Original Research
Health professional productivity in Ethiopian hospitals: evidence from a multicenter time–motion study
AUTHORS
Zeine Abosse Anore1,2 (Hadiya (Ethiopia)) MPH, Health Workforce Lead * 
Jemal Mohammed Ali3 MPH
Tegbar Yigzaw Sendekie4 PhD, Consultant, Health Workforce Initiatives
Firew Ayalew3 PhD
Shelemo Shawula Kachara3 MD, MPH
Mezgebu Yitayal5 PhD, Professor of Health Systems and Policy and Director, School of Public Health
Trhas Tadesse Berhe3 PhD
Solomon Woldeamanuel6 MPH, Head, HRH Information System, Planning & Motivation Desk
Assegid Samuel6 MSc, Lead Executive Officer, Human Resources for Health Development and Improvement
Jelle Stekelenburg2 Professor
AFFILIATIONS
1 Management Sciences for Health, Addis Ababa, Ethiopia
2 University Medical Center Groningen, University of Groningen, Netherlands
3 Freelance Researcher, Ethiopia
4 Mastercard Foundation, Rwanda
5 College of Medicine and Health Sciences, School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
6 Ministry of Health, Addis Ababa, Ethiopia
ACCEPTED: 26 May 2026
Early Abstract:
Background: Efficient use of health worker time is critical for improving service delivery in low resource and rural settings, where persistent workforce shortages limit progress toward universal health coverage. Ethiopia faces a severe health workforce deficit, yet empirical evidence on how hospital based professionals utilize their working hours particularly in rural and remote hospitals remains limited. This study assessed productive time use among health professionals and examined factors associated with achieving an eight hour productive workday.
Methods: A cross sectional time–motion study was conducted in 18 public and private hospitals, including rural facilities across Ethiopia. A total of 180 health professionals representing five cadres were observed over two full working days using a standardized time motion protocol. Productive activities included direct and indirect patient care and essential administrative functions. Structured interviews assessed workload, workplace conditions, and performance management practices. Descriptive statistics and multivariable logistic regression identified predictors of high productivity.
Results: Health professionals spent a total of 5.55 hours per day on productive activities (69.4% of official working hours). Nearly one third of time was lost to non productive activities, primarily waiting for patients and extended breaks. Productivity was positively associated with postgraduate training, greater experience, higher daily patient load, and receipt of performance appraisal. Patterns were consistent across rural and urban hospitals, though rural facilities reported longer waiting times and greater supply constraints.
Conclusion: Despite systemic constraints, health professionals dedicate a substantial share of their time to productive tasks. A portion of non-productive time reflects system-level factors such as patient flow disruptions and supply constraints rather than individual inefficiency, particularly in rural hospitals. Addressing these bottlenecks, alongside strengthening workforce capacity through training, supervision, and performance systems, could improve efficiency within existing resources and support equitable, high-quality care.
Keywords: Ethiopia, hospital efficiency, productivity, rural health workforce, time–motion study.