Authors: Adam, Taghreed¹; Amorim, Débora G²; Edwards, Sally J¹; Amaral, João²; Evans, David B¹

Source: Health Policy and Planning, Volume 20, Supplement 1, December 2005 , pp. i49-i57(9)

Publisher: Oxford University Press

Abstract:

Information on how health workers spend their time can help programme managers determine whether it is possible to add new services or activities to their schedules and at what cost. One set of interventions with the potential to reduce under-five mortality is training of facility-based health workers according to the guidelines for Integrated Management of Childhood Illness (IMCI), along with improvements to supervision, procurement and information systems that are part of the IMCI strategy. Although it has been shown that IMCI is associated with improved quality of care, it is important to determine if it also requires additional consultation time. To investigate the amount of time required to provide clinical care to children under 5 years based on IMCI compared with routine care, a time and motion study was conducted in Northeast Brazil.

IMCI-trained providers spent 1 minute and 26 seconds longer per consultation with under-fives than untrained providers, holding confounding factors constant at the mean levels observed in the sample. The difference was greater when patient load was low, and decreased as the number of patients a provider saw per day increased. This has three implications. First, the ability of the system to absorb new technologies depends on current capacity utilization. Secondly, the cost of treating a child also depends on the level of capacity utilization, at least in terms of provider time. Thirdly, where patient loads are high it is important to determine if the quality of care required for IMCI can be maintained.

Keywords: IMCI; time and motion; capacity; provider productivity; under-five children; Brazil

Document Type: Research article

DOI: http://dx.doi.org/10.1093/heapol/czi057

Affiliations: 1: World Health Organization, Geneva, Switzerland and 2: Federal University of Ceará, Fortaleza, Brazil

Publication date: 2005-12-01

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• Health Policy and Planning blends such individual specialities as epidemiology, health and development economics, management and social policy, planning and social anthropology into a lively academic mix that constantly stimulates and keeps readers abreast of modern international health care.

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