Workload and task distribution in integrated pharmaceutical supply chain and service delivery: a time and motion study in Ethiopia’s primary health care facilities

In the quiet corners of a health clinic, a different kind of work happens alongside the treatment of patients. It is the work of keeping medicines flowing, of counting stock, of filling out forms, and of ensuring that when a doctor writes a prescription, the drug is actually there to be given. This is the pharmaceutical supply chain, a complex web of logistics that must function perfectly to support the human side of medicine. In many places with limited resources, the people who run these systems are often the same individuals who treat patients, wearing multiple hats that range from inventory manager to community health worker. When the system works well, these roles blend seamlessly. When it does not, the result is often a clinic where the staff are busy, but not necessarily busy with the tasks that save lives. Understanding exactly how these workers spend their time is crucial, because every minute spent waiting for a system to respond is a minute lost for a patient in need.

Researchers recently stepped into primary health care facilities across Ethiopia to watch, measure, and understand exactly how this time is spent. They did not rely on surveys or interviews, where people might guess how they spend their day. Instead, they used a method called a time-and-motion study, a technique borrowed from industrial engineering that involves watching workers continuously and recording every single action they take. The team observed 65 health workers in 36 different facilities, ranging from small health posts in rural villages to larger health centers and primary hospitals. They tracked every moment of the workday, from the moment a worker arrived to the moment they left, categorizing each activity as either something that directly helped a patient or the supply chain, or something that did not.

The results revealed a striking imbalance in how time is used. In the larger facilities, such as health centers and primary hospitals, nearly half of the total observed time—42.2 percent—was spent on activities that did not directly add value to patient care. This means that for every hour a worker was on duty, they spent more than 25 minutes on tasks that did not move a patient toward recovery or a medicine toward a shelf. The situation was even more pronounced at the smaller health posts, where non-value-adding activities consumed more than half of the workday, reaching 56.6 percent. The largest chunk of this unproductive time was not spent on personal breaks or chatting with colleagues, but on what the researchers called "system-induced idle time." This is time when the worker is present and ready to work, but the system around them prevents them from doing so. They might be waiting for a shipment to arrive, waiting for a computer to load, or simply standing by because there is no work to be done due to a lack of supplies or patients.

When the researchers looked at what the workers were doing when they were being productive, a clear divide emerged between the different types of facilities. In the health centers and primary hospitals, the most time-consuming productive task was not treating patients, but managing the supply chain. Almost 30 percent of the total workday was dedicated to logistics: preparing orders, receiving supplies, recording stock transactions, and organizing the medicine stores. In fact, when looking only at the time spent on useful work, more than half of it was spent on these supply chain tasks. Direct patient care, such as dispensing medicine and counseling patients, accounted for only about 15 percent of the total time. This suggests that the staff in these facilities are spending a disproportionate amount of their energy keeping the shelves stocked rather than interacting with the people who need the medicine.

At the smaller health posts, the picture was different but still highlighted significant inefficiencies. Here, the workers, who are mostly health extension workers, spent the majority of their productive time on clinical and public health services like immunizations and treating common illnesses. However, they spent very little time on supply chain tasks, which made up only about 2 percent of their day. Despite this shift in focus, the health posts still suffered from high levels of non-value-adding time. The workers were often idle, waiting for supplies from the larger centers or dealing with interruptions. The study found that the workers at these posts spent significantly more time on non-productive activities than their counterparts at the larger facilities, averaging over 200 minutes of idle or interrupted time per day, compared to about 147 minutes at the larger centers.

The researchers also examined whether these patterns changed depending on where in the country the facilities were located. They looked at data from three different regions: Amhara, Oromia, and Somali. The findings showed that the inefficiencies were not specific to one region or another. The amount of time wasted and the way tasks were distributed were remarkably similar across all three areas. This suggests that the problem is not a local issue of management or culture in a single district, but a systemic one affecting the entire primary health care structure. The differences in efficiency were driven almost entirely by the level of the facility, with the larger hospitals and centers having more productive time than the smaller posts, yet still struggling with a heavy burden of logistical work.

The study points to a few specific bottlenecks that are eating up valuable time. In the larger facilities, the act of issuing and dispatching medicines, recording stock transactions, and processing internal orders took up the most time. These are repetitive, manual tasks that could potentially be streamlined. At the health posts, the main issue was the sheer amount of time spent waiting or being interrupted, which prevented the workers from focusing on the community health services they are trained to provide. The researchers noted that while some idle time is natural in any job, the volume observed here was so high that it likely reflects deeper structural problems, such as poor coordination between facilities, unreliable supply chains, or a mismatch between the number of staff and the actual demand for services.

This research does not claim to have solved the problem, but it provides a clear map of where the energy is going. It shows that in these Ethiopian facilities, the workforce is often held back by the very systems designed to support them. The staff are not inefficient by nature; rather, they are caught in workflows that force them to spend more time managing the supply chain than caring for patients. The study suggests that to fix this, the system needs to change how tasks are assigned and how information flows. It proposes that moving some logistical tasks to different roles, redesigning the workflow to reduce waiting, and introducing digital tools to manage inventory could free up significant amounts of time. If these changes were made, the hours currently lost to waiting and paperwork could be redirected toward the people who walk through the clinic doors, ensuring that the promise of primary health care is met not just in theory, but in the reality of every working day.