{"type":"script","doc_desc":{"producers":[{"name":"Reproducibility WBG","abbr":"DECDI","affiliation":"World Bank - Development Impact Department","role":"Verification and preparation of metadata"}],"prod_date":"2026-06-03","version":"1"},"project_desc":{"authoring_entity":[{"name":"Jishnu Das","affiliation":"Georgetown University, McCourt School of Public Policy","email":"jishnu.das@georgetown.edu"},{"name":"Benjamin Daniels","affiliation":"Harvard University, School of Public Health","email":"bdaniels@fas.harvard.edu"},{"name":"Roberta Gatti","affiliation":"World Bank Group","email":"rgatti@worldbank.org"},{"name":"Andres Yi Chang","affiliation":"World Bank Group","email":"ayichang@worldbank.org"}],"title_statement":{"title":"Reproducibility package for Reassessing The Human Resources Crisis In Primary Health Care: A Review Of Global Findings With New Evidence From 10 Sub-Saharan African countries","idno":"PP_SSA_2026_667"},"data_statement":"Some data is restricted and has not been included in the reproducibility package. Intermediate data is included in the reproducibility package and can be used to fully reproduce the results in the paper. For more details, please refer to the README file.\n","software":[{"name":"Stata","version":"19.5 MP"}],"scripts":[{"title":"Reproducibility package for Reassessing The Human Resources Crisis In Primary Health Care: A Review Of Global Findings With New Evidence From 10 Sub-Saharan African countries","date":"2026-06","notes":"Computational reproducibility verified by Development Impact (DECDI) Analytics team, World Bank.","instructions":"See README in reproducibility package.","file_name":"PP_SSA_2026_667","zip_package":"PP_SSA_2026_667.zip","dependencies":"Stata dependencies are listed in the ado folder."}],"repository_uri":[{"name":"Reproducible Research Repository (World Bank)","uri":"https:\/\/reproducibility.worldbank.org"}],"production_date":"2026-06-03","abstract":"This paper revisits the widely held idea of a \u201chuman resources crisis\u201d in primary health care (PHC) across low- and middle-income countries (LMICs). First, we review micro- and macro-level evidence, finding little empirical support for generalized workforce shortages. Providers in LMICs appear to operate with substantial excess capacity, characterized by low caseloads, short consultation lengths, and modest wait times. Second, using nationally representative data from 7,915 facilities across 10 African countries, we estimate that the median provider sees 10.9 patients per day. We suggest that the widely perceived experience of overcrowding arises from a highly unequal distribution of caseloads, with most visits concentrated among a minority of providers. In other words, the average provider is not busy, but the average patient visits a busy provider. Third, we assess allocative inefficiencies using matched data on provider caseload and competence, documenting that caseloads are not concentrated among more competent providers. Using simulations, we show that this misallocation reduces potential aggregate service quality by 4%\u201333%, depending on the country. These findings suggest that failures in PHC service delivery cannot be addressed by simply expanding human resources under existing systems arrangements\u2013 the competence, allocation, and utilization of both new and existing providers must be improved to meaningfully impact care quality.","geographic_units":[{"name":"Sub-Saharan Africa","code":"SSA"}],"keywords":[{"name":"Health"},{"name":"Human Resources"},{"name":"Sub-Saharan Africa"},{"name":"Capacity Utilization"},{"name":"Misallocation"}],"topics":[{"id":"I20","uri":"https:\/\/www.aeaweb.org\/econlit\/jelCodes.php?view=jel","vocabulary":"Journal of Economic Literature (JEL)","name":"General","parent_id":"I2"},{"id":" I15","uri":"https:\/\/www.aeaweb.org\/econlit\/jelCodes.php?view=jel","vocabulary":"Journal of Economic Literature (JEL)","name":"Health and Economic Development","parent_id":"I1"},{"id":" O15","uri":"https:\/\/www.aeaweb.org\/econlit\/jelCodes.php?view=jel","vocabulary":"Journal of Economic Literature (JEL)","name":"Human Resources \u2022 Human Development \u2022 Income Distribution \u2022 Migration","parent_id":"O1"}],"output":[{"title":"Reassessing The Human Resources Crisis In Primary Health Care: A Review Of Global Findings With New Evidence From 10 Sub-Saharan African countries","authors":"Benjamin Daniels, Jishnu Das, Roberta Gatti, Andres Yi Chang"}],"language":[{"name":"English","code":"EN"}],"disclaimer":"The materials in the reproducibility packages are distributed as they were prepared by the staff of the International Bank for Reconstruction and Development\/The World Bank. The findings, interpretations, and conclusions expressed in this event do not necessarily reflect the views of the World Bank, the Executive Directors of the World Bank, or the governments they represent. The World Bank does not guarantee the accuracy of the materials included in the reproducibility package.","license":[{"name":"MIT License","uri":"https:\/\/opensource.org\/license\/mit"},{"name":"World Bank IGO Rider","uri":"https:\/\/github.com\/worldbank\/metadata-editor\/blob\/main\/WB-IGO-RIDER.md"}],"contacts":[{"name":"Jishnu Das","affiliation":"Georgetown University, McCourt School of Public Policy","email":"jishnu.das@georgetown.edu"},{"name":"Reproducibility WBG","affiliation":"World Bank","email":"reproducibility@worldbank.org"}],"datasets":[{"name":"Service Delivery Indicators Health Survey -  Kenya (2018) ","citation":"Waly Wane., Jane Chuma., World Bank. Service Delivery Indicators Health Survey - Kenya (2018) [dataset]. Accessed June 2026. ","license":"Custom license","access_type":"Data access to restricted source data was granted directly to the study authors by the data owners\/managers. The de-identified dataset constructed by the authors is included in the reproducibility package.","note":"Filename: data\/kenya.dta. The authors used restricted Service Delivery Indicators (SDI) data to construct this de-identified dataset included in the reproducibility package. Potential replicators seeking access to restricted data should apply through the access request process described in the Service Delivery Indicators (SDI) catalog on the World Bank Microdata Library. A version of the de-identified dataset is also available through the World Bank Microdata Library at https:\/\/microdata.worldbank.org\/catalog\/3872."},{"name":"Service Delivery Indicators Survey -  Madagascar (2016) ","citation":"Waly Wane, The World Bank. Service Delivery Indicators Survey - Madagascar (2016) [dataset]. Accessed June 2026. ","license":"Custom license","note":"Filename: data\/madagascar.dta. The authors used restricted Service Delivery Indicators (SDI) data to construct this de-identified dataset included in the reproducibility package. Potential replicators seeking access to restricted data should apply through the access request process described in the Service Delivery Indicators (SDI) catalog on the World Bank Microdata Library. A version of the de-identified dataset is also available through the World Bank Microdata Library at https:\/\/microdata.worldbank.org\/catalog\/3884.","access_type":"Data access to restricted source data was granted directly to the study authors by the data owners\/managers. The de-identified dataset constructed by the authors is included in the reproducibility package."},{"note":"Filename: data\/malawi.dta. The authors used restricted Service Delivery Indicators (SDI) data to construct this de-identified dataset included in the reproducibility package. More information on the survey can be found here: http:\/\/documents.worldbank.org\/curated\/en\/417871611550272923","access_type":"Data access to restricted source data was granted directly to the study authors by the data owners\/managers. The de-identified dataset constructed by the authors is included in the reproducibility package.","license":"Custom license","name":"Malawi - Harmonized Health Facility Assessment: 2018-2019","citation":"Government of Malawi. Malawi - Harmonized Health Facility Assessment : 2018-2019 [dataset]. Accessed June 2026. Unpublished. "},{"note":"Filename: data\/mozambique.dta. The authors used restricted Service Delivery Indicators (SDI) data to construct this de-identified dataset included in the reproducibility package. Potential replicators seeking access to restricted data should apply through the access request process described in the Service Delivery Indicators (SDI) catalog on the World Bank Microdata Library. A version of the de-identified dataset is also available through the World Bank Microdata Library at https:\/\/microdata.worldbank.org\/catalog\/3876.","license":"Custom license","citation":"Waly Wane., Ezequiel Molina., World Bank. Service Delivery Indicators Health Survey - Mozambique (2014) [dataset]. Accessed June 2026.","name":"Service Delivery Indicators Health Survey -  Mozambique (2014)","access_type":"Data access to restricted source data was granted directly to the study authors by the data owners\/managers. The de-identified dataset constructed by the authors is included in the reproducibility package."},{"note":"Filename: data\/niger.dta. The authors used restricted Service Delivery Indicators (SDI) data to construct this de-identified dataset included in the reproducibility package. Potential replicators seeking access to restricted data should apply through the access request process described in the Service Delivery Indicators (SDI) catalog on the World Bank Microdata Library. A version of the de-identified dataset is also available through the World Bank Microdata Library at https:\/\/microdata.worldbank.org\/catalog\/3222.","citation":"Christophe Rockmore. The World Bank. Service Delivery Indicators Health Survey - Niger (2015) [dataset]. Accessed June 2026.","name":"Service Delivery Indicators Health Survey -  Niger (2015) ","access_type":"Data access to restricted source data was granted directly to the study authors by the data owners\/managers. The de-identified dataset constructed by the authors is included in the reproducibility package.","license":"Custom license"},{"note":"Filename: data\/nigeria.dta. The authors used restricted Service Delivery Indicators (SDI) data to construct this de-identified dataset included in the reproducibility package. Potential replicators seeking access to restricted data should apply through the access request process described in the Service Delivery Indicators (SDI) catalog on the World Bank Microdata Library. A version of the de-identified dataset is also available through the World Bank Microdata Library at https:\/\/microdata.worldbank.org\/catalog\/2559.","citation":"Obert Pimhidzai., World Bank. Service Delivery Indicators Health Survey - Nigeria (2013) [dataset]. Accessed June 2026. ","name":"Service Delivery Indicators Health Survey -  Nigeria (2013) ","access_type":"Data access to restricted source data was granted directly to the study authors by the data owners\/managers. The de-identified dataset constructed by the authors is included in the reproducibility package.","license":"Custom license"},{"note":"Filename: data\/sierra_leone.dta. The authors used restricted Service Delivery Indicators (SDI) data to construct this de-identified dataset included in the reproducibility package. Potential replicators seeking access to restricted data should apply through the access request process described in the Service Delivery Indicators (SDI) catalog on the World Bank Microdata Library. A version of the de-identified dataset is also available through the World Bank Microdata Library at https:\/\/microdata.worldbank.org\/catalog\/4038.","citation":"Statistics Sierra Leone. Service Delivery Indicators Health Survey - Sierra Leone (2018) ) [dataset]. Accessed June 2026. ","name":"Service Delivery Indicators Health Survey -  Sierra Leone (2018) ","access_type":"Data access to restricted source data was granted directly to the study authors by the data owners\/managers. The de-identified dataset constructed by the authors is included in the reproducibility package.","license":"Custom license"},{"note":"Filename: data\/tanzania.dta. The authors used restricted Service Delivery Indicators (SDI) data to construct this de-identified dataset included in the reproducibility package. Potential replicators seeking access to restricted data should apply through the access request process described in the Service Delivery Indicators (SDI) catalog on the World Bank Microdata Library. A version of the de-identified dataset is also available through the World Bank Microdata Library at https:\/\/microdata.worldbank.org\/catalog\/3873.","citation":"Waly Wane, World Bank. Service Delivery Indicators Health Survey - Tanzania (2016)  [dataset]. Accessed in June 2026. ","name":"Service Delivery Indicators Health Survey -  Tanzania (2016) ","license":"Custom license","access_type":"Data access to restricted source data was granted directly to the study authors by the data owners\/managers. The de-identified dataset constructed by the authors is included in the reproducibility package."},{"note":"Filename: data\/togo.dta. The authors used restricted Service Delivery Indicators (SDI) data to construct this de-identified dataset included in the reproducibility package. Potential replicators seeking access to restricted data should apply through the access request process described in the Service Delivery Indicators (SDI) catalog on the World Bank Microdata Library. A version of the de-identified dataset is also available through the World Bank Microdata Library at https:\/\/microdata.worldbank.org\/catalog\/2560.","citation":"Christophe Rockmore, The World Bank. Service Delivery Indicators Survey - Togo (2012) [dataset]. Accessed June 2026. ","access_type":"Data access to restricted source data was granted directly to the study authors by the data owners\/managers. The de-identified dataset constructed by the authors is included in the reproducibility package.","license":"Custom license","name":"Service Delivery Indicators Survey - Togo  (2012) "},{"note":"Filename: data\/uganda.dta. The authors used restricted Service Delivery Indicators (SDI) data to construct this de-identified dataset included in the reproducibility package. Potential replicators seeking access to restricted data should apply through the access request process described in the Service Delivery Indicators (SDI) catalog on the World Bank Microdata Library. A version of the de-identified dataset is also available through the World Bank Microdata Library at https:\/\/microdata.worldbank.org\/catalog\/2750.","citation":"Waly Wane, World Bank. SDI Health Survey - Uganda (2013) [dataset]. Accessed June 2026. ","name":"Service Delivery Indicators Health Survey -  Uganda (2013)","access_type":"Data access to restricted source data was granted directly to the study authors by the data owners\/managers. The de-identified dataset constructed by the authors is included in the reproducibility package.","license":"Custom license"}],"technology_environment":"Paper exhibits were reproduced on a computer with the following specifications:\n\u2022 OS: Windows 11 Enterprise\n\u2022 Processor: INTEL(R) XEON(R) PLATINUM 8562Y+ 2.80 GHz (2 processors)\n\u2022 Memory available: 32.0 GB\n\u2022 Software version: Stata 19.5 MP","technology_requirements":"Run time: ~ 1 hour","reproduction_instructions":"To reproduce the findings in this paper, a replicator must:\n1. **Run the Package:** Update the working directory in line 4 of the do-file `runfile`, and run it.\n\n**Note:** The reproducibility package begins with intermediate data as the raw data is restricted. Intermediate data is included in the reproducibility package and can be used to fully reproduce the results in the paper."},"datacite":{"creators":[{"givenName":"Jishnu","familyName":"Das","nameType":"Personal","affiliation":[{"name":"Georgetown University, McCourt School of Public Policy","affiliationIdentifierScheme":"ROR","schemeUri":"https:\/\/ror.org","affiliationIdentifier":"https:\/\/ror.org\/05vzafd60"}]},{"givenName":"Benjamin","familyName":"Daniels","nameType":"Personal","affiliation":[{"name":"Harvard University, School of Public Health","affiliationIdentifierScheme":"ROR","schemeUri":"https:\/\/ror.org","affiliationIdentifier":"https:\/\/ror.org\/03vek6s52"}]},{"givenName":"Roberta","familyName":"Gatti","nameType":"Personal","affiliation":[{"name":"World Bank Group","affiliationIdentifier":"https:\/\/ror.org\/02md09461","affiliationIdentifierScheme":"ROR","schemeUri":"https:\/\/ror.org"}]},{"givenName":"Andres Yi","familyName":"Chang","nameType":"Personal","affiliation":[{"name":"World Bank Group","affiliationIdentifier":"https:\/\/ror.org\/02md09461","affiliationIdentifierScheme":"ROR","schemeUri":"https:\/\/ror.org"}]}],"titles":[{"lang":"en","title":"Reproducibility package for Reassessing The Human Resources Crisis In Primary Health Care: A Review Of Global Findings With New Evidence From 10 Sub-Saharan African countries"},{"title":"PP2_SSA_2026_667","titleType":"Other"}],"publisher":"World Bank","publicationYear":"2026","types":{"resourceType":"Reproducibility package","resourceTypeGeneral":"Other"},"url":"https:\/\/reproducibility.worldbank.org\/index.php\/catalog\/study\/PP2_SSA_2026_667","language":"en"},"tags":[{"tag":"DOI"},{"tag":"Open Code"},{"tag":"Restricted Data"}],"schematype":"script"}