Primary care for HIV positive patients in Mozambique: Findings from a nation-wide time and motion study
The below content is presented as a poster at the AIDS2020 virtual conference on July 6-10, 2020. It was prepared by Flavia Moi, Federica Fabozzi, Michela Romanelli, and Jorge Cabral.
With an estimated 2.2 million people living with HIV—for a prevalence of 12.6% among adults—and a health professional to population ratio well below international standards, understanding how primary health care (PHC) professionals in Mozambique spend their time is essential to identify efficiency gains and improve HIV care in the country.
This study investigates health workers’ use of time at the health facility and the duration of consultations in Mozambique to assess differences in attending to HIV+ and HIV- patients and uncover potential opportunities for improvement within this scarce resource setting.
In 2017, a time and motion study was conducted in a nationally representative sample of 29 primary health facilities across Mozambique.
The study observed 192 days of work undertaken by the main cadres of PHC professionals involved in HIV care provision (physicians, nurses, maternal and child health (MCH) nurses, clinical officers), for a total of 8342 patient-provider interactions.
Data was recorded directly on tablets using a locally designed data collection software and analyzed on STATA to estimate means and 95% confidence intervals.
Consultations for HIV+ patients in Mozambique are generally brief—ranging from an average of 8.03 to 14.34 minutes—although they are longer than those for HIV- patients. As health professionals spend an average of 1.5 to 2 hours per day on personal matters or waiting for patient, it is possible to increase the duration of consultations without increasing the number of health workers.
The average duration of outpatient consultations for HIV+ patients was found to range from 8.03 [7.28-8.78] to 10.90 minutes [9.22-12.59], when performed by physicians or nurses respectively. Maternal health consultations for HIV+ patients ranged between 8.05 minutes [5.23-10.88] for postnatal consults and 14.73 minutes [12.62-16.83] for antenatal consults, both performed by MCH nurses. While these consultations are short, our analysis shows that they are 2 to 3 times longer than when performed for HIV- patients.
Additionally, our study showed that health professionals spend on average 1.5 to 2 hours on personal matters or waiting for patients during their time at the facility. This suggests it would be possible to increase the duration of consultations without increasing the number of health workers.
Our findings indicate that there are opportunities to improve efficiency in the use of health workers’ time at PHC facility in Mozambique and improve the duration of consults for HIV positive patients without increasing the number of human resources. Furthermore, the short durations of consultations raise questions about the quality of care and indicate the need to further investigate this topic.
Field work and reporting for this study was funded by the Presidents’ Emergency Program for AIDS Relief (PEFPAR) through the Centers for Disease Control and Prevention (CDC), Project Esperança Cooperative Agreement U2GGH000422-01.