Technical efficiency of health-care systems in selected middle-income countries: an empirical investigation

Nassar, Heba; Sakr, Hala; Ezzat, Asmaa; Fikry, Pakinam

doi:10.1108/reps-03-2020-0038

Cited by 8 publications

(7 citation statements)

References 44 publications

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“…We synthesised the inputs and outputs under system-level studies and health facility/sub-national level studies. Out of the 12 system-level efficiency studies included, expenditure (n = 10) was the most used input variable [ 6 , 13 - 16 , 47 , 49 , 50 , 52 , 53 ], followed by total health workforce (n = 6) [ 6 , 13 , 47 , 48 , 51 , 52 ], and capacity (n = 3) [ 6 , 48 , 51 ]. Other input variables included unemployment rate [ 6 , 50 ], immunisation rate, Gini coefficient [ 50 , 53 ], educational index [ 49 , 50 ], age group of participants [ 14 , 50 ], food production index, inflation rate, purchasing power parity, urbanisation [ 49 ], external resources [ 14 ], and use of sanitation services [ 50 ].…”

Section: Resultsmentioning

confidence: 99%

The state and significant drivers of health systems efficiency in Africa: A systematic review and meta-analysis

Nabyonga-Orem,

Christmal,

Addai

et al. 2023

J Glob Health

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Background Low-and-middle-income countries, especially in Africa, lack the capacity to adequately invest in health systems to attain universal health coverage (UHC). As such, countries must improve efficiency and provide more services within the available resources. This systematic review synthesised evidence on the efficiency of health systems in the African region and its drivers. Methods We conducted a systematic literature review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Related studies were grouped and meta-analysed, while others were descriptively analysed. We employed a qualitative content synthesis for synthesising the drivers of efficiency. Results Overall, 39 studies met a predetermined inclusion criterion and were included from a possible 4 609 records retrieved through a rigorous search and selection process. Using a random effects restricted maximum likelihood method, the pooled efficiency score for the Africa region was estimated to be 0.77, implying that on the flip side, health system inefficiency across countries in the African region was approximately 23%. Across 22 studies that used data envelopment analysis to examine efficiency at the level of health facilities and sub-national entities, the efficiency level was 0.67. Facility-level studies tended to estimate low levels of efficiency compared to health system-level studies. Across the 39 studies, 21 significant drivers of inefficiency were reported, including population density of the catchment area, governance, health facility ownership, health facility staff density, national economic status, type of health facility, education index, hospital size and bed occupancy rate. Conclusion With approximately 23% of the inefficiency of health systems in Africa, improving efficiency alone will yield an average of 34% improvement in resource availability, assuming all countries are performing similarly to the frontier countries. However, with the low level of health expenditure per capita in Africa, the efficiency gains alone will be insufficient to meet the minimum funding requirement for UHC. Registration PROSPERO: CRD42022318122.

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Section: Resultsmentioning

confidence: 99%

The state and significant drivers of health systems efficiency in Africa: A systematic review and meta-analysis

Nabyonga-Orem,

Christmal,

Addai

et al. 2023

J Glob Health

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“…It has been documented that between 20% and 40% of health system resources are not used appropriately. 30 Regarding technical efficiency of the HECP to achieve initiated communities, informed communities, and certified communities, only 4 or 5 states (out of 32) get the maximum frontier of production. 27 These results show the low levels of technical efficiency of the program.…”

Section: Discussionmentioning

confidence: 99%

“…Efficiency is a relevant issue because public resources to finance programs are scarce. It has been documented that between 20% and 40% of health system resources are not used appropriately 30. Regarding technical efficiency of the HECP to achieve initiated communities, informed communities, and certified communities, only 4 or 5 states (out of 32) get the maximum frontier of production 27.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Health Promotion Program at the Community Level in Mexico: Is the Program Efficient and Effective?

Alcalde‐Rabanal

Flores-Loera

Chivardi

et al. 2023

Journal of Public Health Management and Practice

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Context: Health promotion programs have been encouraged in the Americas since 1990. In Mexico, health program promotion at the community level was implemented by the Ministry of Health in 2001 to encourage community health status improvement. Despite the longtime of its implementation, evaluations of its efficiency and effectiveness are scarce. Objective: To evaluate the efficiency of the Healthy Environments and Communities Program (HECP) through 2 means: (1) efficiency of the implementation and (2) technical efficiency, as well as to evaluate its effectiveness. Setting: Target communities of the HECP of 32 Mexican states during 2013-2017. The HECP developed community interventions to improve community organization, health behaviors, and family and communitarian sanitation. Methodology: We conducted a cross-sectional study to evaluate the efficiency of HECP implementation and estimated the inclusion of target communities (focalization index), the retention of communities (continuity index), and the desertion of communities in the program (desertion index). To evaluate the adequate use of the program resources (technical efficiency), we used data-enveloped analysis and the Tobit regression model to identify external factors that can influence results. Finally, to evaluate the program's effectiveness, we estimated the index of the communities that improved their health indicators and were certified as healthy (community certification). Results: The median rate of focalization was 3.44 (1.31-85.13); the continuity of communities' rate was 0.50 (0.16-2.67). Regarding technical efficiency to reach healthy communities, only 2 states reached the optimal efficiency (score 1); where the efficiency was adjusted for external factors, 6 states reached a score of 1. The median of global effectiveness was 0.19 (0.01-0.78). We found differences in efficiency and effectiveness scores among states. Conclusion: We found lower efficiency of the implementation and technical efficiency, as well as poor effectiveness of the program to reach healthy communities. To achieve HECP purpose, it is necessary to revise its guidelines, improve its strategies to work in communities, and establish the right mechanisms to monitor its implementation. It is essential to focus on the resources used to enhance technical efficiency and effectiveness at the community level.

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“…Some studies reported that decentralisation of health functions was associated with higher technical efficiency of national and subnational health systems [59]. An assessment of the technical efficiency of healthcare systems of selected middle-income countries found that technical efficiency was enhanced by decentralisation, which enhanced the delivery of care in rural areas, and improved the responsiveness of health systems to community needs through improved community participation in healthcare decision making [104]. Effective performance monitoring and accountability was found to improve health system efficiency in Canada [46].…”

Section: Health System Characteristicsmentioning

confidence: 99%

Analysing the Efficiency of Health Systems: A Systematic Review of the Literature

Mbau

Musiega

Nyawira

et al. 2022

Appl Health Econ Health Policy

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Background Efficiency refers the use of resources in ways that optimise desired outcomes. Health system efficiency is a priority concern for policy makers globally as countries aim to achieve universal health coverage, and face the additional challenge of an aging population. Efficiency analysis in the health sector has typically focused on the efficiency of healthcare facilities (hospitals, primary healthcare facilities), with few studies focusing on system level (national or sub-national) efficiency. We carried out a thematic review of literature that assessed the efficiency of health systems at the national and sub-national level. Methods We conducted a systematic search of PubMed and Google scholar between 2000 and 2021 and a manual search of relevant papers selected from their reference lists. A total of 131 papers were included. We analysed and synthesised evidence from the selected papers using a thematic approach (selecting, sorting, coding and charting collected data according to identified key issues and themes). Findings There were more publications from high-and upper middle-income countries (53%) than from low-income and lower middle-income countries. There were also more publications focusing on national level (60%) compared to sub-national health systems' efficiency. Only 6% of studies used either qualitative methods or mixed methods while 94% used quantitative approaches. Data envelopment analysis, a non-parametric method, was the most common methodological approach used, followed by stochastic frontier analysis, a parametric method. A range of regression methods were used to identify the determinants of health system efficiency. While studies used a range of inputs, these generally considered the building blocks of health systems, health risk factors, and social determinants of health. Outputs used in efficiency analysis could be classified as either intermediate health service outputs (e.g., number of health facility visits), single health outcomes (e.g., infant mortality rate) or composite indices of either intermediate outputs of health outcomes (e.g., Health Adjusted Life Expectancy). Factors that were found to affect health system efficiency include demographic and socio-economic characteristics of the population, macro-economic characteristics of the national and sub-national regions, population health and wellbeing, the governance and political characteristics of these regions, and health system characteristics. Conclusion This review highlights the limited evidence on health system efficiency, especially in low-and middle-income countries. It also reveals the dearth of efficiency studies that use mixed methods approaches by incorporating qualitative inquiry. The review offers insights on the drivers of the efficiency of national and sub-national health systems, and highlights potential targets for reforms to improve health system efficiency.

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Technical efficiency of health-care systems in selected middle-income countries: an empirical investigation

Cited by 8 publications

References 44 publications

The state and significant drivers of health systems efficiency in Africa: A systematic review and meta-analysis

The state and significant drivers of health systems efficiency in Africa: A systematic review and meta-analysis

Evaluation of Health Promotion Program at the Community Level in Mexico: Is the Program Efficient and Effective?

Analysing the Efficiency of Health Systems: A Systematic Review of the Literature

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