Examination of patient flow in a rural health center in Malawi

Abstract

BackgroundMalawi, like many low-income countries, is facing a severe health worker shortage. A potential stop-gap solution to this crisis is improving the efficiency of health center operations. Given the lack of research on center efficiency in rural health centers in Malawi, we conducted a study to identify deficiencies in center organization and barriers to patient flow.MethodsWe performed a time-motion survey at a rural health center in Ntaja, Malawi over a period of 1 week. We used a standardized questionnaire to collect information on the amount of time a patient spent with each health worker, the number of center staff that attended to each patient, and the total time spent at the center. Additionally, at the end of the visit, we conducted an exit survey to collect demographic information and data on perception of quality of care with the center visit for all patients.ResultsA total of 1018 patients were seen over the five-day study. The average total time spent at the center by the patients was 123 min (2–366 min). Adults had an average total time spent at the center of 111 min (2–366 min) and children 134 min (7–365 min). Patient waiting time (PWT) was higher in the early morning hours ranging from 157 min (between 06:00 and 08:00) to 53 min (between 14:00 and 16:00). Health worker contact time (HCT) was higher for adults (2.3 min) than children (1.7 min). Shorter wait times were associated with higher perceptions of quality of service.ConclusionDespite shortages in health workers and funds, opportunities are available to increase efficiency in rural health centers. By removing bottlenecks to increase the productivity of health workers, centers in low-income countries can treat more patients and improve service quality.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-016-2144-x) contains supplementary material, which is available to authorized users.

“Are we getting the biometric bioethics right?” – the use of biometrics within the healthcare system in Malawi

“…There is evidence of long waiting periods for patients in a patient-flow study conducted in three HIV clinics in Uganda (Russell et al, 2016 ). Similar findings were mirrored by a study conducted by Jafry et al ( 2016 ) on general patients in rural health centres in Malawi. These studies revealed the need to find ways to improve the flow of patients through the health centres.…”

The impact and cost-effectiveness of user fee exemption by contracting out essential health package services in Malawi

“…Second, only if/when newly established facilities are significantly more efficient in providing health services than are CHAM facilities with savings of operational costs offsetting the upfront costs, would it be better to establish government facilities instead of contracting CHAM facilities. The efficiency of health service delivery in public sector has been a concern in Malawi 30 31. Even if public health facilities are as efficient as CHAM facilities, we still have to assume establishing government facilities has the same impact as contracting CHAM has, which may not be correct, given that CHAM facilities have a better quality of care4 32 and that new facilities would have to compete with CHAM facilities for patients.…”

A time‐motion study of cardiovascular disease risk factor screening integrated into HIV clinic visits in Swaziland

“…reported that the mean visit length of outpatient consultations in Mozambique was 5.3 minutes , Jafry et al. noted that while average visit length to a health clinic in Malawi was 123 minutes, health worker contact time averaged 2.3 minutes , and Were et al. found the average time spent with a clinician at hospital‐based ART clinics in Uganda was 7.5 minutes .…”