Overworked? The relationship between workload and health worker performance in rural Tanzania

The current 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 a high caseload reduces the level of effort per patient in the diagnostic process, using a new data set from rural Tanzania. Tanzania has a severe shortage of health workers, and previous research has pointed at high workload as a main reason for sub-standard clinical performance. We observed and evaluated the level of effort of 159 clinicians in 2,095 outpatient consultations at 126 health facilities with different levels of caseload per clinician. Surprisingly, we find no association between caseload and the level of effort per patient in the diagnostic process. In fact, 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 in this setting is unlikely to raise the quality of health services. A more promising measure for improved quality is to raise the level of formal clinical training among the clinicians, although training alone seems far from enough to raise quality to adequate levels.Human Resources; Quality health services; Workload; Tanzania

Overworked? The relationship between workload and health worker performance in rural Tanzania

The current 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 a high caseload reduces the level of effort per patient in the diagnostic process, using a new data set from rural Tanzania. Tanzania has a severe shortage of health workers, and previous research has pointed at high workload as a main reason for sub-standard clinical performance. We observed and evaluated the level of effort of 159 clinicians in 2,095 outpatient consultations at 126 health facilities with different levels of caseload per clinician. Surprisingly, we find no association between caseload and the level of effort per patient in the diagnostic process. In fact, 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 in this setting is unlikely to raise the quality of health services. A more promising measure for improved quality is to raise the level of formal clinical training among the clinicians, although training alone seems far from enough to raise quality to adequate levels.Health personnel Tanzania

Subglacial discharge plume behaviour revealed by CTD-instrumented ringed seals

This research was supported by the Norwegian Polar Institute’s Centre for Ice, Climate and Ecosystems (ICE) and the Research Council of Norway. Some of this financial support was derived from the TIGRIF (RCN project number 243808/E40) and TW-ICE research programmes. AP was also funded by The Ministry of Earth Sciences, India, Grant/Award number: MoES/16/22/12-RDEAS (PhD fellowship-NPI).Subglacial discharge plumes increase submarine melting of marine-terminating glaciers significantly; however, in-situ data on their properties and behaviour are limited. We present oceanographic data collected by ringed seals (Pusa hispida) instrumented with GPS-equipped conductivity-temperature-depth satellite relay data loggers (GPS-CTD-SRDLs) in Kongsfjorden, Svalbard, during 2012. The seals foraged just outside the plumes and collected hydrographic data from within the plumes’ upwelling cores as they returned to the surface. The seals encountered water with fractions of subglacial discharge as high as 27% at 60 m below the ocean surface. The ringed seals responded rapidly to spatial and temporal variations in subglacial discharge at the glacier terminus, suggesting that prey becomes available quickly following the appearance of plumes. The seals’ dive locations were used to monitor the presence of plumes over a four-month period. High surface runoff from Kronebreen catchment created strong plumes, but weak plumes were present even during periods of low surface runoff. The continued retreat of Kronebreen, and other tidewater glaciers, will lead to the loss of these marine-termini as the glaciers retreat onto land. The techniques presented here improve our understanding of the drivers of glacial retreat and the implications of future habitat loss for glacier-associated birds and mammals.Publisher PDFPeer reviewe

Productivity dynamics, performance feedback and group incentives in a sales organization

This paper investigates the effect of performance feedback on productivity in a company where workers operate in teams and receive a bonus that depends on both individual worker and team productivity. To address this issue, we employ weekly productivity and administrative data obtained from the customer service centre of an insurance company. We find evidence that performance feedback given each Monday morning about past team production and individual rank position within teams influences current individual productivity. The effect of rank position is strongest when bonuses depend on team performance. Overall, our findings suggest that team dynamics may alleviate the free-rider problem often associated with team bonuses, where it is essential that team leaders provide information about individual and team performance in previous periods

Overworked? The relationship between workload and health worker performance in rural Tanzania

The current 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 a high caseload reduces the level of effort per patient in the diagnostic process, using a new data set from rural Tanzania. Tanzania has a severe shortage of health workers, and previous research has pointed at high workload as a main reason for sub-standard clinical performance. We observed and evaluated the level of effort of 159 clinicians in 2,095 outpatient consultations at 126 health facilities with different levels of caseload per clinician. Surprisingly, we find no association between caseload and the level of effort per patient in the diagnostic process. In fact, 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 in this setting is unlikely to raise the quality of health services. A more promising measure for improved quality is to raise the level of formal clinical training among the clinicians, although training alone seems far from enough to raise quality to adequate levels

Overworked? On the relationship between workload and health worker performance

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.Human resources Quality health services Workload Tanzania