IFMR Graduate School of Business, KREA University, 5655, Central Expressway, Sri City, Andhra Pradesh, 517646, India.
Foundation for Research in Community Health, 3-4, Trimiti-B Apartments, Anand Park, Aundh, Pune, Maharashtra, 411007, India.
BMC Health Serv Res. 2019 Nov 21;19(1):878. doi: 10.1186/s12913-019-4732-7.
Community Health Workers (CHWs) are critical to providing healthcare services in countries such as India which face a severe shortage of skilled healthcare personnel especially in rural areas. The aim of this study is to understand the work flow of CHWs in a rural Community Mental Health Project (CMHP) in India and identify inefficiencies which impede their service delivery. This will aid in formulating a targeted policy approach, improving efficiency and supporting appropriate work allocation as the roles and responsibilities of the CHWs evolve.
A continuous observation Time Motion study was conducted on Community Health Workers selected through purposive sampling. The CHWs were observed for the duration of an entire working day (9 am- 3 pm) for 5 days each, staggered during a period of 1 month. The 14 different activities performed by the CHWs were identified and the time duration was recorded. Activities were then classified as value added, non-value added but necessary and non-value-added to determine their time allocation.
Home visits occupied the CHWs for the maximum number of hours followed by Documentation, and Traveling. Documentation, Administrative work and Review of work process are the non-value-added but necessary activities which consumed a significant proportion of their time. The CHWs spent approximately 40% of their time on value added, 58.5% of their time on non-value added but necessary and 1.5% of their time on non-value added activities. The CHWs worked for 0.7 h beyond the stipulated time daily.
The CHW's are "dedicated" mental health workers as opposed to being "generalists" and their activities involve a significant investment of their time due to the specialized nature of the services offered such as counselling, screening and home visits. The CHWs are stretched beyond their standard work hours. Non-value added but necessary activities consumed a significant proportion of their time at the expense of value-added activities. Work flow redesign and implementation of Health Management Information Systems (HMIS) can mitigate inefficiencies.
社区卫生工作者（CHW）对于提供医疗保健服务至关重要，尤其是在印度等国家，这些国家面临着熟练医疗人员严重短缺的问题，尤其是在农村地区。本研究旨在了解印度农村社区心理健康项目（CMHP）中 CHW 的工作流程，并确定阻碍其服务提供的效率低下问题。这将有助于制定有针对性的政策方法，提高效率，并支持适当的工作分配，因为 CHW 的角色和职责正在不断演变。
通过目的抽样选择社区卫生工作者进行连续观察时间运动研究。对 CHW 进行了为期 5 天的整个工作日（上午 9 点至下午 3 点）的观察，每隔 1 个月进行 1 次。确定了 CHW 执行的 14 种不同活动，并记录了时间持续时间。然后将活动分为增值、非增值但必要和非增值，以确定他们的时间分配。
家访占用了 CHW 最多的时间，其次是文档记录和旅行。文档记录、行政工作和工作流程审查是非增值但必要的活动，占用了他们大量的时间。CHW 将大约 40%的时间用于增值活动，58.5%的时间用于非增值但必要的活动，1.5%的时间用于非增值活动。CHW 每天的工作时间超过规定时间 0.7 小时。
CHW 是“专注”的心理健康工作者，而不是“多面手”，他们的活动涉及大量时间投入，因为提供的服务具有专业性，如咨询、筛查和家访。CHW 的工作时间超过了标准工作时间。非增值但必要的活动消耗了他们大量的时间，而增值活动则受到影响。工作流程重新设计和实施健康管理信息系统（HMIS）可以缓解效率低下问题。
