Work Time Allocation of Family Doctors in Rural Tajikistan

Introduction

The main priority of health care reform is the quality development of primary health care (PHC) since it is the most popular part in the health care system, affordable for all segments of the population and economically accessible. At this level, there are great opportunities to prevent many diseases, to take real measures to improve the health of individuals, families and the local population, to successfully treat many diseases that do not need hospital treatment at al., and also to carry out rehabilitation.

For this period, as part of the implementation of the Concept of Health Care Reform of the Republic of Tajikistan, the structure of the network of healthcare institutions, as well as management and financing methods, is being reviewed. The first step was a change in the organizational structure of PHC facilities, which was approved by Decree of the Government of the Republic of Tajikistan dated December 31, 2002 No. 525. There was a transformation of polyclinics at PHC level (Soviet health system) into health centers. In accordance with this, the organizational structure of PHC facilities includes:

• •

  City health centers;

• •

  District health centers;

• •

  Rural health centers;

• •

  Ambulance stations;

• •

  Health houses in the structure of rural health centers;

• •

  Health points in the structure of urban and district health centers;

• •

  Dispensaries.

The position register also included the position of a family doctor, who in his person replaces the functions of three doctors, who worked in the health system of the Soviet Union - a district pediatrician, a therapist and an obstetrician-gynecologist. This means that the burden on the family doctors in providing medical care has increased several times.

Healthcare workers have been known to be a highly stressful group and were associated with higher rates of psychological distress than many other workers of different sectors (Abu-Helalah et al., 2014). Some of stress factors related with the working environment is the irrational organization of work. One way to assess the workload of health care workers is through a time motion study (Tipping et al., 2010a). In these investigations, health care workers are “shadowed” by an observer who regularly records the activities being performed as well as the time spent on each of the activities. Time-motion studies have been used to assess the time allocation of health care personnel in hospitals and long term care facilities (Mallidou et al., 2013; Qian et al., 2014). The approach has also been used to assess the impact of various interventions on the allocation of time by health care workers, such as for example the introduction of electronic patient documentation for primary care physician to decrease the time spending for documentation (Thorpe-Jamison PT et al., 2013; Westbrook JI et al., 2013; Pizziferri L. et al., 2005).

In order to better understand the use of time in the course of routine working days by health care workers both at rural health centers (RHC) and district health centers (polyclinics) in Tajikistan, daily activities of health care personnel were directly observed in the framework of a time-motion study.

The overall objective of this study was to gain a better understanding of the amount of time that is spent on administrative tasks, direct patient care and other activities by assess time allocation of health workers in family medicine in the rayons of Tajikistan.

Specific objective of the time-motion study was to collect data to compare the time allocation of family doctors at rural health centers (RHC) and district health centers (polyclinics).

Method