Clinic Capacity Management: Planning Treatment Programs that Incorporate Adherence

For infectious diseases like tuberculosis and HIV, treatment adherence plays an important role in treatment effectiveness and epidemic control. Studies of some infectious diseases indicate that patients who live closer to their health facilities maintain higher adherence; however, most models ignore the heterogeneity of patients' adherence. Clinics must balance knowledge about adherence with epidemic growth when creating successful treatment programs. We develop an optimization model that integrates a clinic's capacity decisions with population health outcomes. We find that incorporating adherence into clinic planning models can lead to decisions that significantly improve outcomes. For example, in a realistic case study of the HIV epidemic in Zambia, we find that decision makers who ignore decreasing adherence make suboptimal decisions and overestimate the effectiveness of their treatment programs by as much as 94%. Our model is a first step toward understanding the relationship between adherence and health delivery.     

Stockpiling supplies for disaster response: an experimental analysis of prepositioning biases

Abstract

Several relief organisations preposition supplies in preparation for disaster response. We show how the structure of prepositioning decisions resemble newsvendor decisions and how common newsvendor biases could affect prepositioning performance. To explore prepositioning biases, we run a behavioural experiment of a prepositioning problem with 20 practitioners from the humanitarian sector. Their task was to choose prepositioning quantities under different cost conditions and for supplies with different degrees of criticality. Results show that participants pull orders away from optimum (pull-to-centre) and follow the prior beneficiary demand realisation (demand chasing) regardless of cost and criticality conditions. However, the estimation of behavioural models reveals patterns hidden in averages, showing that participants weigh undersupply costs more for urgent supplies and urgency moderates demand chasing. A follow-up validation experiment manipulates the salience of urgent supplies by bundling them with non-urgent supplies in a portfolio. Results show that the portfolio strengthens these patterns, increasing the availability of urgent supplies. We offer practice implications of these findings for prepositioning activities and theory implications for inventory experiments in general.     

Stochastic Optimization for Natural Disaster Asset Prepositioning

A key strategic issue in pre‐disaster planning for humanitarian logistics is the pre‐establishment of adequate capacity and resources that enable efficient relief operations. This paper develops a two‐stage stochastic optimization model to guide the allocation of budget to acquire and position relief assets, decisions that typically need to be made well in advance before a disaster strikes. The optimization focuses on minimizing the expected number of casualties, so our model includes first‐stage decisions to represent the expansion of resources such as warehouses, medical facilities with personnel, ramp spaces, and shelters. Second‐stage decisions concern the logistics of the problem, where allocated resources and contracted transportation assets are deployed to rescue critical population (in need of emergency evacuation), deliver required commodities to stay‐back population, and transport the transfer population displaced by the disaster. Because of the uncertainty of the event's location and severity, these and other parameters are represented as scenarios. Computational results on notional test cases provide guidance on budget allocation and prove the potential benefit of using stochastic optimization.     

Using Fairness Models to Improve Equity in Health Delivery Fleet Management

Inefficiency and inequity are two challenges that plague humanitarian operations and health delivery in resource‐limited regions. Increasing capacity in humanitarian and health delivery supply chains is one option that has the potential to improve equity while maintaining efficiency. For example, the nonprofit organization Riders for Health has worked to increase capacity by providing reliable transportation to health workers in rural parts of sub‐Saharan Africa; with more motorcycle hours at their disposal, health workers can perform more outreach to outlying communities. We develop a model using a family of fairness function to quantify the efficiency and equity of health delivery as capacity is increased via development programs. We present optimal resource allocations under utilitarian, proportionally fair, and egalitarian objectives and extend the model to include dual modes of transport and diminishing returns of subsequent outreach visits. Finally, we demonstrate how to apply our model at a regional level to provide support for humanitarian decision makers such as Riders for Health. We use data from the baseline phase of our evaluation trial of Riders for Health in Zambia to quantify efficiency and equity for one real‐world scenario.     

Improving Humanitarian Operations through Technology‐Enabled Collaboration

Humanitarian supply chains involve many different entities, such as government, military, private, and non‐governmental organizations and individuals. Well‐coordinated interactions between entities can lead to synergies and improved humanitarian outcomes. Information technology (IT) tools can help facilitate collaboration, but cost and other barriers have limited their use. We document the use of an IT tool to improve last‐mile supply distribution and data management in one of many camps for internally displaced persons after the January 2010 earthquake in Haiti, and we describe other current uses of technology in camp management. Motivated by these examples and the interest among humanitarian organizations in expanding the use of such tools to facilitate coordination, we introduce a cooperative game theory model and explore insights about the conditions under which multi‐agency coordination is feasible and desirable. We also outline an agenda for future research in the area of technology‐enabled collaboration in the humanitarian sector.     

国家自然科学基金委员会管理科学部资助项目评估研究

国家自然科学基金委员会管理科学部自1998年起对1992~2003年(见P7表3)后资助的已结题面上项目进行全面的绩效评估。对项目的绩效评估结果进行了初步分析,结论是管理科学部开展项目的评估效果是好的,同时总结了评估中存在的问题,提出了今后改进与完善评估工作的若干建议。