This thesis analyses how the upstream supply chain for caffeine could be structured to enable access within Malawi’s neonatal care system. Caffeine is the recommended first-line treatment for apnoea of prematurity, yet it is currently not available in Malawi’s public health system. Previous studies have primarily framed this issue as a problem of price and affordability, while limited attention has been given to how upstream supply chain structures influence both cost build-up and supply continuity.

This research therefore examines how the main characteristics of an upstream supply chain for caffeine can be designed to support availability and affordability in Malawi. The study identifies key upstream cost drivers and explores how different supply chain configurations affect these drivers. A design-oriented approach is applied, combining literature research, stakeholder insights, and supply chain mapping. Alternative supply chain configurations are generated using a morphological chart and subsequently evaluated using a multi-criteria analysis (MCA) supported by scenario analysis.

The results indicate that upstream design choices, such as procurement structure, sourcing strategies, and coordination, play an important role in shaping affordability and supply reliability. In particular, configurations that create scale and reduce coordination complexity appear most promising under conditions of low and uncertain demand. The findings demonstrate how a structured supply chain design approach can support decision-making for improving access to essential neonatal medicines in resource-constrained health systems. ... Read more