Decision models for performance evaluation and human resources planning in Tunisian public hospitals during the COVID-19 pandemic: a case study

The shortage of public hospital resources in developing countries such as Tunisia creates major challenges during health crises like the COVID-19 pandemic. Efficient allocation of limited human and material resources is essential to strengthen the healthcare system’s resilience. This study evaluates the performance of COVID-19 healthcare units in Tunisia, focusing on operational efficiency and responsiveness under resource constraints. A real-world COVID-19 unit at the University Hospital Center (UHC) SAHLOUL in Sousse, Tunisia, is modeled using discrete event simulation to analyze patient flow and resource utilization. Results reveal long waiting times, congestion, and bottlenecks that reduce daily patient throughput. Multiple “What-if” scenarios are tested, including workflow reconfiuration strategies, structural redesign, optimization of staff scheduling, and capacity planning. The best scenario increases patient discharges by 40%, decreases untreated cases by 48.5%, and reduces average patient length of stay by 25.3%, improving flow efficiency and overall resource utilization.