RESUMO
An operations research was undertaken in Jamaica in 1983 to investigate productivity problems of primary health care teams throughout the country. Specific objectives of the study were: (1) to develop a methodology for measuring the productivty and cost effectiveness of primary health care teams, (2) to describe the various categories of personnel in the health centers distribute their working time among certain predefined activities, (3) to determine how productive and cost effective primary health care teams are and how these factors relate to coverage of the population with essential services, and (4) to develop strategies to improve productivity. Since personnel costs are the major item in the primary health care budget, maximization of worker productivity to a central concern. Phase 1 of the study suggest that the major factors contributing to low productivity were: lack of an adequate system for manpower planning at the regional and national levels, inappropriate allocation of manpower to health centers in relation to demand for services, lack of explicit criteria for establishment of clinic durations and schedules in relation to expected demand, and lack of an effective performance monitoring system of clinics. It was decided that the productivity improvement stategy would include the combination of antenatal, postnatal, child welfare, and family planning clinics with emphasis on the provision of health care for mothers and children. It was predicted that the integration of preventive clinics would help clinic staff achieve a better balance in their workloads. The model also involved preparing clinic schedules and durations in relation to anticipated demand. The model showed that current demand could be met with fewer personnel, a reduction of 9-18 percent in personnel costs, and an increase in the cost-effectiveness index to 30 percent. It is hoped that this plan will be implemented for a 3-month trial period with monthly review of actual versus projected performance (AU)
