A comparison of four approaches for measuring clinician time use

Concern about rapid growth in demand for reproductive health services in de veloping countries has created interest in productivity and costs of existi ng programmes. Staff costs usually constitute the largest share of total se rvice costs, meriting special effort to ensure that they are measured accur ately. 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 observa tional 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 fr om TM are particularly large for non-contact time, defined as clinician act ivities carried out when clients are not present. Implications of these fin dings for productivity and cost studies are discussed, and possible avenues for future research are proposed.