Abstract
BackgroundWe describe wait and consult times across public-sector clinics and identify health facility determinants of wait and consult times.DesignWe observed 8,102 patient arrivals and departures from clinical service areas across 12 public-sector clinics in Sofala and Manica Provinces between January and April 2011. Negative binomial generalized estimating equations were used to model associated health facility factors.ResultsMean wait times (in minutes) were: 26.1 for reception; 43.5 for outpatient consults; 58.8 for antenatal visits; 16.2 for well-child visits; 8.0 for pharmacy; and 15.6 for laboratory. Mean consultation times (in minutes) were: 5.3 for outpatient consults; 9.4 for antenatal visits; and 2.3 for well-child visits. Over 70% (884/1,248) of patients arrived at the clinic to begin queuing for general reception prior to 10:30 am. Facilities with more institutional births had significantly longer wait times for general reception, antenatal visits, and well-child visits. Clinics in rural areas had especially shorter wait times for well-child visits. Outpatient consultations were significantly longer at the smallest health facilities, followed by rural hospitals, tertiary/quaternary facilities, compared with Type 1 rural health centers.DiscussionThe average outpatient consult in Central Mozambique lasts 5 min, following over 40 min of waiting, not including time to register at most clinics. Wait times for first antenatal visits are even longer at almost 1 h. Urgent investments in public-sector human resources for health alongside innovative operational research are needed to increase consult times, decrease wait times, and improve health system responsiveness.
Highlights
Since the 2006 World Health Report, which highlighted the global crisis of a shortage of 4.3 million trained health workers globally, research and policy attention has increased around human resources for health (HRH) in lowand middle-income countries (LMICs) [1]
Clinics included in the sampling frame conducted a median of 74,082 outpatient consultations in 2010 and 2,331 institutional births
Eight of the 12 facilities were located in rural areas, and two clinics were observed across each of the five different classifications of health facilities included in this study, with the exception of Type 1 rural health centers, where four facilities were selected for patient observation
Summary
Since the 2006 World Health Report, which highlighted the global crisis of a shortage of 4.3 million trained health workers globally, research and policy attention has increased around human resources for health (HRH) in lowand middle-income countries (LMICs) [1]. We describe wait and consult times across public-sector clinics and identify health facility determinants of wait and consult times. Results: Mean wait times (in minutes) were: 26.1 for reception; 43.5 for outpatient consults; 58.8 for antenatal visits; 16.2 for well-child visits; 8.0 for pharmacy; and 15.6 for laboratory. Mean consultation times (in minutes) were: 5.3 for outpatient consults; 9.4 for antenatal visits; and 2.3 for well-child visits. Facilities with more institutional births had significantly longer wait times for general reception, antenatal visits, and wellchild visits. Discussion: The average outpatient consult in Central Mozambique lasts 5 min, following over 40 min of waiting, not including time to register at most clinics. Urgent investments in public-sector human resources for health alongside innovative operational research are needed to increase consult times, decrease wait times, and improve health system responsiveness
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