Efficiency Estimates of Public Health Center II Facilities in Southwestern Uganda
Keywords:
Technical Efficiency, Scale Efficiency, Economic Savings, Health Center II, DEA
Abstract
The study estimates the efficiency of public health centre II (HCII) facilities in Southwestern Uganda. Specifically, it determines the level of technical efficiency (TE), scale efficiency (SE) and estimates the economic savings required to make inefficient public health facilities efficient. An output-oriented Data Envelopment Analysis (DEA) is employed in the estimation of TE and SE. It was found out that 73 % of the HCIIs were technically inefficient while 27% were technically efficient. Mean TE stood at 72.3% implying that an average HCII could potentially improve its efficiency by increasing its outputs by 27.7%. In addition, 77% of the facilities were SE implying that they obtained the most productive scale size given the input-output combination. 23% of the facilities were scaled inefficient implying that they have more input waste attributable to their size. There is great potential for economic savings shown by different magnitudes of input reductions and output augmentations required to make inefficient facilities efficient. The study has important policy implications. The health sector should embark on rigorous periodic research and development to enhance healthcare delivery efficiently. Since the health units are small, there is a need to augment their scale sizes and improve on their management practices so as to enhance their overall productivity and efficiency. Stakeholders should scale up efforts to attract, align skills with needs and improve retention and motivation of the health workforce. Holistic investment in resource inputs is essential. A comprehensive monitoring and evaluation plan with key verifiable indicators to monitor the overall health sector performance is required.
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References
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Ahmad, M. F., Ishtiaq, M., Hamid, K., Khurram, M. U. & Nawaz, A. (2017). Data Envelopment Analysis and Tobit Analysis for Firm Efficiency in Perspective of Working Capital Management in Manufacturing Sector of Pakistan. International Journal of Economics and Financial Issues, 7(2), 706-713. Akazili, J., Adjuik, M., Jehu-Appiah, C. & Zere, E. (2008). Using Data Envelopment Analysis to Measure the Extent of Technical Efficiency of Public Health Centres in Ghana. BMC International Health and Human Rights, 8(1), 11. Ali, M., Debela, M. & Bamud, T. (2017). Technical Efficiency of Selected Hospitals in Eastern Ethiopia. Health Economics Review, 7(1), 24. Aristovnik, A. (2015). Regional Performance Measurement of Healthcare Systems in the European Union: A Non-Parametric Approach. Lex Localis, 13(3), 579. Bahadori, M., Izadi, A. R., Ghardashi, F., Ravangard, R. & Hosseini, S. M. (2016). The Evaluation of Hospital Performance in Iran: A Systematic Review Article. Iranian Journal of Public Health, 45(7), 855. Banker, R. D., Charnes, A. & Cooper, W. W. (1984). Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis. Management Science, 30(9), 1078-1092. Banker, R. D., Charnes, A., Cooper, W. W., Swarts, J. & Thomas, D. (1989). An Introduction to Data Envelopment Analysis with Some of its Models and their Uses. Research in Governmental and Nonprofit Accounting, 5, 125-163. Basaasa, M. M., Ondoa, C. J. & Basheka, B. C. (2013). Institutional Dynamics and Health Service Delivery in Regional Referral Hospitals in Uganda: What Lessons from a Case of Jinja Regional Hospital? African Journal of Governance and Development, 2(1), 40-56. Borisov, D., Cicea, C. & Turlea, C. (2012). Dea Model for Assessing Efficiency in Providing Health Care and Management Decisions. Management Research and Practice, 4(1), 5. Bundi, E. (2018). Technical Efficiency in Public Health Dispensaries: Evidence from Imenti-South Sub-County, Kenya. International Journal of Education and Research, 6(1). Charnes, A., Cooper, W. W. & Rhodes, E. (1978). Measuring the Efficiency of Decision Making Units. European Journal of Operational Research, 2(6), 429-444. Chu, K., Zhang, N. & Chen, Z. (2015). The Efficiency and Its Determinants for China’s Medical Care System: Some Policy Implications for Northeast Asia. Sustainability, 7(10), 14092-14111. Coelli, Rao, D. & Battese, G. (1998). An Introduction to Efficiency and Productivity Analysis, Kluwer, Boston. Coelli, Rao, D. S. P., O'Donnell, C. J. & Battese, G. E. (2005). An Introduction to Efficiency and Productivity Analysis: Springer Science & Business Media. De Almeida, A. T., Ferreira, F. J. & Quintino, A. (2012). Technical and Economical Considerations on Super High-Efficiency Three-Phase Motors.Paper presented at the Industrial & Commercial Power Systems Technical Conference (I&CPS), 2012 IEEE/IAS 48th. Ding, J., Hu, X., Zhang, X., Shang, L., Yu, M. & Chen, H. (2018). Equity and Efficiency of Medical Service Systems at the Provincial Level of China’s Mainland: A Comparative Study from 2009 to 2014. BMC Public Health, 18(1), 214. Farrell, M. J. (1957). The Measurement of Productive Efficiency. Journal of the Royal Statistical Society. Series A (General), 120(3), 253-290. Farzianpour, F., Emami, A. H., Foroushani, A. R. & Ghiasi, A. (2016). Determining the Technical Efficiency of Hospitals in Tabriz City Using Data Envelopment Analysis for 2013-2014. Global Journal of Health Science, 9(5), 42. Gannon, B. (2005). Testing for Variation in Technical Efficiency of Hospitals in Ireland. The Economic and Social Review, 36(3), 273-294. Gebresilassie, Y. H. & Nyatanga, P. (2017). Efficiency of the Ethiopian Health Extension Program; an Application of Data Envelopment Analysis. Eurasian Journal of Business and Economics, 10(19), 99126. Grigoli, F. (2012). Public Expenditure in the Slovak Republic: Composition and Technical Efficiency. IMF Working Paper , 12/173. Grigoli, F. & Kapsoli, J. (2018). Waste Not, Want Not: The Efficiency of Health Expenditure in Emerging and Developing Economies. Review of Development Economics, 22(1), 384-403. Hernandez, A. R. & Sebastian, M. S. (2014). Assessing the Technical Efficiency of Health Posts in Rural Guatemala: A Data Envelopment Analysis. Global Health Action, 7(1), 23190. Jacobs, R., Smith, P. C. & Street, A. (2006). Measuring Efficiency in Health Care: Analytic Techniques and Health Policy: Cambridge University Press.
Jarjue, G., Nor, N. M., Ghani, J. A. & Jalil, S. H. (2015). Technical Efficiency of Secondary Health Care Service Delivery in the Gambia. International Journal of Economics & Management, 9(1). Jehu-Appiah, C., Sekidde, S., Adjuik, M., Akazili, J., Almeida, S. D., Nyonator, F. & Kirigia, J. M. (2014). Ownership and Technical Efficiency of Hospitals: Evidence from Ghana Using Data Envelopment Analysis. Cost Effectiveness and Resource Allocation, 12(1), 9. Kasule, A. & Agwu, E. (2015). Health Budget Shortfalls and Inefficient Communication Systems as Setback to Efficient Management and Control of Infectious Diseases in Bushenyi District, Uganda. Special Pathogens Review Journal,(SPRJ), 1(1), 0012-0017. Kirigia, J. M., Emrouznejad, A., Gama Vaz, R., Bastiene, H. & Padayachy, J. (2007). A Comparative Assessment of Performance and Productivity of Health Centres in Seychelles. International Journal of Productivity and Performance Management, 57(1), 72-92. Kirigia, J. M., Emrouznejad, A., Sambo, L. G., Munguti, N. & Liambila, W. (2004). Using Data Envelopment Analysis to Measure the Technical Efficiency of Public Health Centers in Kenya. Journal of Medical Systems, 28(2), 155-166. Kirigia, J. M., Sambo, L. G., Renner, A., Alemu, W., Seasa, S. & Bah, Y. (2011). Technical Efficiency of Primary Health Units in Kailahun and Kenema Districts of Sierra Leone. International Archives of Medicine, 4(1), 15. Kumbhakar, S. & Lovell, C. (2000). Stochastic Frontier Analysis. Cambridge University Press, Cambridge, United Kingdom. Mahajan, V., Nauriyal, D. & Singh, S. (2018). Efficiency and Its Determinants: Panel Data Evidence from the Indian Pharmaceutical Industry. Margin: The Journal of Applied Economic Research, 12(1), 19-40. Makheti. (2017). Technical Efficiency in Public Health Facilities in Meru County. Dea Analysis. Health Economics and Outcome Research: Open Access. Marschall, P. & Flessa, S. (2009). Assessing the Efficiency of Rural Health Centres in Burkina Faso: An Application of Data Envelopment Analysis. Journal of Public Health, 17(2), 87. McKillop, D. G., Glass, J. C., Kerr, C. A. & McCallion, G. (1999). Efficiency in Northern Ireland Hospitals: A NonParametric Analysis. The Economic and Social Review, 30(2), 175-196. Mogha, S. K., Yadav, S. P. & Singh, S. (2016). Estimating Technical Efficiency of Public Sector Hospitals of Uttarakhand (India). International Journal of Operational Research, 25(3), 371-399. MoH. (2010). Annual Health Sector Perfornance Report 2009-10. Kampala, Uganda. MoH. (2015). Annual Health Sector Performance Report 2014-15. Kampala, Uganda. Molem Christopher, S., Beri Parfait, B. & Ntangsi Max, M. (2017). Determinants of the Inefficiency of Public Hospitals in Cameroon. International Journal of Academic Research in Business and Social Sciences, 7(6), 404-419. Molem, C. S., Parfait, B. B. & Ntangsi, M. M. (2017). Determinants of the Inefficiency of Public Hospitals in Cameroon. International Journal of Academic Research in Business and Social Sciences, 7(6), 404-419. Mujasi, P. N., Asbu, E. Z. & Puig-Junoy, J. (2016). How Efficient Are Referral Hospitals in Uganda? A Data Envelopment Analysis and Tobit Regression Approach. BMC Health Services Research, 16(1), 230. Mulumba, Z. M., Nalubanga, L., Nankanja, C., Manasseh, K., Mansson, J. & Hollén, J. (2017). Technical Efficiency Decomposed–The Case of Ugandan Referral Hospitals. The Central European Review of Economics and Management, 1(4), 117-146. Mwihia, F. K., M’Imunya, J. M., Mwabu, G., Kioko, U. M. & Estambale, B. B. (2018). Technical Efficiency in Public Hospitals in Kenya: A Two–Stage Data Envelopment Analysis. International Journal of Economics and Finance, 10(6), 141. Nanyingi, M., Kazungu, J., Katongole, S. P., Wampande, L. N. & Anguyo, R. D. (2015). The State of Mortuary and Mortuary Services in Public Health Facilities of South Western Uganda.International Journal of Public Health Research, 3(6), 360-369. Nistor, C. S., Ștefănescu, C. A. & CriÈ™an, A. R. (2017). Performance through Efficiency in the Public Healthcare System–a Dea Approach in an Emergent Country. Studia Universitatis Babes-Bolyai Oeconomica, 62(1), 31-49. Nunamaker, T. R. (1985). Using Data Envelopment Analysis to Measure the Efficiency of Nonâ€Profit Organizations: A Critical Evaluation. Managerial and Decision Economics, 6(1), 50-58. Oglobin, C. (2011). Health Care Efficiency across Countries: A Stochastic Frontier Analysis. Applied Econometrics and International Development, 11(1), 5-14.
Okwero, P., Tandon, A., Sparkes, S., McLaughlin, J. & Hoogeveen, J. G. (2010). Fiscal Space for Health in Uganda. World Bank Publications, 186. Ozcan, Y. A. (2014). Evaluation of Performance in Health Care. Health Care Benchmarking and Performance Evaluation.Springer, 3-14. Pope, C., Ziebland, S. & Mays, N. (2000). Qualitative Research in Health Care: Analysing Qualitative Data. BMJ: British Medical Journal, 320(7227), 114. Renner, A., Kirigia, J. M., Zere, E. A., Barry, S. P., Kirigia, D. G., Kamara, C. & Muthuri, L. H. (2005). Technical Efficiency of Peripheral Health Units in Pujehun District of Sierra Leone: A Dea Application. BMC Health Services Research, 5(1), 77. Samsudin, S. (2016). Are Public Hospitals in Malaysia Efficient? An Application of Dea and Tobit Analysis. Southeast Asian Journal of Economics, 4(2), 1-20. San Sebastian, M. & Lemma, H. (2010). Efficiency of the Health Extension Programme in Tigray, Ethiopia: A Data Envelopment Analysis. BMC International Health and Human Rights, 10(1), 16. Stierman, E., Ssengooba, F. & Bennett, S. (2013). Aid Alignment: A Longer Term Lens on Trends in Development Assistance for Health in Uganda. Globalization and Health, 9(1), 7. Torabipour, A., Najarzadeh, M., Mohammad, A., Farzianpour, F. & Ghasemzadeh, R. (2014). Hospitals Productivity Measurement Using Data Envelopment Analysis Technique. Iranian Journal of Public Health, 43(11), 1576. UBOS. (2014). The National Population and Housing Census 2014. Kampala, Uganda. VanderWielen, L. M. & Ozcan, Y. A. (2015). An Assessment of the Health Care Safety Net: Performance Evaluation of Free Clinics. Nonprofit and Voluntary Sector Quarterly, 44(3), 474-486. WHO. (2010). World Healh Report, Health Systems Financing: The Path to Universal Coverage World Health Organization. Xenos, P., Nektarios, M., Constantopoulos, A. & Yfantopoulos, J. (2016). Two-Stage Hospital Efficiency Analysis Including Qualitative Evidence: A Greek Case. Journal of Hospital Administration, 5(3), 1. Zamo-Akono, C., Ndjokou, M. M. & Song-Ntamack, S. (2013). Institutions and Hospital Efficiency in Cameroon: A Data Envelope Analysis. Journal of African Development, 15(1), 45-71. Zere, E., Mbeeli, T., Shangula, K., Mandlhate, C., Mutirua, K., Tjivambi, B. & Kapenambili, W. (2006). Technical Efficiency of District Hospitals: Evidence from Namibia Using Data Envelopment Analysis. Cost Effectiveness and Resource Allocation, 4(1), 5.
Published
2018-09-14
How to Cite
Tindimwebwa, K., Kidane, A., & Joel, S. (2018). Efficiency Estimates of Public Health Center II Facilities in Southwestern Uganda. Journal of Economics and Behavioral Studies, 10(4(J), 135-151. https://doi.org/10.22610/jebs.v10i4(J).2414
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Research Paper
Copyright (c) 2018 Kenneth Tindimwebwa, Asmerom Kidane, Silas Joel
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