Excess capacity and the cost of adding services at family planning clinics in Zimbabwe

CONTEXT. With the expense of providing reproductive health services increasing, information on how staff members spend their time con help program managers determine whether there is sufficient downtime to add new services at minimal additional cost. METHODS: Providers in Zimbabwe were retrained in syndromic management of reproductive tract infections. Before and after retraining, mini-situation analyses were performed of several clinics to determine how staff spent their contact time with clients. The mean length of visits was calculated, as was the amount of time spent on risk assessments, pelvic exams and collection of lab specimens. Time-motion studies were conducted to determine how providers spent their time following retraining, including client services, administrative activities and unoccupied time. RESULTS: The median length of visits for new acceptors was longer following retraining (27 minutes) than it was before (20 minutes), and the proportion of such clients who received various syndromic management services increased Yet even after retraining, providers spent less than 4096 of their time with clients. Observation revealed substantial unoccupied time in early morning and late afternoon. If more clients received services, time spent with clients would increase and unoccupied time would decrease, thus, the labor cost of a clinic visit could be cut-at one clinic, by almost one-half Overall, the average provider cost of family planning visits could be reduced by more than one-third if providers increased the share of time spent with clients from 4096 to 60%. CONCLUSIONS. Reduction of provider down time (time absent from the clinic, time spent unoccupied or time not otherwise used productively) at family planning clinics in the developing world could increase capacity to provide services with a minimal rise in costs. Poorly paid providers, however, may require financial incentives to increase their workload.