title: Examination of patient flow in a rural health center in Malawi.
abstract: BACKGROUND
  Malawi, like many low-income countries, is facing a severe health worker shortage. A potential stop-gap solution to this crisis is improving the efficiency of health center operations. Given the lack of research on center efficiency in rural health centers in Malawi, we conducted a study to identify deficiencies in center organization and barriers to patient flow.
  
  
  METHODS
  We performed a time-motion survey at a rural health center in Ntaja, Malawi over a period of 1 week. We used a standardized questionnaire to collect information on the amount of time a patient spent with each health worker, the number of center staff that attended to each patient, and the total time spent at the center. Additionally, at the end of the visit, we conducted an exit survey to collect demographic information and data on perception of quality of care with the center visit for all patients.
  
  
  RESULTS
  A total of 1018 patients were seen over the five-day study. The average total time spent at the center by the patients was 123 min (2-366 min). Adults had an average total time spent at the center of 111 min (2-366 min) and children 134 min (7-365 min). Patient waiting time (PWT) was higher in the early morning hours ranging from 157 min (between 06:00 and 08:00) to 53 min (between 14:00 and 16:00). Health worker contact time (HCT) was higher for adults (2.3 min) than children (1.7 min). Shorter wait times were associated with higher perceptions of quality of service.
  
  
  CONCLUSIONS
  Despite shortages in health workers and funds, opportunities are available to increase efficiency in rural health centers. By removing bottlenecks to increase the productivity of health workers, centers in low-income countries can treat more patients and improve service quality.
authors.affiliation: University of Washington, Seattle, WA, USA. mjafry@uw.edu.
authors.forename: M A
authors.initials: MA
authors.lastname: Jafry
authors.affiliation: Global Medicines Program, University of Washington, Seattle, WA, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Jenny
authors.affiliation: Global Medicines Program, University of Washington, Seattle, WA, USA.|Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Lubinga
authors.affiliation: VillageReach, Seattle, WA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Larsen-Cooper
authors.affiliation: VillageReach, Lilongwe, Malawi.
authors.forename: J
authors.initials: J
authors.lastname: Crawford
authors.affiliation: VillageReach, Lilongwe, Malawi.
authors.forename: C
authors.initials: C
authors.lastname: Matemba
authors.affiliation: Global Medicines Program, University of Washington, Seattle, WA, USA.|Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Babigumira
mesh_terms: D000328:Adult; D002648:Child; D003695:Delivery of Health Care / Q000458:organization & administration*; D003906:Developing Countries; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D005260:Female; D006282:Health Personnel / Q000458:organization & administration; D006801:Humans; D008295:Malawi; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population; D011795:Surveys and Questionnaires
keywords: Health centers; Malawi; Patient flow; Patient satisfaction; Rural; Time-motion; Wait times