This article employs quantitative analysis to evaluate the effectiveness of the community health worker (CHW) training program used by the Ministry of Public Health in Ecuador. The study first assesses CHW knowledge in the areas of prevention, maternal-child health, first aid, and treatment of common illnesses. The analysis reveals that CHWs retained less than 50 percent of what they learned one year after graduation. Demographic factors accounted for some variance in performance. Higher levels of community organization were associated with improved CHW knowledge. The presence of a health committee was also an important factor. The second phase of the study was designed to assess the community impact of the program. Surprisingly, neither the demographic characteristics of the health worker nor his or her level of competence affected the impact of the program on the community, as measured by patient satisfaction, utilization indices, and adoption of preventive health behaviors. It was the characteristics of the beneficiaries themselves that accounted for the variance in community impact. These results yield some important implications for public health policy in Ecuador.

Just-in-time (JIT) principles were used to analyze the operation of Ecuador's medical supply system that serves rural community health workers (CHWs). We completed a descriptive analysis of supply shortages and replenishment policies in six of Ecuador's provinces. Our 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. We used a set-covering algorithm to provide a systematic analysis of some supply-replenishment alternatives that reduced costs associated with CHW-initiated JIT practices.

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Published admissions standards typically include factors such as test scores, grades, and letters of recommendation. Yet there is little direct evidence in the literature on how these criteria as well as race and sex are actually utilized in student selection. That is, what are the operative rules in admissions decisions? This study reports the results of a survey of the National Association of Schools of Public Affairs and Administration principal representatives. Each respondent was presented an applicant profile booklet designed to estimate the impact of grades, GRE scores, references, race, and gender on admission decisions. In the findings we discuss how these variables are considered in the selection process. The analysis concludes with a commentary on the implications of the data for Master of Public Administration programs, and their admissions practices.