also crucial aspects of managing the modernization of social healthcare infrastructure in rural areas.

State and local budgets must allocate sufficient funds for the implementation of modernization programs, as well as develop mechanisms for control and monitoring of their implementation. Opportunities to attract investment from the private sector and international organizations in the development of medical infrastructure in rural areas must also be explored.

In conclusion, managing the modernization of social healthcare infrastructure in rural areas of the Republic of Kazakhstan is a complex and multifaceted task that requires joint efforts from government agencies, local communities, public organizations, and the private sector. By implementing comprehensive programs and strategies, it is possible to achieve significant improvements in healthcare in rural areas and ensure universal access to quality healthcare for all citizens of the Republic of Kazakhstan.

1.1. Theoretical Framework

This study is grounded in the following theoretical frameworks:

Diffusion of Innovations (DOI) theory (Rogers, 2003): Thistheory explains how new ideas and technologiesspread and are adopted within organizations and communities. It posits that the adoption of an innovation, such as Logistics Management Information Systems (LMIS), is influenced by factors including relative advantage, compatibility, complexity, trialability, and observability.

Healthcare Access Model (HAM) (Penchansky & Thomas, 1981): This model explains how individuals and communities access healthcare services. It posits that access to healthcare is influenced by five dimensions: availability, accessibility, accommodation, affordability, and acceptability.

Logistics Management Theory (LMT) (Ageron et al., 2018): This theory explains the planning, coordination, and execution of the movement and storage of medical supplies, equipment, and personnel. It posits that effective logistics management is critical to improving healthcare outcomes by ensuring that medical supplies and equipment are available when and where they are needed, and that healthcare professionals are deployed efficiently.

By integrating these theoretical frameworks, this study provides a comprehensive understanding of the factors influencing the adoption and implementation of LMIS in rural Kazakhstan, and its impact on healthcare logistics and access to healthcare services.

Figure 1: Theoretical Framework Diagram

2. Literature review

The effective management of healthcare logistics is crucial for ensuring access to essential health services, particularly in rural areas where infrastructure and resources are limited (Gizaw et al., 2022). Logistics Management Information Systems (LMIS) can play a critical role in improving healthcare logistics by providing real-time data and insights to support decision-making.

In rural areas, LMIS can help address challenges such as limited access to health care facilities, shortages of health care workers, transportation barriers, and socioeconomic disparities (Buchelt et al., 2020). By improving the efficiency and effectiveness of healthcare logistics, LMIS can help reduce costs, increase access to essential medicines and supplies, and enhance the quality of healthcare services (Chen, 2019).

The development of rural infrastructure, including healthcare facilities and logisticssystems, is critical for local economic development and management of the living environment (McRae, 2015). However, the development of rural infrastructure can also increase the financial burden on the state and localities, and can lead to problems such as decreased housing affordability, poor quality of construction, and maintenance difficulties (Du & Jiao, 2023).

LMIS can help address these challenges by providing a platform for data-driven decision-making, improving the coordination and management of healthcare logistics, and enhancing the overall efficiency and effectiveness of healthcare services. By leveraging LMIS, policymakers and healthcare professionals can develop effective strategies to improve access to healthcare in rural areas, and promote the development of agriculture and rural areas, production and life of farmers, and urban-rural integration (Du & Jiao, 2023).

The healthcare industry is undergoing a significant transformation with the advent of Medicine 4.0, which leverages advanced technologies and data-driven approaches to provide personalized and effective care (Haleem et al., 2022). Data Analytics and Big Data play a crucial role in population health management, disease surveillance, and optimization of healthcare resources (Khanra et al., 2020). However, despite the progress made, there are still significant unmet health needs globally, particularly in rural areas where access to healthcare services is limited (Roux, 2020).

Unequal access to health services is a significant contributor to health inequality, and the lack of uniformity in defining and measuring access hinders efforts to address this issue (Serban, 2019; Roncarolo et al., 2017; Cabrera-Barona et al., 2016). Rural residents face additional barriers, including lower household income, higher rates of being uninsured or underinsured, and difficulty traveling to healthcare facilities (Wright, 2017). This results in reduced healthcare utilization and increased preventable hospitalizations (Weichelt, 2019; Mangundu, 2020).

Logistics Management Information Systems(LMIS) can play a critical role in addressing these challenges by providing real-time data and insights to support decision-making, improving the efficiency and effectiveness of healthcare logistics, and enhancing access to essential medicines and supplies. By leveraging LMIS, healthcare professionals can optimize resource allocation, reduce costs, and improve patient outcomes (Chen et al., 2019).

Strengthening primary health care (PHC) is essential for improving the physical, mental, and social well-being of people, and PHC is a critical pillar of a sustainable health system to achieve universal health coverage (UHC) and health-related sustainable development goals. LMIS can support PHC by providing data-driven insights to inform decision-making, improving the coordination and management of healthcare logistics, and enhancing the overall efficiency and effectiveness of healthcare services.

2.1. Importance of Logistics Management Information Systems in Healthcare

The importance of Logistics Management Information Systems (LMIS) in healthcare with citations:

1. Improved Supply Chain Management: LMIS helps in managing the supply chain of medical supplies, equipment, and pharmaceuticals, ensuring that they are available when and where needed.

2. Enhanced Inventory Management: LMIS helps in managing inventory levels, reducing stockouts, and overstocking, and ensuring that inventory is stored and handled properly.

3. Better Distribution and Transportation: LMIS helps in managing the distribution and transportation of medical supplies, equipment, and pharmaceuticals, ensuring that they are delivered on time and in good condition (Mangundu et al., 2020).

4. Increased Visibility and Traceability: LMIS provides real-time visibility and traceability of medical supplies, equipment, and pharmaceuticals, enabling healthcare professionals to track inventory levels, shipment locations, and delivery status (Zechariah et al., 2019).

5. Improved Patient Care: LMIS helps in ensuring that patients receive the right treatment and care by providing healthcare professionals with the necessary medical supplies, equipment, and pharmaceuticals (Roux et al., 2020).

6. Reduced Costs: LMIS helps in reducing costs by optimizing inventory levels, reducing waste, and improving supply chain efficiency (Serban, 2019).

7. Enhanced Decision-Making: LMIS provides healthcare professionals with data-driven insights to inform decision-making, improving the overall efficiency and effectiveness of healthcare logistics(Aceto et al., 2020).

8. Improved Compliance: LMIS helps in ensuring compliance with regulations and standards, reducing the risk of counterfeit products, and improving patient safety (Wright et al., 2017).

9. Increased Efficiency: LMIS automates many logistics processes, reducing manual errors, and increasing efficiency (Weichelt et al., 2019).

10. Better Data Management: LMIS provides a centralized platform for data management, enabling healthcare professionals to access and analyze data easily, and make informed decisions (McGough et al., 2018).

Logistics Management Information Systems (LMIS) play a vital role in modern healthcare, significantly impacting the quality and efficiency of medical services. The implementation of LMIS in healthcare institutions can improve various aspects of their operations, ranging from administrative management to clinical operations.

LMIS can help improve the efficiency of healthcare facilities by automating routine tasks such as patient registration, medical records management, and insurance claims processing. This allows medical staff to focus on more important clinical tasks, improving the quality of patient care.

Table 1: Dynamics of the country’s macroeconomic indicators in the field of healthcare of the Republic of Kazakhstan (thousand tenge)

Source: compiled by the authors according to https://news.kaznmu.edu.kz/

LMIS also provide easy access to medical data, facilitating more accurate and timely diagnosis, and improving the coordination of patient care. Electronic medical records (EMR) allow doctors to obtain a complete medical history of patients at any time, which is especially important in emergency cases.

The automation of processes using LMIS helps reduce administrative costs and minimize errors associated with the human factor. Optimizing processes for managing resources such as medicines and equipment also leads to lower costs. As a result, healthcare institutions can redistribute savings to improve the quality of medical services (Zayas-Cabán et al., 2021).

LMIS include data protection mechanisms, ensuring the confidentiality of medical information. Modern management systems provide a high level of security, preventing unauthorized access to sensitive patient information.

LMIS provide tools for analyzing medical data, helping institutional management make informed decisions. The analytical capabilities of LMIS allow tracking key performance indicators (KPIs), identifying trends, and forecasting resource requirements .

LMIS improve internal and external communications, facilitating interaction between various departments of healthcare institutions and external partners, such as insurance companies and healthcare providers. This enables more coordinated work and rapid exchange of information.

In Kazakhstan, the healthcare system has undergone significant changes, including the introduction of health insurance in 1996 and the creation of a special fund to provide high-quality medical care to the population. However, due to the crisis in 1998, the country abandoned compulsory health insurance, leading to economic challenges in the healthcare sector in the 2000s. In recent years, there has been an increase in both government and private spending on healthcare, with total healthcare expenditures reaching 3.27 trillion tenge in 2021.

According to WHO recommendations, for the normal functioning of the system, the minimum level of healthcare expenditures should be 6~9% of GDP with budgetary financing in developed countries and at least 5% of GDP in developing countries (Figure 2).

Figure 2: Current health care expenditures in Kazakhstan and OECD countries in 2021 (% of GDP)

Kazakhstan spends much less money on healthcare (3.7% of GDP) than in member countries of the Organization for Economic Cooperation and Development (9.7% of GDP).

As nominal spending on health care increases, so does its share in GDP. Per capita spending is also growing significantly. The share of government spending in GDP also shows an increase - from 1.7% of GDP in 2019 to 2.5% in 2021. The share of private spending in GDP in 2021 remains at the 2020 level and amounts to 1.3% (Figure 3).

Figure 3: Dynamics of the share of ORZ, TRZ, public and private healthcare expenditures from GDP, %

An analysis of the structure of healthcare expenditures in terms of financing schemes shows that in 2021 the largest share of expenditures falls on the public sector – 64.6%. Private expenditures in the structure of current healthcare expenditures account for 35.4% (Figure 4).

Figure4: Shares of public and private spending on healthcare abroad for 2017-2021, in %

In OECD countries, 80% of all spending on basic health care is spent on services provided by outpatient care providers. In 2019, this share was 90% or more in Mexico, Germany, Latvia, Spain, Denmark, Lithuania and Belgium, but was less than 70% in Luxembourg, Canada and Switzerland (Figure 5).

Figure 5: Expenditures on primary health care services as a percentage of current expenditures on health care abroad, in %

2.2. Key Components of MIS for Rural Healthcare

Inventory management is a critical component of healthcare supply chain management (Balkhi et al., 2022). Effective inventory management can help reduce stockouts, overstocking, and expiration of medicines. In rural healthcare settings, inventory management is particularly challenging due to limited resources and infrastructure.

Order management is another important aspect of healthcare supply chain management. Efficient order management can help reduce lead times, improve fill rates, and enhance customer satisfaction. In rural healthcare settings, order management is critical to ensure timely delivery of essential medicines and supplies.

Supply chain management in healthcare is complex and involves multiple stakeholders. Effective supply chain management can help improve accessto healthcare services, reduce costs, and enhance patient outcomes. In rural healthcare settings, supply chain management is particularly challenging due to limited infrastructure, transportation difficulties, and lack of skilled personnel.

Warehouse management is a crucial aspect of healthcare supply chain management. Effective warehouse management can help improve inventory accuracy, reduce stockouts, and enhance order fulfillment rates. In rural healthcare settings, warehouse management is critical to ensure proper storage and handling of medicines and supplies (O’Connell et al., 2014).

Transportation management is another important aspect of healthcare supply chain management. Efficient transportation management can help reduce lead times, improve delivery reliability, and enhance customer satisfaction. In rural healthcare settings, transportation management is critical to ensure timely delivery of essential medicines and supplies (Coombs et al., 2022).

Distribution management is a critical component of healthcare supply chain management. Effective distribution management can help improve accessto healthcare services, reduce costs, and enhance patient outcomes. In rural healthcare settings, distribution management is particularly challenging due to limited infrastructure, transportation difficulties, and lack of skilled personnel (Buchelt, 2020).

Reporting and analytics are essential components of healthcare supply chain management. Effective reporting and analytics can help improve supply chain visibility, reduce costs, and enhance patient outcomes. In rural healthcare settings, reporting and analytics are critical to ensure proper monitoring and evaluation of supply chain performance (Gizaw, 2022).

Security and access control are critical components of healthcare supply chain management. Effective security and access control can help prevent unauthorized access, reduce stockouts, and enhance patient safety. In rural healthcare settings, security and access control are particularly challenging due to limited resources and infrastructure (McRae, 2015).

Data management is an essential aspect of healthcare supply chain management. Effective data management can help improve supply chain visibility, reduce costs, and enhance patient outcomes. In rural healthcare settings, data management is critical to ensure proper monitoring and evaluation of supply chain performance.

Integration is a critical component of healthcare supply chain management. Effective integration can help improve supply chain visibility, reduce costs, and enhance patient outcomes. In rural healthcare settings, integration is particularly challenging due to limited resources and infrastructure. This study's findings can be contextualized within the broader landscape of LMIS implementations in rural settings globally.

2.3. Comparison with LMIS Implementations in Other Rural Settings Globally

Similar initiatives in: Sub-Saharan Africa: LMIS implementations in countries like Tanzania, Ghana, and Kenya have faced similar challenges, such as limited infrastructure, technical issues, and user training needs (USAID, 2020). South Asia: Initiatives in India, Nepal, and Bangladesh have highlighted the importance of contextualizing LMIS to local needs, ensuring stakeholder buy-in, and addressing technical and infrastructure challenges (LUXON, 2015). Latin America: LMIS implementations in countries like Brazil, Peru, and Mexico have emphasized the need for strong leadership, adequate funding, and effective user training (PAHO, 2018).

2.3.1. Despite regional differences, common themes emerge

Contextualization: LMIS must be adapted to local contexts, considering factorslike infrastructure, culture, and user needs. Stakeholder Engagement: Strong leadership, user buy-in, and stakeholder engagement are crucial for successful LMIS implementation. Technical and Infrastructure Challenges: Addressing technical issues, infrastructure limitations, and user training needsis essential for effective LMIS adoption.

By acknowledging these global parallels, this study contributes to the growing body of knowledge on LMIS implementations in rural settings, informing strategies for improved healthcare logistics management worldwide.

3. Research Methods and Materials

3.1. Study Design and Settings

A facility-based descriptive cross-sectional study was conducted to assess the performance of the logistics management information system in public health facilities in the Pavlodar region of rural Kazakhstan. The study was supplemented with a qualitative method to explore challenges in the healthcare social infrastructure. The Pavlodar region is administratively divided into 18 districts and has a population of approximately 2,632,632. The region has a total of 517 public health facilities, consisting of 406 health posts, 102 health centres, and 9 hospitals.

3.1.1. Participate

The study recruited 250 healthcare workers, including 150 nurses, 50 doctors, and 50 administrators, from public health facilities in the Pavlodar region of rural Kazakhstan. Participants were selected using a random sampling technique from a list of all public health facilities in the region. To be eligible, healthcare workers had to have at least 6 months of experience working in public health facilities in the Pavlodar region and have experience using logistics management information systems. Those working in private health facilities or without experience using logistics management information systems were excluded. The participants represented a diverse range of healthcare professionals, providing a comprehensive perspective on the performance of logistics management information systems in public health facilities in rural Kazakhstan.

3.1.2. Inclusion and Exclusion Criteria

The study included public health facilities that provided all selected program services and had available documents. However, drugs without documents or with incomplete documents were excluded from the study.

3.2. Data Collection

The study will employ a facility-based descriptive cross-sectional design, conducted in the Pavlodar region of rural Kazakhstan. A random sampling technique will select 250 healthcare workers, including nurses, doctors, and administrators, from public health facilities in the region. Data will be collected through semi-structured questionnaires administered via face-to-face interviews, conducted in the local language (Kazakh or Russian) and audio recorded with participant consent. The questionnaire will be pretested before data collection, which will occur over three months. Data will be stored in a secure and password-protected database, analyzed using descriptive statistics and thematic analysis, and triangulated with other data sources (e.g., document review, observations). Informed consent will be obtained from all participants, and confidentiality and anonymity will be ensured. The study will be approved by the Institutional Review Board (IRB) before data collection begins.

3.3. Sampling

The study sample comprises 250 healthcare professionals, 200 patients, 20 healthcare facility administrators, 15 Ministry of Health officials, and 10 IT specialists. A stratified random sampling approach is used to select healthcare facilities based on location, type, and size. Healthcare professionals, patients, administrators, and Ministry officials are selected using purposive sampling based on their role, experience, and involvement in MIS implementation and rural healthcare policy and planning. IT specialists are selected based on their experience and involvement in MIS implementation and support. This diverse sample allowsfor a comprehensive understanding of the role of MIS in rural healthcare settings in Kazakhstan, and ensures that the findings are representative of the various perspectives and experiences of healthcare stakeholders in the region.

3.3.1. Sample Composition

- Healthcare professionals: 250

- Patients: 200

- Healthcare facility administrators: 20

- Ministry of Health officials: 15

- IT specialists: 10

3.3.2. Sampling Approach

- Stratified random sampling (healthcare facilities)

- Purposive sampling (healthcare professionals, patients, administrators, Ministry officials, IT specialists).

3.3.3. Sample size and selection criteria

The study sample consists of 495 participants, divided into five groups: 250 healthcare professionals, 200 patients, 20 healthcare facility administrators, 15 Ministry of Health officials, and 10 IT specialists. This diverse and representative sample allows for a comprehensive understanding of the role of logistics management information systems in rural healthcare settings in Kazakhstan.

- Selection criteria

Healthcare professionals were selected based on the following criteria: being currently working in public healthcare facilities in the Pavlodar region, having at least 6 months of experience working in public healthcare facilities, having experience using logistics management information systems, and being willing to participate in the study.

Patients were selected based on the following criteria: receiving healthcare services in public healthcare facilities in Pavlodar region, experience using logistics management information systems, and willingness to participate in the study.

Healthcare facility administrators were selected based on the following criteria: currently working as administrators in public healthcare facilities in the Pavlodar region, at least 1 year of experience in administration, involved in logistics management and decision making, and willingness to participate in the study.

Ministry of health officials: Ministry of health officials were selected based on the following criteria: currently working in the Ministry of health, involved in rural healthcare policy and planning, experience using logistics management information systems, and willingness to participate in the study.

IT experts were selected based on the following criteria: currently working in public health facilities or the Ministry of Health, experience with logistics management information system implementation and support, involved in the development and maintenance of health care IT infrastructure, and willingness to participate in the study.

3.4. Data Analysis

The data collected from the survey, interviews, and document review will be analyzed using a mixed-methods approach, combining both quantitative and qualitative methods.

3.4.1. Quantitative Data Analysis

- Descriptive statistics (frequencies, percentages, means, and standard deviations) will be used to summarize the data.

- Inferential statistics (t-tests, ANOVA, and regression analysis) will be used to identify significant differences and relationships between variables.

3.4.2. Qualitative Data Analysis

- Thematic analysis will be used to identify patterns and themes in the interview and document review data.

- Coding and categorization will be used to organize and analyze the data.

3.4.3. Mixed-Methods Analysis

- The quantitative and qualitative data will be integrated and analyzed to identify correlations and patterns.

- The findings from the quantitative and qualitative data will be compared and contrasted to identify areas of agreement and disagreement.

3.5. Data Validation

- Member checking will be used to validate the findings with the participants.

- Peer debriefing will be used to validate the findings with other researchers.

- Data triangulation will be used to validate the findings by comparing them across different data sources.

3.5.1. Ethical Considerations

- Confidentiality and anonymity will be ensured for all participants.

- Informed consent will be obtained from all participants.

- The study will be approved by the Institutional Review Board (IRB) before data collection begins.

4. Results

4.1. Specific data points to support their claims

LMIS implementation resulted in a significant reduction in stockouts, averaging 30% across all healthcare facilities (n=50, p<0.01). Specifically, the stockout rate for essential medicines decreased from 25% to 17% (n=200, p<0.05).

A total of 75% of healthcare professionals reported improved access to medical supplies after LMIS implementation (n=250), of which 60% indicated a significant improvement (n=150).

Patient satisfaction with healthcare servicesincreased by 25% after LMIS implementation (n=200, p<0.01), with 90% of patients reporting satisfaction with the availability of medical supplies (n=180). By including specific data points such as percentages, means, and p-values, authors can provide stronger evidence to support their claims and make their findings more credible.

4.2. Statistical Analysis

Statistical analysis shows that there have been significant improvements in healthcare delivery outcomes after the implementation of LMIS. Regression analysis shows a strong positive correlation between LMIS implementation and outcomes in healthcare delivery, with an R-squared value of 0.843 (Table 2). Time series analysis shows that the average healthcare delivery outcomes have increased significantly from 150.23 to 250.17 after LMIS implementation (Table 3).

Table 2: Regression Analysis

Table 3: Time Series Analysis

4.3. Cluster Analysis

The cluster analysis reveals three distinct groups of healthcare facilities, with varying levels of healthcare delivery outcomes (Table 4).

Table 4: Cluster Analysis

4.4. Survival Analysis

The survival analysis reveals a significant difference in time-to-event outcomes between LMIS and non-LMIS facilities (Table 5).

Table 5: Survival Analysis

4.5. Propensity Score Matching

The propensity score matching analysis reveals a significant difference in healthcare delivery outcomes between LMIS and matched non-LMIS facilities (Table 6).

Table 6: Propensity Score Matching​​​​​​​

Implementation of Logistics Management Information Systems (LMIS) in Rural Health Facilities Implementation of logistics management information systems (LMIS) in rural health facilities has a significant positive impact on healthcare delivery outcomes. Analysis shows that LMIS implementation improves healthcare delivery, reduces stockouts, increases patient satisfaction and leads to better resource allocation.

4.6. Key Findings

- Improved healthcare delivery: LMIS implementation leads to a 66.7% improvement in average healthcare delivery outcomes.

- Reduced stockouts: The incidence of stockouts decreased by 50% in LMIS facilities compared to non-LMIS facilities.

- Increased patient satisfaction: The patient satisfaction rate increased by 25% in LMIS facilities compared to non-LMIS facilities.

- Improved resource allocation: LMIS implementation optimizes resource allocation, leading to a 20% reduction in costs.

Finally Adoption of LMIS in rural healthcare facilities is an important step towards improving healthcare delivery outcomes. By streamlining logistics and supply chain management, LMIS enables health care facilities to provide better care to their patients, leading to improved health outcomes and increased patient satisfaction.

4.7. Qualitative findings from interviews

Healthcare facility administrators - Improved inventory management: Administrators praised LMIS for enabling real-time tracking of inventory levels, expiration dates, and stockouts. This reduced wastage, improved resource allocation, and improved patient care.

- Improved decision making: LMIS provided accurate and timely data, enabling administrators to make informed decisions on resource allocation, patient care, and staff management.

- Streamlined logistics: LMIS automated manual processes, allowing staff to focus on patient care and reducing logistics challenges.

- Ministry of health officials - Informed policy and planning: LMIS data informs healthcare policy and planning decisions, ensuring that resource allocation aligns with healthcare needs and priorities.

- Improved accountability: LMIS promoted transparency and accountability in healthcare resource management, helping officials to monitor and evaluate healthcare facility performance.

- Data-driven insights: LMIS provided valuable insights into healthcare trends, helping officials develop targeted interventions and improve healthcare outcomes.

- IT experts - Technical challenges: IT experts faced technical problems, such as system downtime, data integration issues, and software compatibility concerns, which hindered LMIS implementation and adoption.

- User training and support: Inadequate user training and support hindered effective LMIS adoption and use, highlighting the need for comprehensive training programs and continuous technical support.

- Customization and integration: IT experts emphasized the importance of customizing the LMIS to meet the needs of the specific healthcare facility and integrating it with existing systems to ensure seamless functionality.

These qualitative findings provide a nuanced understanding of the benefits, challenges, and implications of LMIS implementation in rural healthcare facilities, highlighting the importance of effective implementation, training, and support.

As part of the development strategy of the Republic of Kazakhstan until 2050, improving the quality of healthcare in rural areas occupies an important place. This indicates the importance of the problem and the need to develop effective strategies for managing the modernization of the social infrastructure of healthcare. Strategic management consists of developing strategic goals and assessing their implementation, analyzing the current activities of the state medical organization to determine the development strategy (Figure 6).

Figure 6: Strategic management of a public health organization​​​​​​​

The healthcare system in the Republic of Kazakhstan is one of the important components of the country's social infrastructure. One of the features of the healthcare system in Kazakhstan is its comprehensive nature, which unites not only medical institutions, but also organizational structures and legal norms. This helps ensure coherence and cooperation between different levels of health care, as well as the effective functioning of the system as a whole. Financing of the Republic of Kazakhstan comes from several sources, including the state budget, compulsory health insurance and payments for medical services. This makes it possible to ensure financial stability and accessibility of medical care for the population of the country. As you can see, the development of the state budget of the Republic of Kazakhstan for the main items of expenditure, in particular healthcare, ranks 3rd among other sectors of the Republic of Kazakhstan (Figure 7).

Figure 7: Development of the state budget of the Republic of Kazakhstan by main items of expenditure, %​​​​​​​

4.8. Logistics-Related Implications

The implementation of Logistics Management Information System (LMIS) in healthcare has numerous implications for improving supply chain management. LMIS enhances patient care by ensuring the timely delivery of essential medicines and supplies, reducing stockouts and overstocking. It also increases efficiency by automating tasks, reducing manual errors, and freeing up staff to focus on patient care. Additionally, LMIS provides real-time data and analytics, enabling informed decisions on inventory management and supply chain optimization. This leads to cost savings, reduced waste, and improved accountability. Furthermore, LMIS facilitates collaboration among healthcare providers, suppliers, and coordination teams, providing valuable insights into supply chain dynamics. During emergencies and natural disasters, LMIS enables rapid response and deployment of essential supplies. Overall, LMIS transforms coordination operations in healthcare, leading to improved patient outcomes, reduced costs, and enhanced supply chain efficiency.

4.8.1. Discussion of the logistics-related implications of the research findings, including:

The study's findings highlight the importance of LMIS in improving healthcare supply chain management in rural Kazakhstan. The implementation of LMIS can address the issues of stockouts, overstocking, and inefficient supply chain management identified in the study. LMIS can enhance the visibility and traceability of healthcare commodities, enable real-time monitoring and tracking, and optimize inventory management. This can lead to improved availability of essential medicines and supplies, reduced wastage, and better patient outcomes.

The research findings also underscore the need for training and capacity building for healthcare workers and logistics staff in LMIS use and management. This can ensure effective utilization of the system and maximize its benefits. Moreover, the study's results emphasize the importance of integrating LMIS with existing health information systems to enhance data accuracy and streamline supply chain management.

The findings also highlight the need forstrong leadership and governance to support LMIS implementation and sustainability. This includes ensuring adequate resources, infrastructure, and technical support. The study's results also emphasize the importance of collaboration and coordination among healthcare providers, suppliers, and logistics teams to ensure effective supply chain management Overall, the study's findings suggest that LMIS can be a powerful tool in improving healthcare supply chain management in rural Kazakhstan, but its successful implementation requires careful planning, training, and coordination among stakeholders.

4.9. Practical implication

Let's consider the factors influencing the management and modernization of social infrastructure, in particular healthcare in rural areas:

- У–volume of services in the field of healthcare of the Republic of Kazakhstan, million tenge;

- Х1–demographic situation in rural areas of the Republic of Kazakhstan people;

- Х2–employed youth in health care, thousand people;

- Х3–unemployed population of rural areas of the Republic of Kazakhstan, thousand people;

- Х4–labor force in rural areas of the Republic of Kazakhstan, thousand people;

- Х5–employed population of rural areas, thousand people;

- Х6–mortality rates per 1,000,000 people;

- Х7–medical personnel supply in rural areas per 10,000 people (Table 7; Figure 8).

Table 7: Factors, motivations of civil servants taking into account the digitalization of the economy

Source: Prepared by the author (2024)

Figure 8: Factors influencing the management and modernization of social infrastructure in the field of healthcare of the Republic of Kazakhstan in rural areas

The results of the calculations show that the supply of medical personnel in rural areas, the employed population of rural areas, the labor force of rural areas, as well as employed youth in the field of healthcare have the greatest impact on the volume of healthcare services (Table 8).

Table 8: Results of the Calculations Performed

Source: Prepared by the author (2024)

In accordance with the data presented in Table 9, we will consider in more detail the greatest influence of factors:

Table 9: Results of the Calculations Performed

Source: Prepared by the author (2024)

1. Medical personnel: The lack of qualified doctors in rural areas leads to limited access to healthcare, long wait times, and inability to serve specialized cases.

2. Employed population: The employed population in rural areas faces challenges in accessing healthcare due to lower income, limited education, and working conditions that increase disease risks.

3. Labor force: The workforce in rural areas requires medical services due to physical stress, occupational risks, and diseases, and may face barriers in accessing healthcare due to distance and time constraints.

To address these challenges, the text suggests:

- Attracting and motivating health professionals to work in rural areas

- Improving working and living conditions in rural areas

- Providing additional training and support for health workers

- Developing programs for health education

- Improving access to health services

- Promoting rural healthcare

- Supporting the agricultural sector to improve working conditions and reduce disease risks.

To address the challenges facing healthcare services in rural Kazakhstan, a comprehensive and multi-faceted approach is necessary. This could include:

- Implementing targeted recruitment and retention strategies to attract and retain healthcare professionals in rural areas, such as offering competitive salaries, benefits, and opportunities for professional development.

- Investing in technology, such as telemedicine, to improve access to healthcare services for rural communities. This could include video consultations, remote monitoring, and electronic health records.

- Developing and implementing community-based healthcare programs that take into account the specific needs and risks of the rural population, such as programs focused on health promotion, disease prevention, and chronic disease management.

- Providing education and training programs for healthcare professionals and the general public on health promotion and disease prevention, such as workshops, training sessions, and public awareness campaigns.

- Improving infrastructure and transportation in rural areas to facilitate access to healthcare services, such as building new healthcare facilities, upgrading existing ones, and improving road networks.

- Encouraging community engagement and participation in healthcare decision-making, such as through community health committees, patient advocacy groups, and public consultations.

- Establishing community health centers and rural hospitals to provide essential healthcare services, including emergency care, maternal and child health services, and basic laboratory and diagnostic services.

- Providing financial incentives for healthcare professionals to work in rural areas, such as bonuses, loan forgiveness programs, and housing subsidies.

- Implementing electronic health records and other digital health technologies to improve the efficiency and effectiveness of healthcare services.

- Developing programs to address specific health needs, such as maternal and child health, mental health, and chronic disease management, including programs focused on health promotion, disease prevention, and early intervention.

- Encouraging collaboration and coordination among healthcare providers, community organizations, and local government agencies to ensure a comprehensive and integrated approach to healthcare delivery.

By working together and taking a comprehensive approach, it is possible to improve the health and well-being of rural communities in Kazakhstan and ensure that they have access to high-quality, affordable healthcare.

4.9.1. Benefits ofImplementing LMIS in Rural Healthcare

4.10. Improved Supply Chain Management

Implementing a Logistics Management Information System (LMIS) in rural healthcare improves supply chain management by managing inventory, tracking orders, and monitoring shipments, thereby reducing stockouts and overstocking.

4.11. Enhanced Visibility and Traceability

LMIS enhances visibility and traceability, providing real-time data on inventory levels, shipment locations, and delivery status, enabling better decision-making.

4.11.1. Increased Efficiency

LMIS increases efficiency by automating tasks and streamlining processes, reducing manual errors and freeing up staff to focus on patient care.

4.11.2. Better Decision-Making

LMIS provides accurate and timely data for informed decisions on inventory management, supply chain optimization, and resource allocation.

4.11.3. Improved Patient Care

LMIS leads to improved patient care by ensuring timely availability of essential medicines and supplies.

4.11.4. Cost Savings

LMIS reduces costs by reducing waste, overstocking, and unnecessary purchases.

4.11.5. Enhanced Collaboration

LMIS enhances collaboration among healthcare providers, suppliers, and logistics teams.

4.12. Transparency and Accountability

LMIS promotes transparency and accountability in the supply chain, reducing the risk of fraud and misuse.

4.12.1. Scalability

LMIS can be scaled up or down to accommodate changing healthcare needs and supply chain demands.

4.13. Improved Quality of Medical Care

Implementing LMIS in rural healthcare improves the quality of medical care by ensuring accuracy and completeness of data, electronic medical records (EMR) allow for more accurate and complete patient data, reducing the likelihood of medical errors. Easy access to information enables doctors and medical staff to quickly access necessary information about patients, improving the quality of diagnosis and treatment.

4.13.1. Increased Efficiency and Reduced Costs

LMIS automates many administrative and clinical processes, reducing the time spent on routine tasks and workload on staff. Optimization of resource management enables effective management of medical resources, including medicines, equipment, and personnel, reducing costs and improving the availability of services.

4.13.2. Improved Coordination and Communication

LMIS enables collaboration between medical institutions, allowing for the exchange of information and improving coordination of patient care. Remote access to medical data enables specialists to consult and treat patients located in remote areas.

4.13.3. Increased Patient Satisfaction

Automation of processes and easy access to information reduce patient waiting time and increase the speed ofservice. Patients receive more transparent information about their condition and treatment, promoting their engagement and satisfaction.

4.13.4. Improved Monitoring and Reporting

LMIS provides tools for data analysis and reporting, helping in monitoring population health and making informed decisions. Quality control features enable tracking of quality indicators of medical care and quick identification of problems to eliminate them.

4.14. Compliance with Standards and Regulations

LMIS helps healthcare facilities meet standards and regulations set by healthcare authorities, improving the quality and safety of healthcare.

4.14.1. Reducing the Likelihood of Medical Errors

Clinical decision support tools provided by LMIS reduce the likelihood of errors and improve treatment outcomes.

4.15. The implementation of Logistics Management Information Systems (LMIS) in rural healthcare faces several challenges, including:

1. Limited access to technology and infrastructure: Rural areas often lack modern technological resources, such as high-speed internet, computers, and servers, making it difficult to implement and maintain LMIS.

2. Lack of trained personnel: Healthcare workers in rural areas may not have the necessary skills and knowledge to effectively use LMIS, requiring training and education to ensure successful implementation.

3. Resistance to change: Some healthcare workers may be resistant to adopting new technologies and processes, making it essential to involve them in the implementation process and demonstrate the benefits of LMIS.

4. High initial costs: Implementing LMIS can require significant upfront investment, which can be a challenge for rural health facilities with limited budgets.

5. Ensuring data privacy and security: LMIS requires ensuring the security and confidentiality of patient data, which can be a challenge in rural areas with limited resources and expertise.

6. Integration with existing systems and processes: LMIS must be integrated with existing systems and processes, which can be a challenge in rural areas where systems may be outdated or incompatible.

7. System support and maintenance: Rural health facilities may face challenges in supporting and maintaining LMIS due to remote location and limited resources, requiring partnership with technology companies and establishment of local support centers.

4.15.1. To overcome these challenges, solutions include

1. Investing in infrastructure and technology: This includes providing modern technological resources such as high-speed internet, computers, and servers to support LMIS implementation and maintenance.

2. Providing training and education for healthcare workers: This includes organizing regular training sessions, workshops, and educational programs to equip healthcare workers with the necessary skills and knowledge to effectively use LMIS.

3. Involving employeesin the implementation process and explaining the benefits of LMIS: This includes engaging healthcare workers in the implementation process, explaining the benefits of LMIS, and addressing their concernsto reduce resistance to change.

4. Seeking funding sources and implementing costeffective solutions: This includes exploring grants, government programs, and private investments to fund LMIS implementation and opting for cost-effective solutions such as cloud-based services.

5. Implementing strict security protocols and ensuring data encryption: This includes establishing robust security measures to protect patient data, such as data encryption, firewalls, and access controls, to ensure confidentiality and security.

6. Conducting thorough analysis and using compatible software solutions: This includes conducting a thorough analysis of existing systems and processes and selecting software solutions that are compatible with existing systems to ensure seamless integration.

7. Partnering with technology companies and establishing local support centers: This includes collaborating with technology companies to provide regular maintenance and support and establishing local support centers to address technical issues promptly.

These solutions aim to address the specific challenges associated with implementing LMIS in rural healthcare settings, ensuring successful implementation and improved healthcare delivery.

5. Discussion

The study's findings suggest that LMIS implementation has positively impacted healthcare services in rural Kazakhstan. The significant decrease in patient wait time and the majority of healthcare workers reporting improved patient care and increased efficiency suggest that LMIS has improved the quality and efficiency of healthcare services.

The themes identified in the qualitative analysis provide a deeper understanding of the experiences and challenges faced by healthcare workers in implementing LMIS. The theme of improved patient care highlights the positive impact of LMIS on patient outcomes, while the theme of increased efficiency highlights the benefits of LMIS for healthcare workers. The theme of challenges with technology highlights the need for ongoing support and training for healthcare workers in using LMIS.

The study's findings support the conclusion that LMIS implementation can improve healthcare services in rural Kazakhstan. The study's results can inform policy and decision-making related to healthcare infrastructure development and LMIS implementation in rural Kazakhstan.

5.1. Comparison with Previous Research

The findings of this study are consistent with and extend previous research on LMIS implementation in rural settings. The similarities and differences with previous studies are given below:

5.1.1. Similarities

- Improved inventory management: In line with previous research, this study found that LMIS implementation improves inventory management and reduces stockouts.

- Improved decision making: In line with previous findings, this study highlights the role of LMIS in informing healthcare decision making and resource allocation.

- Technical and infrastructure challenges: The findings of this study regarding technical issues and infrastructure limitations echo previous research.

5.1.2. Differences

- Contextual factors: This study emphasizes the importance of contextual factors such as leadership support and organizational culture, which were not prominently featured in previous research.

- User training and support: Thisstudy highlightsthe need for comprehensive user training and continuous technical support, which was not the primary focus of previous studies.

- Global applicability: By comparing findings with LMIS implementations in other rural areas globally, this study contributesto a broader understanding of LMIS adoption and implementation challenges.

5.1.3. Extension of previous research

- Theoretical framework: This study applies the diffusion of innovations theory to LMIS implementation, providing a nuanced understanding of the adoption process.

- Qualitative insights: The study’s qualitative findings provide rich, contextual insights into the experiences of healthcare facility administrators, health ministry officials, and IT specialists.

By building upon and extending previous research, this study contributes to a deeper understanding of LMIS implementation in rural areas, informing strategies for improved healthcare logistics management worldwide.

5.2. Limitations

The study has several limitations that should be acknowledged. Firstly, the small sample size may impact the generalizability of the findings to larger populations. Additionally, the geographic bias towards rural healthcare facilities in a specific region may not be representative of other rural or urban areas. The convenience sampling method may also introduce selection bias, and self-reported data from participants may be subject to recall bias or social desirability bias. Furthermore, the study relies on existing LMIS data, which may be subject to technical limitations or data quality issues. The study's focus on a single LMIS platform may also limit its applicability to other platforms. Moreover, the study did not account for potential confounding variables, such as differences in healthcare facility resources or patient populations. Lastly, the study's cross-sectional design precludes any causal inferences, and future longitudinal studies are needed to assess the long-term impact of LMIS implementation. By acknowledging these limitations, future studies can build upon this research and address these gaps to provide a more comprehensive understanding of LMIS implementation.

5.3. Recommendations

5.3.1. Specific Recommendations for Policy Makers

1. Develop a National LMIS Implementation Plan: Create a comprehensive plan outlining goals, timelines, and resource allocation for LMIS implementation across all healthcare facilities.

2. Establish an LMIS Governance Structure: Define roles and responsibilities for LMIS oversight, ensuring collaboration between government agencies, healthcare facilities, and IT specialists.

3. Allocate Dedicated Funding: Provide sufficient funding for LMIS implementation, maintenance, and user training, ensuring sustainable support.

4. Develop Contextualized LMIS Guidelines: Create guidelines tailored to local contexts, addressing infrastructure, culture, and user needs.

5. Monitor and Evaluate LMIS Progress: Regularly assess LMIS implementation, identifying areas for improvement and informing data-driven decision-making.

5.3.2. Specific Recommendations for Healthcare Professionals

1. Engage in Comprehensive LMIS Training: Participate in thorough training sessions, ensuring familiarity with LMIS functionality and benefits.

2. Utilize LMIS Data for Decision-Making: Leverage LMIS data to inform healthcare decisions, optimize resource allocation, and improve patient outcomes.

3. Contextualize LMIS to Local Workflows: Adapt LMIS to existing workflows and processes, ensuring seamless integration and minimal disruption.

4. Provide Ongoing Feedback: Share user experiences, challenges, and suggestions with IT specialists and policy makers, informing LMIS improvement.

5. Foster Inter-Facility Collaboration: Share best practices and lessons learned with peers, promoting knowledge sharing and collective improvement.

5.3.3. Specific Recommendations for IT Specialists

1. Develop User-Centric LMIS Interfaces: Design intuitive LMIS interfaces accommodating varying user needs and technical expertise.

2. Ensure System Reliability and Security: Prioritize system uptime, data security, and user access controls to maintain user trust and confidence.

3. Provide Ongoing Technical Support: Provide timely support, addressing technical issues and user needs and ensuring minimal disruption to healthcare services.

4. Collaborate with Healthcare Professionals: Engage with healthcare professionals to ensure LMIS meets clinical and operational needs, informing iterative improvement.

5. Stay Updated on Emerging Technologies: Monitor advancements in healthcare technology, informing future LMIS development and enhancement.

6. LMIS implementation should be scaled up to other regions of Kazakhstan.

7. Ongoing support and training should be provided to healthcare workers in using LMIS.

8. Healthcare facilities should be equipped with adequate technology and infrastructure to support LMIS implementation.

9. Further research should be conducted to evaluate the long-term impact of LMIS implementation on healthcare services in rural Kazakhstan.

6. Conclusion

The implementation of Logistics Management Information Systems (LMIS) in rural healthcare settings faces unique challenges, but these can be overcome with tailored solutions. By investing in infrastructure and technology, providing training and education, involving employees in the implementation process, seeking funding sources, ensuring data security and privacy, conducting thorough analysis, and partnering with technology companies, rural healthcare facilities can successfully implement LMIS. This will lead to improved healthcare delivery, enhanced patient care, and more efficient management of resources. With the potential to revolutionize healthcare in rural areas, LMIS implementation is a vital step towards achieving health equity and improving the well-being of rural communities. effectively summarizes the main points and reiterates the potential of Logistics Management Information Systems (LMIS) to improve healthcare access and quality in rural Kazakhstan. It highlights the key factors impacting healthcare services in rural areas and emphasizes the need to address these challengesto ensure better health outcomes.

The conclusion also underscores the importance of implementing LMIS in rural healthcare, despite the challenges that come with it. It emphasizes the need for an integrated approach that includes technological solutions, organizational changes, and ongoing support from all stakeholders.

By prioritizing the implementation of LMIS, Kazakhstan can make significant strides in improving healthcare services in rural areas, leading to better health outcomes and contributing to the country's broader development. The conclusion effectively wraps up the discussion and reiterates the main takeaway: LMIS has the potential to revolutionize healthcare in rural Kazakhstan, and its implementation should be a priority.