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Overworked? On the relationship between workload and health worker performance

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  • Mæstad, Ottar
  • Torsvik, Gaute
  • Aakvik, Arild

Abstract

The shortage of health workers in many low-income countries poses a threat to the quality of health services. When the number of patients per health worker grows sufficiently high, there will be insufficient time to diagnose and treat all patients adequately. This paper tests the hypothesis that high caseload reduces the level of effort per patient in the diagnostic process. We observed 159 clinicians in 2095 outpatient consultations at 126 health facilities in rural Tanzania. Surprisingly, we find no association between caseload and the level of effort per patient. Clinicians appear to have ample amounts of idle time. We conclude that health workers are not overworked and that scaling up the number of health workers is unlikely to raise the quality of health services. Training has a positive effect on quality but is not in itself sufficient to raise quality to adequate levels.

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  • Mæstad, Ottar & Torsvik, Gaute & Aakvik, Arild, 2010. "Overworked? On the relationship between workload and health worker performance," Journal of Health Economics, Elsevier, vol. 29(5), pages 686-698, September.
    • Handle: RePEc:eee:jhecon:v:29:y:2010:i:5:p:686-698
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    Cited by:

    1. Lange, Siri & Mwisongo, Aziza & Mæstad, Ottar, 2014. "Why don't clinicians adhere more consistently to guidelines for the Integrated Management of Childhood Illness (IMCI)?," Social Science & Medicine, Elsevier, vol. 104(C), pages 56-63.
    2. Christophe Lemiére & Gaute Torsvik & Ottar Mæstad & Christopher H. Herbst & Kenneth L. Leonard, 2013. "Evaluating the Impact of Results-Based Financing on Health Worker Performance: Theory, Tools and Variables to Inform an Impact Evaluation," Health, Nutrition and Population (HNP) Discussion Paper Series 98269, The World Bank.
    3. Anand Chand & Suwastika Naidu, 2017. "Health Care Service Quality and Availability of Skilled Health Workforce: A Panel Data Modelling of the UK, USA and Israel," Modern Applied Science, Canadian Center of Science and Education, vol. 11(10), pages 152-152, October.
    4. J. Michelle Brock & Andreas Lange & Kenneth L. Leonard, 2016. "Generosity and Prosocial Behavior in Healthcare Provision: Evidence from the Laboratory and Field," Journal of Human Resources, University of Wisconsin Press, vol. 51(1), pages 133-162.
    5. Mirko Kremer & Francis de Véricourt, 2022. "Mismanaging diagnostic accuracy under congestion," ESMT Research Working Papers ESMT-22-01, ESMT European School of Management and Technology.
    6. Delasay, Mohammad & Ingolfsson, Armann & Kolfal, Bora & Schultz, Kenneth, 2019. "Load effect on service times," European Journal of Operational Research, Elsevier, vol. 279(3), pages 673-686.
    7. World Bank, 2012. "Service Delivery Indicators : Senegal," World Bank Publications - Reports 20125, The World Bank Group.
    8. Kovacs, Roxanne J. & Lagarde, Mylène, 2022. "Does high workload reduce the quality of healthcare? Evidence from rural Senegal," LSE Research Online Documents on Economics 113759, London School of Economics and Political Science, LSE Library.
    9. Kovacs, Roxanne & Lagarde, Mylene, 2022. "Does high workload reduce the quality of healthcare? Evidence from rural Senegal," Journal of Health Economics, Elsevier, vol. 82(C).
    10. Ida Lindkvist, 2013. "Informal Payments And Health Worker Effort: A Quantitative Study From Tanzania," Health Economics, John Wiley & Sons, Ltd., vol. 22(10), pages 1250-1271, October.
    11. Kjell Hausken & Mthuli Ncube, 2013. "Working Paper 172 - Political Economy of Service Delivery: Monitoring versus Contestation," Working Paper Series 468, African Development Bank.
    12. World Bank, 2012. "Service Delivery Indicators : Tanzania," World Bank Publications - Reports 20126, The World Bank Group.
    13. J. Michelle Brock & Andreas Lange & Kenneth L. Leonard, 2012. "Generosity norms and intrinsic motivation in health care provision: evidence from the laboratory and the field," Working Papers 147, European Bank for Reconstruction and Development, Office of the Chief Economist.

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