RESUMO
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.
Assuntos
Serviços de Planejamento Familiar , Pesquisa sobre Serviços de Saúde/métodos , Padrões de Prática Médica , Análise e Desempenho de Tarefas , Equador , Análise MultivariadaRESUMO
The continuing trend of donor attention and resources away from Latin America threatens the sustainability of nongovernmental family planning organizations in that region. Managers can improve sustainability through cost control, cost recovery, and income generation. The Population Council's INOPAL II and INOPAL III projects and Family Health International assisted CEMOPLAF, an Ecuadoran private voluntary organization, in carrying out operations research in each of these areas. Studies included cost-savings analysis from altering IUD revisit norms (cost control), an ability-to-pay study that showed potential gains from increased prices for reproductive health services (cost recovery), and a feasibility study to estimate income from ultrasound services (income generation). Results indicate that any one intervention will probably have a limited impact, and that managers likely will need to undertake several initiatives simultaneously to make significant progress toward sustainability.