Problem definition: Healthcare systems in resource-limited settings rely on diagnostic networks in which medical samples (e.g., blood, sputum) and results need to be transported between geographically dispersed healthcare facilities and centralized laboratories.

Academic/practical relevance: Existing sample transportation (ST) systems typically operate fixed schedules, which do not account for demand variability and lead to unnecessary transportation visits as well as delays.

Methodology: We design an optimized sample transportation (OST) system that comprises two components: (i) a new approach for timely collection of information on transportation demand (samples and results) using low-cost technology based on feature phones, and (ii) an optimization-based solution approach to the problem of routing and scheduling courier trips in a multistage transportation system.

Results: Our solution approach performs well in a range of numerical experiments. Furthermore, we implement OST in collaboration with Riders For Health, who operate the national ST system in Malawi. Based on analysis of field data describing over 20,000 samples and results transported during July–October 2019, we show that the implementation of OST routes reduced average ST delays in three districts of Malawi by approximately 25%. In addition, the proportion of unnecessary trips by ST couriers decreased by 55%.

Managerial implications: Our approach for improving ST operations is feasible and effective in Malawi and can be applied to other resource-limited settings, particularly in sub-Saharan Africa.