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A practical measure of health facility efficiency: an innovation in the application of routine health information to determine health worker productivity in Ethiopia
BACKGROUND: A simple indicator of technical efficiency, such as productivity of health workers, measured using routine health facility data, can be a practical approach that can inform initiatives to improve efficiency in low- and middle-income countries. This paper presents a proof of concept of us...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8340541/ https://www.ncbi.nlm.nih.gov/pubmed/34353335 http://dx.doi.org/10.1186/s12960-021-00636-6 |
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author | Hasan, Md Zabir Dinsa, Girmaye D. Berman, Peter |
author_facet | Hasan, Md Zabir Dinsa, Girmaye D. Berman, Peter |
author_sort | Hasan, Md Zabir |
collection | PubMed |
description | BACKGROUND: A simple indicator of technical efficiency, such as productivity of health workers, measured using routine health facility data, can be a practical approach that can inform initiatives to improve efficiency in low- and middle-income countries. This paper presents a proof of concept of using routine information from primary healthcare (PHC) facilities to measure health workers’ productivity and its application in three regions of Ethiopia. METHODS: In four steps, we constructed a productivity measure of the health workforce of Health Centers (HCs) and demonstrated its practical application: (1) developing an analytical dataset using secondary data from health management information systems (HMIS) and human resource information system (HRIS); (2) principal component analysis and factor analysis to estimate a summary measure of output from five indicators (annual service volume of outpatient visits, family planning, first antenatal care visits, facility-based deliveries by skilled birth attendants, and children [< 1 year] with three pentavalent vaccines); (3) calculating a productivity score by combining the summary measure of outputs and the total number of health workers (input), and (4) implementing regression models to identify the determinant of productivity and ranking HCs based on their adjusted productivity score. RESULTS: We developed an analytical dataset of 1128 HCs; however, significant missing values and outliers were reported in the data. The principal component and factor scores developed from the five output measures were highly consistent (correlation coefficient = 0.98). We considered the factor score as the summary measure of outputs for estimating productivity. A very weak association was observed between the summary measure of output and the total number of staff. The result also highlighted a large variability in productivity across similar health facilities in Ethiopia, represented by the significant dispersion in summary measure of output occurring at similar levels of the health workers. CONCLUSIONS: We successfully demonstrated the analytical steps to estimate health worker productivity and its practical application using HMIS and HRIS. The methodology presented in this study can be readily applied in low- and middle-income countries using widely available data—such as DHIS2—that will allow further explorations to understand the causes of technical inefficiencies in the health system. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12960-021-00636-6. |
format | Online Article Text |
id | pubmed-8340541 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-83405412021-08-06 A practical measure of health facility efficiency: an innovation in the application of routine health information to determine health worker productivity in Ethiopia Hasan, Md Zabir Dinsa, Girmaye D. Berman, Peter Hum Resour Health Research BACKGROUND: A simple indicator of technical efficiency, such as productivity of health workers, measured using routine health facility data, can be a practical approach that can inform initiatives to improve efficiency in low- and middle-income countries. This paper presents a proof of concept of using routine information from primary healthcare (PHC) facilities to measure health workers’ productivity and its application in three regions of Ethiopia. METHODS: In four steps, we constructed a productivity measure of the health workforce of Health Centers (HCs) and demonstrated its practical application: (1) developing an analytical dataset using secondary data from health management information systems (HMIS) and human resource information system (HRIS); (2) principal component analysis and factor analysis to estimate a summary measure of output from five indicators (annual service volume of outpatient visits, family planning, first antenatal care visits, facility-based deliveries by skilled birth attendants, and children [< 1 year] with three pentavalent vaccines); (3) calculating a productivity score by combining the summary measure of outputs and the total number of health workers (input), and (4) implementing regression models to identify the determinant of productivity and ranking HCs based on their adjusted productivity score. RESULTS: We developed an analytical dataset of 1128 HCs; however, significant missing values and outliers were reported in the data. The principal component and factor scores developed from the five output measures were highly consistent (correlation coefficient = 0.98). We considered the factor score as the summary measure of outputs for estimating productivity. A very weak association was observed between the summary measure of output and the total number of staff. The result also highlighted a large variability in productivity across similar health facilities in Ethiopia, represented by the significant dispersion in summary measure of output occurring at similar levels of the health workers. CONCLUSIONS: We successfully demonstrated the analytical steps to estimate health worker productivity and its practical application using HMIS and HRIS. The methodology presented in this study can be readily applied in low- and middle-income countries using widely available data—such as DHIS2—that will allow further explorations to understand the causes of technical inefficiencies in the health system. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12960-021-00636-6. BioMed Central 2021-08-05 /pmc/articles/PMC8340541/ /pubmed/34353335 http://dx.doi.org/10.1186/s12960-021-00636-6 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Hasan, Md Zabir Dinsa, Girmaye D. Berman, Peter A practical measure of health facility efficiency: an innovation in the application of routine health information to determine health worker productivity in Ethiopia |
title | A practical measure of health facility efficiency: an innovation in the application of routine health information to determine health worker productivity in Ethiopia |
title_full | A practical measure of health facility efficiency: an innovation in the application of routine health information to determine health worker productivity in Ethiopia |
title_fullStr | A practical measure of health facility efficiency: an innovation in the application of routine health information to determine health worker productivity in Ethiopia |
title_full_unstemmed | A practical measure of health facility efficiency: an innovation in the application of routine health information to determine health worker productivity in Ethiopia |
title_short | A practical measure of health facility efficiency: an innovation in the application of routine health information to determine health worker productivity in Ethiopia |
title_sort | practical measure of health facility efficiency: an innovation in the application of routine health information to determine health worker productivity in ethiopia |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8340541/ https://www.ncbi.nlm.nih.gov/pubmed/34353335 http://dx.doi.org/10.1186/s12960-021-00636-6 |
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