Despite significant increases in funding directed at improving access to health care in developing and transition countries, important obstacles to quality care remain. Why do health workers not do the things for their patients that they are supposed to do? The low quality of services can be traced to poorly trained health workers, inadequate levels of infrastructure, equipment, and consumables and low levels of motivation among health workers; but which of these problems is more important and how can they be best leveraged to improve performance?
Using a unique data set from Liberia, this discussion will introduce a model of individual health worker performance that uses three measures of performance: the knowledge to perform, the capacity to perform and actual performance itself. Three gaps are defined from these measures: the gap between what a health worker should be doing and what they have the knowledge to do (the know gap); the gap between what they have the knowledge to do and their capacity to perform (the know-can gap) and the gap between what they have the capacity to do and what they do (the can-do gap). The analysis of these gaps and their patterns across health workers in a health system help to paint a better picture of performance and can assist policy makers in choosing policy.
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