add bingling pub

Author: tbhallett

docs/publications.bib

@@ -1,4 +1,22 @@
 
+@misc{she_where_2026,
+	title = {Where does healthcare worker time go? {Evidence} from a time-and-motion study in {Malawi}},
+	copyright = {© 2026, Posted by openRxiv. This pre-print is available under a Creative Commons License (Attribution 4.0 International), CC BY 4.0, as described at http://creativecommons.org/licenses/by/4.0/},
+	shorttitle = {Where does healthcare worker time go?},
+	url = {https://www.medrxiv.org/content/10.64898/2026.05.04.26352396v1},
+	doi = {10.64898/2026.05.04.26352396},
+	abstract = {Low- and middle-income countries face critical shortages of healthcare workers (HCWs) and funding for human resources for health (HRH), while patients often receive less care time than expected. Understanding how the existing workforce capacity is used is therefore essential for improving health system performance in resource-constrained settings. We examined HCW time-use patterns in Malawi using data from a time-and-motion study conducted between January and May 2024, which recorded activities across multiple cadres, days, and representative health facilities in the healthcare system. Across cadres, median daily working time, including breaks, was 7.35 hours (IQR 4.40-8.35), approximately 1.65 hours below the typical contracted schedule. HCWs spent most time on direct patient care: 2.82 hours per day (IQR 1.89-3.97), accounting for 48\% of total working time (IQR 30\%-67\%). Administrative tasks accounted for 0.30 hours (IQR 0.00-1.23; 5.21\%, IQR 0\%-18\%) and break time remained consistent with the contracted expectations at 1.25 hours (IQR 0.00-2.12; 18\%, IQR 0\%-28\%). Unallocated time, defined as time neither work-related nor recorded as breaks, was 0.72 hours (IQR 0.02-1.92; 12\%, IQR 0\%-29\%), mainly attributed to the absence of patients based on available information. Median patient load was 21 per staff member per day in outpatient care (IQR 12-35), 12 in inpatient care (IQR 7-18), and 14 in emergency care (IQR 10-23), with median time per patient of 3 (IQR 1.0-6.5), 6 (IQR 2.5-14), and 10 (IQR 5-20) minutes, respectively. These measures, particularly time per patient, vary by cadre, facility type, facility ownership, region, and service area. The findings present a first system-wide picture of HCW time use in a low-income setting and can inform health systems planning. The gap between contracted and actual working time and unallocated time suggests scope to improve workforce utilisation, while high patient loads highlight the need for sustained HRH investment and workforce expansion.},
+	language = {en},
+	urldate = {2026-05-06},
+	publisher = {medRxiv},
+	author = {She, Bingling and Chitsulo, Precious and Collins, Joseph Harry and Mulwafu, Watipaso and Mnjowe, Emmanuel and Bhatia, Sangeeta and Mangal, Tara Danielle and Mboma, Sebastian and Mohan, Sakshi and Molaro, Margherita and Mphamba, Pemphero Norah and Murray-Watson, Rachel E. and Phillips, Andrew N. and Revill, Paul and Suarez, Mariana and Mwapasa, Victor and Nkhoma, Dominic and Mfutso-Bengo, Joseph and Hallett, Timothy B. and Tafesse, Wiktoria and Colbourn, Tim},
+	month = may,
+	year = {2026},
+	note = {ISSN: 3067-2007
+Pages: 2026.05.04.26352396},
+	keywords = {Data Collection - Protocol and Analyses},
+}
+
 @article{mohan_estimating_2026,
 	title = {Estimating {System}-{Wide} {Healthcare} {Costs} {Using} a {Health} {System} {Model}: {Application} to the {Thanzi} {La} {Onse} {Model} of {Malawi}},
 	issn = {1175-5652, 1179-1896},