Stage 4: Identify potential productivity improvements

Overview

After completing the qualitative assessment and discussing the findings with stakeholders (see Step 1), you will be ready to identify potential interventions to address the underlying causes of the productivity problems and improve health workforce productivity. You will find that actions are likely to be needed at the facility level but also at higher levels of the health system, such as the district, provincial, or central levels, and may require linking with other health systems building blocks. For example, if stockouts of medicines or lack of equipment are noted as causes of low patient demand or health facility inefficiencies, then an intervention to address issues within the “medical products, vaccines, and technologies” component of the health system would be required.  It is also important to keep in mind that some of the causes of low productivity may be difficult to address from a health sector perspective. For example, poor roads or high transport costs may result in low patient demand for services at a health facility. Thus, we recommend first addressing the causes or factors that are within health workers’ and facility managers’ spheres of influence.

When considering an intervention, we strongly recommend focusing on the “low-hanging fruit”—meaning the relatively low-cost/high-effect interventions that health workers and facility- or district-level managers can readily implement on their own. Approaches developed at the facility or community level with local contributions may often be the most effective and sustainable.