A hybrid inventory management model for pediatric tertiary hospitals in low- and middle-income countries: Integration of ABC–XYZ classification, simulation, and Just-in-Time implementation

Abstract

Background: Inventory inefficiency remains a systemic barrier to responsive care delivery in low- and middle-income countries (LMICs), particularly in tertiary pediatric hospitals. Challenges include rigid procurement cycles, fragmented data architecture, and insufficient alignment between clinical needs and supply planning. These structural limitations are exacerbated by demand volatility and resource constraints, leading to recurrent stock-outs and waste. Objective: This study evaluates a hybrid inventory management approach combining ABC–XYZ classification, discrete-event simulation (DES), and a context-adapted Just-in-Time (JIT) strategy. The objective is to assess whether these integrated tools can improve inventory responsiveness and cost-effectiveness within the administrative constraints of a public hospital system. Additionally, the study explores how risk-based stratification and simulation modeling can inform pragmatic policy adaptation in LMIC settings. Methods: A mixed-methods study was conducted at Children’s Hospital 1 (Vietnam) from 2019 to 2025. Inventory data were stratified using ABC–XYZ analysis, and a DES model was applied to simulate the effects of JIT policies under real-world constraints. A pilot implementation was performed in the interventional cardiology unit, focusing on high-value, low-variability items.Triangulated data sources included retrospective performance indicators, audit reports, and stakeholder interviews to identify systemic bottlenecks and assess organizational readiness. Results: Simulation projected a 46% reduction in stock-outs, a 35% decrease in inventory days, and over 30% in cost savings. The JIT pilot confirmed feasibility, showing a 72.7% reduction in stock-outs and no clinical delays. However, systemic constraints—procurement inflexibility, data fragmentation, and weak supplier accountability—were identified as key bottlenecks to scalability.Feedback from clinical and logistics personnel further indicated improved predictability and coordination under the hybrid model. Conclusions: The findings highlight that technical innovations in inventory control must be embedded within broader administrative reform. Strategic procurement agility, digital integration, and governance restructuring are essential for sustainable inventory modernization in LMIC hospitals. JIT is most effective when selectively applied within a hybrid governance framework that balances operational efficiency with clinical risk mitigation.