The Three-Gap Model of Health Worker Performance

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.