Understanding the key factors that underlie the efficiency of specific health programs is key to improve population health. This is especially true for Haiti, where utilization of health services (in the formal sector) on average is very low, even when compared to other low-income countries, and despite a relatively high density of health facilities per unit area (meaning that distance is not the main barrier to access). There is a particular need to evaluate policies that may enhance primary health care utilization and outcomes, since primary care has proven to be an effective platform for strengthening health systems in several countries. Potential interventions to be evaluated include community health workers as possible key determinants of health care utilization in Haiti. Limited healthcare resources in low, and middle-income countries (LMICs) have led policymakers to improve healthcare productivity. A simple indicator of efficiency, such as productivity of health facilities, measured using routine health facility data and demographic health surveys, as well as other data sources such as health facility surveys, is an approach that can be replicated and compared across different contexts
more specifically, productivity is defined as the ratio of the output to the inputs of any system. Therefore, a productive system is one which achieves higher levels of performance (outcomes, outputs) relative to the inputs (e.g., resources, time) consumed
and for this study, we measure outcomes or outputs as total provision of services, either outpatient visits or vaccine provision, while the number of clinical health workers is the input measure for this study. The latter is a viable measure since health care workers account for the largest share of the total cost of functioning of health facility. Hence the productivity measure used is the number of patient visits, or the number of pentavalent vaccines provided, per clinical health care worker at a health facility.