Stage 2: Understand health workforce productivity problem types and their possible underlying causes


Before seeking to make health workforce productivity improvements, you must examine the nature of the productivity problems and their possible underlying causes. The problems of low productivity and its underlying causes are complex, multifaceted, and often interconnected.

Based on our experiences and a review of the literature—and in an attempt to present the information in a somewhat simplified manner—low health workforce productivity can be due to one or several of the three types of problems shown in the figure below. There is overlap between these categories. Moreover, a root cause of one may directly influence another (to be described further in later steps). For example, if health workers are absent from a facility, the remaining few staff may take longer to attend to patients, creating long waiting times, and thus possibly diminishing patients’ perception of quality and making them less likely to return (i.e., lowering patient demand).




Much of the research on productivity is concerned with how efficiently and effectively health workers use their time to deliver health care services. There is evidence that low health workforce productivity may be due to inefficiencies that exist within the health facility and work environment or due to poor management.

Health workforce productivity levels may be low when workers are absent or otherwise not performing assigned tasks. Despite the costs incurred to staff facilities, if health workers are not present, then they cannot deliver services. Absenteeism has compromised health workforce effectiveness in numerous countries, including Bangladesh and Tanzania. In Uganda, an average of 37% of all health workers are inexplicably absent from work. In a Kenya study, the absenteeism rate in Machakos District averaged 25% and cost each facility $51,000 per month.

Lower utilization of or lower patient demand for health services compromises the effectiveness of care, as found in Zambia and Uganda, where low volume decreased productivity because health workers were spending less time on direct care.