Site Reassignment for Mobile Outreach Teams: Investigating the Effectiveness of Decentralized Decision-Making

United Nations Sustainable Development Goal (SDG) 3.8 states that health coverage should be universal by 2030. This is challenging in rural areas. To address this challenge, mobile outreach teams of healthcare workers visit a fixed set of remote sites to provide healthcare services. Dynamics in demand and supply cause once rational site-to-team assignment decisions to become far from optimal. This paper considers the problem of reassigning sites to maximize effectiveness. Outreach teams commonly have a high degree of decision-making autonomy, and there are good reasons to maintain this. Since reassignment requires coordination, the key question for decision makers is whether and when a decentralized approach is effective. We examine the trade-off between the level of centralization and effectiveness and study how design choices and information gaps brought about by centralization affect this trade-off. We propose a mixed integer programming model for centralized site reassignment. We extend this model to represent a decentralized approach where teams collaborate in team meetings to reassign sites and develop a set of simple decision rules for this approach. We use empirical data from six country outreach programs of the non-governmental organization MSI Reproductive Choices. Our results suggest that, when properly designed, simple decentralized decision-making systems tend to perform close to or even outperform centralized decision-making. We develop several propositions useful for decision makers in humanitarian organizations when making design choices, taking account of context. In particular, we show that decentralized site reassignment provides a feasible and effective alternative to centralized approaches in many contexts.