Does integration of HIV and sexual and reproductive health services improve technical efficiency in Kenya and Swaziland? An application of a two-stage semi parametric approach incorporating quality measures

Obure, Carol Dayo; Jacobs, Rowena; Guinness, Lorna; Mayhew, Susannah; Initiative, Integra; Vassall, Anna

doi:10.1016/j.socscimed.2016.01.013

Cited by 29 publications

(44 citation statements)

References 34 publications

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“…DEA models include input-and output-oriented models. An input-oriented model reflects the degree to which a DMU can reduce its input without changing its outputs, while an output-oriented model indicates the degree to which a DMU can expand its output without changing its inputs [24]. In this study, the outputs are associated with the quantity of maternal and child health services.…”

Section: Dea Modelmentioning

confidence: 99%

Equity and efficiency of maternal and child health resources allocation in Hunan Province, China

Minyuan

Luo

Wang

et al. 2020

BMC Health Serv Res

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Background: A reasonable allocation of health resources is often characterized by equity and high efficiency. This study aims to evaluate the equity and efficiency of maternal and child health (MCH) resources allocation in Hunan Province, China. Methods: Data related to MCH resources and services was obtained from the Hunan maternal and child health information reporting and management system. The Gini coefficient and data envelopment analysis (DEA) were employed to evaluate the equity and efficiency of MCH resources allocation, respectively. Results:The MCH resources allocation in terms of demographic dimension were in a preferred equity status with the Gini values all less than 0.3, and the Gini values for each MCH resources' allocation in terms of the geographical dimension ranged from 0.1298 to 0.4256, with the highest values in the number of midwives and medical equipment (≥ CNY 10,000), which exceeds 0.4, indicating an alert of inequity. More than 40% regions in Hunan were found to be relatively inefficient with decreased return to scale in the allocation of MCH resources, indicating those inefficient regions were using more inputs than needed to obtain the current output levels. Conclusions:The equity of MCH resources by population size is superior by geographic area and the disproportionate distribution of the number of medical equipment (≥ CNY 10,000) and midwives between different regions was the main source of inequity. Policy-makers need to consider the geographical accessibility of health resources among different regions to ensure people in different regions could get access to available health services. More than 40% of regions in Hunan were found to be inefficient, with using more health resources than needed to produce the current amount of health services. Further investigations on factors affecting the efficiency of MCH resources allocation is still needed to guide regional health plans-making and resource allocation.

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Section: Dea Modelmentioning

confidence: 99%

Equity and efficiency of maternal and child health resources allocation in Hunan Province, China

Minyuan

Luo

Wang

et al. 2020

BMC Health Serv Res

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“…Moreover, facility type was also found to be an useful predictor of hospital e ciency whereby facilities operating at a large scale may realize greater technical e ciency due to increasing returns to scale. [30] Third, a higher mortality rate (low quality health services) was found to raise the costs of the hospitals [34] and thereby to erode hospital e ciency. Fourth, shorter average lengths of stay was expected to improve the use of medical beds and enhance e ciency.…”

Section: Study Variablesmentioning

confidence: 99%

“…[25][26][27][28][29] However, weak and, on occasions, negative impacts of IC on hospital e ciency were also found. [30][31] As such, there is an opportunity to add to the literature by directly assessing the impact of IC on hospital e ciency.…”

mentioning

confidence: 99%

Can Integrated Care Improve the Efficiency of Hospitals? - Research based on 200 Hospitals in China

Peng

Zhu

Wan

et al. 2020

Preprint

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Abstract Backgrounds: The shift towards integrated care (IC) represents a global trend towards more comprehensive and coordinated systems of care, particularly for vulnerable populations, such as the elderly. When health systems face fiscal constraints, integrated care has been advanced as a potential solution by simultaneously improving health service effectiveness and efficiency. This paper addresses the latter. There are three study objectives: first, to compare efficiency differences between IC and non-IC hospitals in China; second, to examine variations in efficiency among different types of IC hospitals; and finally, to explore whether the implementation of IC impacts hospital efficiency. Methods This study uses Data Envelopment Analysis (DEA) to calculate efficiency scores among a sample of 200 hospitals in H Province, China. Tobit regression analysis was performed to explore the influence of IC implementation on hospital efficiency scores after adjustment for potential confounding. Moreover, the association between various input and output variables and the implementation of IC was investigated using regression techniques. Results The study has four principal findings: first, IC hospitals, on average, are shown to be more efficient than non-IC hospitals after adjustment for covariates. Holding output constant, IC hospitals are shown to reduce their current input mix by 12% and 4% to achieve optimal efficiency under constant and variable returns-to-scale, respectively, while non-IC hospitals have to reduce their input mix by 26% and 20% to achieve the same level of efficiency; second, with respect to the efficiency of each type of IC, we show that higher efficiency scores are achieved by administrative and virtual IC models over a contractual IC model; third, we demonstrate that IC influences hospitals efficiency by impacting various input and output variables, such as length of stay, inpatient admissions, and staffing; fourth, while bed density per nurse was positively associated with hospital efficiency, the opposite was shown for bed density per physician. Conclusions Integrated Care has the potential to promote hospital efficiency by influencing an array of input and output variables. Policies designed to facilitate the implementation of IC in hospitals need to be cognizant of the complex way IC impacts hospital efficiency.

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“…The Integra Initiative, which assessed the impact of different models of delivering integrated HIV-SRH service delivery in 40 health facilities in Kenya and Swaziland on service and health outcomes, found mixed effects in terms of technical efficiency of service delivery [40, 41]. Number of HIV and STI services in maternal and child health units, public ownership, and facility type resulted in positive effects on technical efficiency of service delivery, but number of HIV services in the same clinical room, relative number of clinical staff to overall staff, proportion of HIV services provided in facility, and rural location had negative effects on technical efficiency of integrated HIV-SRH services [41].…”

Section: Introductionmentioning

confidence: 99%

“…Number of HIV and STI services in maternal and child health units, public ownership, and facility type resulted in positive effects on technical efficiency of service delivery, but number of HIV services in the same clinical room, relative number of clinical staff to overall staff, proportion of HIV services provided in facility, and rural location had negative effects on technical efficiency of integrated HIV-SRH services [41]. Another analysis of these data that quantified the extent and type of integration between HIV and SRH services in Kenya and Swaziland suggested that both structural integration (infrastructure and multi-tasking providers in same facility) and functional integration (delivery of care to clients in one place at one time) are needed for effective integration of these services to clients [34].…”

Section: Introductionmentioning

confidence: 99%

Emtonjeni—A Structural Intervention to Integrate Sexual and Reproductive Health into Public Sector HIV Care in Cape Town, South Africa: Results of a Phase II Study

et al. 2016

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Integration of sexual and reproductive health within HIV care services is a promising strategy for increasing access to family planning and STI services and reducing unwanted pregnancies, perinatal HIV transmission and maternal and infant mortality among people living with HIV and their partners. We conducted a Phase II randomized futility trial of a multi-level intervention to increase adherence to safer sex guidelines among those wishing to avoid pregnancy and adherence to safer conception guidelines among those seeking conception in newly-diagnosed HIV-positive persons in four public-sector HIV clinics in Cape Town. Clinics were pair-matched and the two clinics within each pair were randomized to either a three-session provider-delivered enhanced intervention (EI) (onsite contraceptive services and brief milieu intervention for staff) or standard-of-care (SOC) provider-delivered intervention. The futility analysis showed that we cannot rule out the possibility that the EI intervention has a 10 % point or greater success rate in improving adherence to safer sex/safer conception guidelines than does SOC (p = 0.573), indicating that the intervention holds merit, and a larger-scale confirmatory study showing whether the EI is superior to SOC has merit.

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Does integration of HIV and sexual and reproductive health services improve technical efficiency in Kenya and Swaziland? An application of a two-stage semi parametric approach incorporating quality measures

Cited by 29 publications

References 34 publications

Equity and efficiency of maternal and child health resources allocation in Hunan Province, China

Equity and efficiency of maternal and child health resources allocation in Hunan Province, China

Can Integrated Care Improve the Efficiency of Hospitals? - Research based on 200 Hospitals in China

Emtonjeni—A Structural Intervention to Integrate Sexual and Reproductive Health into Public Sector HIV Care in Cape Town, South Africa: Results of a Phase II Study

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