Jafry M A, Jenny A M, Lubinga S J, Larsen-Cooper E, Crawford J, Matemba C, Babigumira J B
University of Washington, Seattle, WA, USA.
Global Medicines Program, University of Washington, Seattle, WA, USA.
BMC Res Notes. 2016 Jul 25;9:363. doi: 10.1186/s13104-016-2144-x.
Malawi, like many low-income countries, is facing a severe health worker shortage. A potential stop-gap solution to this crisis is improving the efficiency of health center operations. Given the lack of research on center efficiency in rural health centers in Malawi, we conducted a study to identify deficiencies in center organization and barriers to patient flow.
We performed a time-motion survey at a rural health center in Ntaja, Malawi over a period of 1 week. We used a standardized questionnaire to collect information on the amount of time a patient spent with each health worker, the number of center staff that attended to each patient, and the total time spent at the center. Additionally, at the end of the visit, we conducted an exit survey to collect demographic information and data on perception of quality of care with the center visit for all patients.
A total of 1018 patients were seen over the five-day study. The average total time spent at the center by the patients was 123 min (2-366 min). Adults had an average total time spent at the center of 111 min (2-366 min) and children 134 min (7-365 min). Patient waiting time (PWT) was higher in the early morning hours ranging from 157 min (between 06:00 and 08:00) to 53 min (between 14:00 and 16:00). Health worker contact time (HCT) was higher for adults (2.3 min) than children (1.7 min). Shorter wait times were associated with higher perceptions of quality of service.
Despite shortages in health workers and funds, opportunities are available to increase efficiency in rural health centers. By removing bottlenecks to increase the productivity of health workers, centers in low-income countries can treat more patients and improve service quality.
与许多低收入国家一样，马拉维正面临严重的卫生工作者短缺问题。解决这一危机的一个潜在权宜之计是提高卫生中心的运营效率。鉴于马拉维农村卫生中心缺乏关于中心效率的研究，我们开展了一项研究，以确定中心组织方面的缺陷以及患者流动的障碍。
我们在马拉维恩塔贾的一个农村卫生中心进行了为期1周的时间动作调查。我们使用标准化问卷收集患者与每位卫生工作者相处的时间、照顾每位患者的中心工作人员数量以及在中心花费的总时间等信息。此外，在就诊结束时，我们进行了出院调查，收集所有患者的人口统计学信息以及对中心就诊护理质量的看法数据。
在为期五天的研究中，共诊治了1018名患者。患者在中心花费的平均总时间为123分钟（2 - 366分钟）。成年人在中心花费的平均总时间为111分钟（2 - 366分钟），儿童为134分钟（7 - 365分钟）。清晨时段患者等待时间（PWT）较高，从157分钟（06:00至08:00之间）到53分钟（14:00至16:00之间）。成人的卫生工作者接触时间（HCT）（2.3分钟）高于儿童（1.7分钟）。等待时间越短，对服务质量的评价越高。
尽管卫生工作者和资金短缺，但仍有机会提高农村卫生中心的效率。通过消除瓶颈以提高卫生工作者的生产力低收入国家的卫生中心可以治疗更多患者并提高服务质量。
