Supplying Ecuador’s health workers just in time

Just-in-time (JIT) principles were used to analyze the operation of Ecuador’s medical supply system that serves rural community health workers (CHWs). The authors completed a descriptive analysis of supply shortages and replenishment policies in six of Ecuador’s provinces. Their findings indicate that supply outages are caused by poor planning associated with replenishment cycle times, centralization of supply centers, and CHW travel time to supply warehouses. Furthermore, CHWs frequently circumvent official policies and procedures in obtaining needed supplies, producing higher health care costs. The authors used a set-covering algorithm to provide a systematic analysis of some supply-replenishment alternatives that reduced costs associated with CHW-initiated JIT practices.