Haiti: Service Quality

The organization Partners in Health recently implemented time-driven activity-based costing (TDABC) exercises in five health centers in Haiti to help identify where and how services could be made more efficient.1 This process enabled three overarching observations. First, the implementers identified variation in care for specific conditions both within and between health centers, facilitating better performance measurement. Second, the health centers were more readily able to recognize bottlenecks in the services they provided. For instance, they found that the health centers often under-prescribed due to medicine stock-outs, catalyzing increased attention to the supply chains. Finally, by tracing patient flow through facilities, managers were able to identify opportunities for task shifting to less specialized providers in order to decrease costs and optimize resources.1 Equipping facility managers with the skills to conduct TDABC may improve facility costing and planning and improve efficiency of services in many LMIC health facilities.


  1. McBain RK, Jerome G, Warsh J, Browning M, Mistry B, Faure PAI, et al. Rethinking the cost of healthcare in low-resource settings: the value of time-driven activity-based costing. BMJ Glob Heal [Internet]. 2016;1(3):e000134. Available from: http://gh.bmj.com/lookup/doi/10.1136/bmjgh-2016-000134