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By: Aleksandr Michuda, Adriana Molina-Garzón, Karen Ortiz-Becerra

Abstract:Ìý

This paper examines how extreme temperatures affect the operational capacity of a national health system by tracking facility-level demand for medical inputs in Ghana. We leverage a high-frequency panel of on-demand aerial deliveries to more than 2,700 facilities and link each facility orders—volumes, emergency status, and product composition—to local monthly temperature exposure. Using a two-way fixed-effects approach, we show that heat spikes raise overall resupply demand and, importantly, increase the share of deliveries triggered by stockouts across all facility types. Mid-to high-tier facilities exhibit a contemporaneous rise in deliveries for critical patients. Productlevel patterns indicate that heat primarily drives up demand for storable consumables such as fluids, while categories not directly heat-sensitive (eg, family-planning supplies) remain flat. The total order counts tend to recede in the months after a heat shock, yet the stockout share persists—especially at higher-level facilities—consistent with inventories being drawn down by sustained caseloads and replenished via just-intime resupply. We further document that consecutive months of extreme heat amplify stockout rates. Taken together, these results provide system-wide, facility-level evidence that temperature shocks transmit quickly through the supply chain, and shed light on the operational vulnerabilities of health systems under climate stress and the need to strengthen supply chain resilience as an adaptation strategy.