Thinkwell Group of Mozambican training participants with completion certificates

Solving Mozambique’s 90-second Health Check-ups with a Workload Tool

08 January 2020

Written by Leah Breen

In most Mozambican health facilities, patients’ time with health professionals is a scarce commodity. When a parent brings their child to a health facility for a “healthy child consultation,” the check-up lasts only 90 seconds on average. Mozambicans living with HIV can expect an outpatient consultation to last 10 minutes. When a woman gives birth at a health facility, a health professional assists the delivery for only 30 minutes. Lightning fast visits are the norm.

The problem is, in part, rooted in inefficient placements of health workers in primary health care facilities. Mozambique’s Ministry of Health (MOH) traditionally relied on inaccurate data and on perceptions of patients’ health service needs to assign health workers to health facilities across the country. ThinkWell saw this as an opportunity to help solve a critical challenge. It was clear that health system decision-makers needed a strategy to strengthen how they manage health worker distribution across Mozambique’s 129 districts. And to accompany the strategy, health leaders needed a tool to help them make evidence-based distribution decisions.

Before we could start building the tool, we needed to gather the right data. For 286 days, we observed health professionals at 29 health facilities in nine provinces to better understand the tasks they perform and the time they spend on each task. With data on health professionals’ workloads from our study, combined with data from the national health information database, health workers could be more efficiently and equitably matched with health facilities.

With reliable data in hand, ThinkWell developed a tool to assign health workers to health facilities. To ensure that the tool would be accessible and straightforward to navigate, it was created in Excel. Since health worker needs are constantly shifting, we designed the tool so it can evolve over time—when new data is available, it’s simple to update. After piloting the tool at the provincial level, we rolled it out at the district level.

The tool’s implementation strategy revolved around increasing local ownership. If health system leaders weren’t empowered to adopt it, the tool would lie untouched. Over three months, ThinkWell trained over 400 MOH officials and district level health system leaders on how to use the tool, update it, interpret results, and how to harness the tool to complement their knowledge of the local context. Beyond simple training, we worked with local decision makers to strategize how they can best collaborate when using it.

As we reflect on the tool’s creation, we identified the following ingredients for success:

  1. Always question: We went beyond pre-packaged solutions to change the status quo for health workers’ allocation to health facilities.
  2. Think big: Instead of jumping into tool design, we first implemented a large-scale study to generate critical new data.
  3. Influence the conversation: We continuously voiced how the tool would help strengthen the country’s health system until we catalyzed a movement of local support.
  4. Evolve by learning: Iteration is key. The tool was designed to constantly improve to better meet user’s needs. Users can always update its data to reflect evolutions in health care needs and norms.
  5. Empower others: Throughout the process, we supported Mozambican health system leaders to help them solve their health system needs.

A few months after the tool was launched, the MOH incorporated the tool into its annual district planning process—a major step towards more effective and efficient health system decision-making. It’s too early to measure the tool’s impact, but we’re confident that its health system contributions will translate to better health care provision. So there can be healthier Mozambicans and fewer 90-second check-ups.

To learn more about the project, read more here.

ThinkWell team members Federica Fabozzi and Flavia Moi (far left and right, bottom row), Mozambican MOH officials, and provincial health directorates pose with their health worker allocation tool training certificates.