Workload and task distribution in integrated pharmaceutical supply chain and service delivery: a time and motion study in Ethiopia’s primary health care facilities

Abstract Background Integrating pharmaceutical supply chain management with primary health care delivery is essential to improving health system performance in resource-limited settings. However, evidence on how health workers allocate time across these functions remains limited. This study assessed time allocation patterns and workflow efficiency among health workers in primary health care facilities in Ethiopia. Methods A facility-based cross-sectional time–motion study was conducted in 36 primary health care facilities across selected woredas of the Amhara, Oromia and Somali regions of Ethiopia from 15 to 31 May 2025. Using the Work Observation Method by Activity Timing (WOMBAT) framework, 65 health workers were continuously observed during routine working hours. Activities were categorized as supply chain and logistics, clinical and patient care (or public health services), administrative and management, community-level, or non-value-adding. Workflow efficiency was defined as the proportion of total observed time spent on value-adding activities. Data were analyzed using descriptive statistics, one-way analysis of variance and Kruskal–Wallis tests. Results A total of 22,825 minutes (380 hours) of observation was completed. Non-value-adding activities accounted for 42.20% of the time observed in health centers and primary hospitals and 56.63% at health posts, with system-induced idle time comprising the largest share at both levels (86.57% and 87.62% of non-value-adding time, respectively). In health centers and primary hospitals, supply chain and logistics activities represented 29.32% of total observed time and 50.72% of value-adding time. In contrast, clinical and public health services dominated value-adding time at health posts (53.44%), while supply chain activities accounted for only 2.09% of total observed time. Value-adding time differed significantly by facility level (202.15 ± 88.11 versus 153.23 ± 62.85 minutes/day; p < 0.001) but not by region (p = 0.156). Conclusions Health workers in Ethiopian primary health care facilities spend a substantial share of their time on non-value-adding activities, while productive time at health centers and primary hospitals is dominated by supply chain functions rather than patient-facing care. Addressing underlying system bottlenecks through task shifting, workflow redesign and digitalized logistics systems is essential to improve pharmaceutical service delivery at the primary care level. Because service demand was not measured, idle time should be interpreted as reflecting both workflow inefficiency and possible structural underutilization.