The Three-Gap Model of Health Worker Performance
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World Bank, Washington, DC
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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.
Palabras clave
HEALTH WORKERS, HEALTH SERVICES, PAY FOR PERFORMANCE, HEALTH CARE EVALUATION, HEALTH SERVICE DELIVERY, PEDIATRIC CARE