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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.

Suggested Citation

  • 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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    References listed on IDEAS

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    1. Nazmul Chaudhury & Jeffrey Hammer & Michael Kremer & Karthik Muralidharan & F. Halsey Rogers, 2006. "Missing in Action: Teacher and Health Worker Absence in Developing Countries," Journal of Economic Perspectives, American Economic Association, vol. 20(1), pages 91-116, Winter.
    2. repec:aph:ajpbhl:2001:91:10:1625-1635_2 is not listed on IDEAS
    3. Jishnu Das & Jeffrey Hammer & Kenneth Leonard, 2008. "The Quality of Medical Advice in Low-Income Countries," Journal of Economic Perspectives, American Economic Association, vol. 22(2), pages 93-114, Spring.
    4. Das, Jishnu & Hammer, Jeffrey, 2007. "Money for nothing: The dire straits of medical practice in Delhi, India," Journal of Development Economics, Elsevier, vol. 83(1), pages 1-36, May.
    5. Madden, J. M. & Quick, J. D. & Ross-Degnan, D. & Kafle, K. K., 1997. "Undercover careseekers: Simulated clients in the study of health provider behavior in developing countries," Social Science & Medicine, Elsevier, vol. 45(10), pages 1465-1482, November.
    6. Kenneth L. Leonard & Melkiory C. Masatu & Alexandre Vialou, 2007. "Getting Doctors to Do Their Best: The Roles of Ability and Motivation in Health Care Quality," Journal of Human Resources, University of Wisconsin Press, vol. 42(3).
    7. Leonard, Kenneth & Masatu, Melkiory C., 2006. "Outpatient process quality evaluation and the Hawthorne Effect," Social Science & Medicine, Elsevier, vol. 63(9), pages 2330-2340, November.
    8. Kenneth L. Leonard & Gilbert R. Mliga & Damen Haile Mariam, 2002. "Bypassing Health Centres in Tanzania: Revealed Preferences for Quality," Journal of African Economies, Centre for the Study of African Economies (CSAE), vol. 11(4), pages 441-471, December.
    9. Ofori-Adjei, David & Arhinful, Daniel K., 1996. "Effect of training on the clinical management of malaria by medical assistants in Ghana," Social Science & Medicine, Elsevier, vol. 42(8), pages 1169-1176, April.
    10. Paredes, Patricia & de la Peña, Manuela & Flores-Guerra, Enrique & Diaz, Judith & Trostle, James, 1996. "Factors influencing physicians' prescribing behaviour in the treatment of childhood diarrhoea: Knowledge may not be the clue," Social Science & Medicine, Elsevier, vol. 42(8), pages 1141-1153, April.
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    Citations

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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. Kjell Hausken & Mthuli Ncube, 2013. "Working Paper 172 - Political Economy of Service Delivery: Monitoring versus Contestation," Working Paper Series 468, African Development Bank.
    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. World Bank, 2012. "Service Delivery Indicators : Tanzania," World Bank Other Operational Studies 20126, The World Bank.
    6. repec:ebd:wpaper:147 is not listed on IDEAS
    7. World Bank, 2012. "Service Delivery Indicators : Senegal," World Bank Other Operational Studies 20125, The World Bank.

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