Effect of armed conflicts on humanitarian operations: Total factor productivity and efficiency of rural hospitals

We study an important but widely neglected topic in humanitarian operations: armed conflicts. Specifically, this paper empirically analyzes the effect of armed conflicts on the operational performance of first-layer response organizations. Using as a case study the Colombian conflict we investigate the effect of conflict on public rural hospitals' (i) total factor productivity, (ii) efficiency and (iii) efficiency variability. The panel data set (2007-2011) used in this study includes information at the hospital level for 163 hospitals and qualitative data collected from interviews with medical staff from the Colombian Ministry of Health and hospitals in different conflict zones. Our results indicate that armed conflict has a positive effect on total factor productivity, while it has a negative impact on hospital efficiency, and interestingly that efficiency and total factor productivity both increase in post conflict. Finally, the results show that efficiency variability is higher in peace and post-conflict hospitals and lower in medium and severe-conflict hospitals. These results have operations management implications and opportunities for future research related to sourcing decisions, supply chain and workforce flexibility, behavioral impacts on the workforce, and humanitarian response to conflicts.