The Three-Gap Model of Health Worker Performance

47 Pages Posted: 26 Mar 2019

See all articles by Fabliha Ibnat

Fabliha Ibnat

University of Maryland

Kenneth L. Leonard

University of Maryland

Luke Bawo

Ministry of Health and Social Welfare, Tanzania

Rianna L. Mohammed-Roberts

World Bank

Date Written: March 14, 2019

Abstract

The Three-Gap Model examines the determinants of low-quality health care by examining the patterns and determinants of three gaps. Using four measures of performance -- target performance, actual performance, capacity to perform, and knowledge to perform -- this paper defines three gaps for each health worker: the gap between target performance and what they have the knowledge to do (the know gap), the gap between their knowledge and their capacity to perform (the know-can gap), and the gap between their capacity and what they actually do (the can-do gap). The paper demonstrates how the patterns of these gaps across health workers in a sample can be used to diagnose failures in the system as well as evaluate the outcomes of policy experiments. Using data on pediatric care from hospitals in Liberia, the paper illustrates how the model can be used to investigate the potential for improvements in the quality of care from several possible policy interventions. The analysis of the relationships between these gaps across health workers in a health system help to paint a better picture of the determinants of performance and can assist policy makers in choosing relevant policies to improve health worker performance.

Keywords: Health Care Services Industry, Health Service Management and Delivery, Pharmaceuticals Industry, Pharmaceuticals & Pharmacoeconomics

Suggested Citation

Ibnat, Fabliha and Leonard, Kenneth L. and Bawo, Luke and Mohammed-Roberts, Rianna L., The Three-Gap Model of Health Worker Performance (March 14, 2019). World Bank Policy Research Working Paper No. 8782, Available at SSRN: https://ssrn.com/abstract=3360140

Fabliha Ibnat (Contact Author)

University of Maryland ( email )

College Park
College Park, MD 20742
United States

Kenneth L. Leonard

University of Maryland ( email )

Symmons Hall, Rm 2200
University of Maryland
College Park, MD 20742-5535
United States

HOME PAGE: http://faculty.arec.umd.edu/kleonard/

Luke Bawo

Ministry of Health and Social Welfare, Tanzania

P O Box 9083
Dar Es Salaam
Tanzania

Rianna L. Mohammed-Roberts

World Bank

1818 H Street, NW
Washington, DC 20433
United States

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