Addressing Infant Mortality through Global Value Chain Analysis

The global value chain (GVC) framework can shed light on issues that are literally a matter of life and death. Case in point is a recent study led by the Duke Global Health Institute (DGHI) and the Duke University Center on Globalization, Governance & Competitiveness (Duke CGGC) that identified value chain improvement opportunities for a life-saving commodity: chlorhexidine (CHX) for umbilical cord care. A Duke team of students, staff and faculty dedicated two semesters of research to investigate this topic. This included site visits to Dhaka, Bangladesh in March and May 2015, just before the CHX launch in the country.

Infections cause 13% of the 3 million newborn deaths each year globally. Clinical trials conducted in Bangladesh and other countries have shown that an estimated 23% of neonatal deaths can be averted using 7.1% chlorhexidine digluconate. The UN Commission on Lifesaving Commodities for Women and Children has advocated for country by country introductions of CHX where newborn deaths are high due to infection. CHX is inexpensive (less than $1 per dose) and is manufactured by local as well as multi-national generic manufacturers in gel and liquid formulations.

Global value chain (GVC) mapping depicts the labor, policies, capabilities, inputs, technologies, standards, regulations and markets relevant to a particular product, commodity or service. Using value chain analysis, Jeffrey Moe (DGHI) and Danny Hamrick (Duke CGGC) authored the study “Chlorhexidine for Umbilical Cord Care: A Value Chain Analysis in Bangladesh”. The report described the full range of CHX activities in the country, including development, production, distribution and adoption and use by mothers and their care-givers.

Duke students contributed to the report by reviewing clinical studies and launches of CHX in other countries and interviewing key actors involved in CHX’s introduction in Bangladesh. Analysis of the map revealed seven “leverage points” — an opportunity to consider “upgrading” to capture efficiencies, reduce costs and increase access and quality. The seven leverage points highlighted in the report are:

  1. Research and development
  2. Packaging
  3. Regional supply and market expansion
  4. Safe delivery kits
  5. Distribution
  6. Global coordination
  7. Monitoring and performance metrics

Moe and Hamrick suggested that the “report provides another application of value chain analysis to studies of global health by highlighting the various roles actors play, the governance structures that guide activities and the crucial leverage points.”

The student work and their visit to Bangladesh was funded by the Bass Connections program at Duke University. USAID’s Health Education Solutions Network also provided support.

Access the report for complete analysis.