Efficiency of Health System Units in Africa

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Description

Despite sending huge sums of money on health every year the African region�s burden of disease is persistently high. Most of the countries in the region are lagging behind in achieving the health-related United Nations Millennium Development Goals. The African region�s dismal health situation has largely been blamed on weakness pertaining to such factors as health leadership and governance; service delivery; health workforce; medicines, vaccines, and health technologies; health information; and health system financing that have undermined the capacity of health systems of countries in the region to improve population health without wastage of resources. Institutionalising health system efficiency monitoring, as a basis for the design and implementation of appropriate policy interventions, has been proposed as an effective way of curbing wastage of health system inputs. Efficiency of Health System Units in Africa: A Data Envelopment Analysis is the first book of its kind on application of the data envelopment analysis technique to examine the efficiency of health system decision-making units in Africa. The book interlaces lecture notes with research articles and case studies to equip students and practitioners of economics, operations research, management science, and public health with knowledge and skills for undertaking technical efficiency, cost efficiency, and total factor productivity analyses.

Informations

• Publié par: University of Nairobi Press
• Date de parution: 29 décembre 2013
• Nombre de lectures: 0
• EAN13: 9789966792426
• Langue: English
• Poids de l'ouvrage: 5 Mo

Extrait

Efficiency of Health System Units in Africa

Efficiency of Health System Units in Africa:A Data Envelopment Analysis

Edited by

Joses Muthuri Kirigia

University of Nairobi Press

First Published 2013 University of Nairobi Press University of Nairobi P.O. Box 30197, Nairobi – 00100 Kenya

Tel: [phone] E-mail:[e-mail]://www.uonbi.ac.ke/press The University of Nairobi Press supports and promotes University of Nairobi’s objectives of discovery, dissemination and preservation of knowledge, and stimulation of intellectual and cultural life by publishing works of the highest quality in association with partners in different parts of the world. In doing so, it adheres to the University’s tradition of excellence, innovation, and scholarship. The moral rights of the editor have been asserted. © University of Nairobi Press, 2013 All rights reserved. Except for the quotation of fully acknowledged short passages for the purposes of criticism, review, research, or teaching no part of this publication may be reproduced, stored in any retrieval system, or transmitted in any form or by any means without prior written permission from the University of Nairobi Press. University of Nairobi Library CIP Data RAEfficiencyofhealthsystemunitsinAfrica:adata  Ͳ 410 envelopment analysis/ ed. by Joses Muthuri Kirigia. .E34 Nairobi : University of Nairobi Press, 2013. xxii,567p.:ill. 1.MedicaleconomicsͲͲAfrica 2.Medicalcare–Africa–Evaluation I.Kirigia, JosesMuthuri.II.Title ISBN 10-9966 792 15 5 ISBN 13-978 9966 792 15 0 Printed by Aliki Printers, P.O. Box 9434-00300 Nairobi, Kenya

Contents

List of Figures ................................................................................................................ vii List of Tables ................................................................................................................... ix List of Appendices.......................................................................................................... ix

Preface............................................................................................................................. xv Acknowledgements ...................................................................................................xviii List of Contributors ...................................................................................................... xxi

Abbreviations and Acronyms...................................................................................xxiv

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Part I Health Systems and Economic Theory of Health Service Decision-Making Units

Overview of Health Situation in Africa ............................................................. 3

Health Challenges in Africa and the Way Forward....................................... 37

Lecture Notes on Efficiency Analysis of Health Systems.............................. 43

Introduction to Health Services Production and Cost Theory .................... 69

Part II Application of Data Envelopment Analysis in Health Systems in Africa

Technical Efficiency of Public Hospitals and Health Centres in Ghana ................................................................................................................. 139

Measurement of Technical Efficiency of Public Hospitals in Kenya: Using Data Envelopment Analysis ................................................................ 161

Using Data Envelopment Analysis to Measure the Technical Efficiency of Public Health Centres in Kenya ............................................... 171

Technical Efficiency of Peripheral Health Units in Pujehun District of Sierra Leone:ADEA Application..................................................................... 185

Are Public Hospitals in Kwazulu-Natal Province of South Africa Technically Efficient? ....................................................................................... 203

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Technical Efficiency of Public Clinics in Kwazulu-Natal Province of South Africa....................................................................................................... 217

Technical Efficiency of Primary Health Units in Kailahun and Kenema Districts of Sierra Leone ................................................................... 239

Efficient Management of Health Centres Human Resources in Zambia ............................................................................................................... 267

A Performance Assessment Method for Hospitals:The Case of Municipal Hospitals in Angola........................................................................... 291

A Comparative Assessment of Performance and Productivity of Health Centres in Seychelles ........................................................................... 312

Productivity Changes in Benin Zone Hospitals:A nonparametric Malmquist approach............................................................................................ 337

Assessment of Productivity of Hospitals in Botswana:A DEA Application.......................................................................................................... 367

Technical Efficiency, Efficiency Change, Technical Progress, and Productivity Growth Among National Health Systems in African Continent ........................................................................................................... 395

Part III Case Studies for Developing Skills in Economic Efficiency Analysis

Technical Efficiency Analysis:A Case Study of Muthuleni Health Centres................................................................................................................. 419

Measurement of Total Cost Efficiency or Economic Efficiency:A Case Study of Health Centres in the Democratic Republic of Njuri-Ncheke............... 451

Measurement of Efficiency Change and Productivity Growth:A Case Study of National Health Systems in the African Union.................................... 479

Part IV Advancing Knowledge and Skills in Efficiency Analysis using Data Envelopment Analysis

Advancing Knowledge and Skills in DEA .................................................... 507

Glossary ........................................................................................................................ 516

Index ............................................................................................................................. 519

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Figure 3.1 Figure 3.2 Figure 3.3 Figure 3.4

Figure 3.5

Figure 4.1

Figure 4.2 Figure 4.3

Figure 4.4

Figure 4.5

Figure 4.6 Figure 4.7 Figure 4.8

Figure 4.9 Figure 4.10 Figure 4.11

Figure 4.12 Figure 4.13

Figure 4.14 Figure 4.15 Figure 4.16 Figure 4.17 Figure 4.18

Figure 4.19 Figure 4.20

List of Figures The WHO health system framework.......................................... 44 Health promoting schools programme ...................................... 50 Production process for a health institution ............................... 51 Technical, allocative, and cost efficiencies of a household health education visits programme......................... 54 Relative efficiency of health districts in Kibari State with one input and two outputs ................................................. 58 Relationship between number of children immunised and number of nurses at Kathera Health Centre ..................... 73 Average and marginal product curves for labour .................... 74 Alternative combinations of two inputs needed to immunise 2,000 children .............................................................. 76 Fixed proportions input-output isoquants when inputs are used in fixed proportions ...................................................... 77 Linear isoquants when inputs are perfect substitutes of each other ....................................................................................... 78 Linear programming isoquant .................................................... 79 Smooth convex isoquant .............................................................. 80 Isoquant map of a health centre immunisation of children........................................................................................... 81 Health system factor/input intensity ......................................... 84 Technical efficiency or efficiency of production ....................... 85 Production in the Edgeworth box to illustrate efficiency in production................................................................ 89 Health service production possibilities frontier....................... 92 Fixed, variable, and total cost of Kathera Health Centre.............................................................................................. 96 Average fixed cost for Kathera Health Centre ......................... 98 Average variable cost for Kathera Health Centre..................... 99 Average total cost of Kathera Health Centre........................... 100 Average and marginal costs of Kathera Health Centre ......... 102 Kathera Health Centre long-run average costs as an envelop of short-run average total cost curves ...................... 103 Kathera Health Centre long-run average cost function ......... 104 Kathera Health Centre total cost function ............................... 104

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Figure 4.21

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Figure 4.23

Figure 4.24

Figure 4.25 Figure 4.26 Figure 5.1

Figure 5.2 Figure 5.3 Figure 6.1 Figure 7.1 Figure 7.2 Figure 8.1

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Figure 11.2 Figure 12.1 Figure 14.1 Figure 14.2 Figure 15.1 Figure 17.1 Figure 17.2

Figure 19.1

Kathera Health Centre long-run marginal cost (LMC) function......................................................................................... 105 Technical efficiency or efficiency of production of a HIV/AIDS prevention community-based programme ........ 107 Output-oriented technical efficiency measure of a community-based condom distribution programme............ 109 Community health centre output-oriented technical and allocative efficiencies........................................................... 110 Efficiency frontier graph for 11 health centres in Kenya ....... 115 Output distance functions.......................................................... 128 Relationship between inputs and the production process and resulting outputs ................................................... 143 DEA Models................................................................................. 144 Production possibilities frontier graph .................................... 146 DEA models ................................................................................. 163 DEA ratio model.......................................................................... 175 Input-oriented DEA model ....................................................... 176 Relationship between inputs and the production process and resulting outputs ................................................... 192 Relationship between inputs and the production process and resulting outputs outputs..................................... 249 DEA models ................................................................................. 250 Health centre technical and allocative efficiencies ................. 273 Technical efficiency..................................................................... 316 Output-based Malmquist productivity index ......................... 320 Hospital technical efficiency ...................................................... 341 Concept and measurement of technical efficiency ................. 398 Frequency distribution of technical efficiency scores of national health systems in Africa (1999-2003) ......................... 404 Production process for a hospital ............................................. 454

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Table 3.1

Table 3.2

Table 3.3

Table 3.4

Table 3.5 Table 4.1

Table 4.2

Table 4.3

Table 4.4 Table 4.5 Table 4.6 Table 4.7

Table 4.8 Table 4.9

Table 4.10 Table 4.11 Table 4.12 Table 4.13 Table 4.14

Table 4.15

Table 4.16 Table 4.17

Table 4.18

List of Tables Distribution of global health workforce across the six WHO regions (2006) ......................................................................... 46 Estimated critical shortages of doctors, nurses, and midwives by WHO region (2006) .................................................. 46 Relative efficiency of health districts in Kibari State with one input and one output ................................................................ 56 Relative efficiency of health districts in Kibari State with one input and two outputs .............................................................. 57 Technical efficiency of Kibari health districts ............................... 63 Output of children immunised when various numbers of nurses are applied to a fixed health centre space of 300 sq. ft.............................................................................................. 72 Average and marginal product of labour (nurses) at Kathera Health Centre ..................................................................... 74 Alternative combinations of two inputs that yield the same level of total output for a representative health centre................ 75 Production function of a health promotion programme............. 87 Regression results ............................................................................. 88 Derivation of the production possibility curve............................. 93 Short-run costs for Kathera Health Centre in Kathera dollars (K$) ........................................................................................ 95 Derivation of average fixed cost for Kathera Health Centre....... 97 Derivation of average variable cost for Kathera Health Centre ................................................................................................. 98 Derivation of average total cost of Kathera Health Centre ....... 100 Derivation of marginal cost of Kathera Health Centre............. 101 Health centre performance ............................................................ 113 Input and output data for selected health centres in Kenya ..... 114 Estimation of technical and scale efficiency among health centres with multiple inputs and multiple outputs ................... 119 Data needs for estimating cost efficiency for selected health centres in Zambia................................................................ 122 DEAP efficiency summary output ............................................... 123 Health systems’ inputs and outputs for the Njuri-Ncheke Health Centre for 2000 and 2007.................................................. 125 Outputs and inputs in selected municipal hospitals in Angola .............................................................................................. 130

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