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Health Policy and Planning; 14(4): 374-381
© Oxford University Press 1999

A comparison of four approaches for measuring clinician time use

John H. Bratt1, James Foreit2, Pai-Lien Chen1, Caroline West1, Barbara Janowitz1 and Teresa De Vargas3

1 Family Health International, Research Triangle Park, North Carolina, USA
2 FRONTIERS Project, The Population Council, New York
3 Centros Médicos de Orientación y Planificación Familiar (CEMOPLAF), Ecuador

Concern about rapid growth in demand for reproductive health services in developing countries has created interest in productivity and costs of existing programmes. Staff costs usually constitute the largest share of total service costs, meriting special effort to ensure that they are measured accurately. Several techniques have been used in the literature to analyze staff activity, but these techniques have not been validated. This paper reports on a study conducted in three Ecuadoran clinics. The study uses an observational time-motion (TM) technique as a benchmark, and compares results from three other techniques to those obtained using TM. None of the alternative techniques produces estimates that agreed with TM estimates; deviations from TM are particularly large for non-contact time, defined as clinician activities carried out when clients are not present. Implications of these findings for productivity and cost studies are discussed, and possible avenues for future research are proposed.


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