The Three-Gap Model of Health Worker Performance

Ibnat, Fabliha ; Leonard, Kenneth L ; Bawo, Luke ; Mohammed-Roberts, Rianna

World Bank, Washington, DC

关键词: HEALTH WORKERS;    HEALTH SERVICES;    PAY FOR PERFORMANCE;    HEALTH CARE EVALUATION;    HEALTH SERVICE DELIVERY;   

DOI  :  10.1596/1813-9450-8782
RP-ID  :  WPS8782

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

The Three-Gap Model examines thedeterminants of low-quality health care by examining thepatterns and determinants of three gaps. Using four measuresof performance -- target performance, actual performance,capacity to perform, and knowledge to perform -- this paperdefines three gaps for each health worker: the gap betweentarget performance and what they have the knowledge to do(the know gap), the gap between their knowledge and theircapacity to perform (the know-can gap), and the gap betweentheir capacity and what they actually do (the can-do gap).The paper demonstrates how the patterns of these gaps acrosshealth workers in a sample can be used to diagnose failuresin the system as well as evaluate the outcomes of policyexperiments. Using data on pediatric care from hospitals inLiberia, the paper illustrates how the model can be used toinvestigate the potential for improvements in the quality ofcare from several possible policy interventions. Theanalysis of the relationships between these gaps acrosshealth workers in a health system help to paint a betterpicture of the determinants of performance and can assistpolicy makers in choosing relevant policies to improvehealth worker performance.