Factors influencing patient contact time at public health clinics in developing countries: Evidence from Bangladesh

The main objective of this study is to investigate factors that determine the patient contact time (PCT), with data from a nationally representative sample of non-governmental organization (NGO) clinics in Bangladesh that provided essential health services to poor and non-poor patients. One provider from 138 randomly selected clinics was surveyed and each provider was followed on a randomly selected day using time-and-motion study techniques. This resulted in a total of 2,850 patient records. Results of the regression analysis yielded new evidence on the factors from both the supply and demand sides that contributed to the variations of PCT among health providers with comparable competence. On the supply side, both the time available for direct services and the number of patients influenced PCT. On the demand side, we found whether or not patients paid for care was significant in determining PCT: paying patients received more time than nonpaying patients. A simulation suggests that there are policy and program interventions that can effectively increase the PCT for essential health services. On the supply side, it is important to reinforce the regulations that require providers to spend their full working hours in the clinics and to raise providers' awareness of the standard service protocol. On the demand side, an alternative financing approach is required to further improve the quality of services to the poor. Instead of using a supply-side grant to provide free services to the poor, it would be better to use demand-side financing to enable the poor to pay for services.