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Efficiency of Health System Units in Africa

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548 Pages
English

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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.

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Published 29 December 2013
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EAN13 9789966792426
Language English
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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: +254-20-2314316, +254-726-610570 E-mail:nup@uonbi.ac.kehttp://www.uonbi.ac.ke/pressThe 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.MedicaleconomicsͲͲAfrica2.MedicalcareAfricaEvaluationI.Kirigia,JosesMuthuri.II.TitleISBN 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 ................................................................................................................ viiList of Tables ................................................................................................................... ixList of Appendices.......................................................................................................... ix
Preface............................................................................................................................. xvAcknowledgements ...................................................................................................xviiiList of Contributors ...................................................................................................... xxi
Abbreviations and Acronyms...................................................................................xxiv
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Part IHealth 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 IIApplication 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 IIICase 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 IVAdvancing 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 3.2Figure 3.3Figure 3.4
Figure 3.5
Figure 4.1
Figure 4.2Figure 4.3
Figure 4.4
Figure 4.5
Figure 4.6Figure 4.7Figure 4.8
Figure 4.9Figure 4.10Figure 4.11
Figure 4.12Figure 4.13
Figure 4.14Figure 4.15Figure 4.16Figure 4.17Figure 4.18
Figure 4.19Figure 4.20
List of Figures The WHO health system framework.......................................... 44 Health promoting schools programme ...................................... 50Production process for a health institution ............................... 51Technical, allocative, and cost efficiencies of a household health education visits programme......................... 54Relative efficiency of health districts in Kibari State with one input and two outputs ................................................. 58Relationship between number of children immunised and number of nurses at Kathera Health Centre ..................... 73Average and marginal product curves for labour .................... 74Alternative combinations of two inputs needed to immunise 2,000 children .............................................................. 76Fixed proportions input-output isoquants when inputs are used in fixed proportions ...................................................... 77Linear isoquants when inputs are perfect substitutes of each other ....................................................................................... 78Linear programming isoquant .................................................... 79Smooth convex isoquant .............................................................. 80Isoquant map of a health centre immunisation of children........................................................................................... 81Health system factor/input intensity ......................................... 84Technical efficiency or efficiency of production ....................... 85Production in the Edgeworth box to illustrate efficiency in production................................................................ 89Health service production possibilities frontier....................... 92Fixed, variable, and total cost of Kathera Health Centre.............................................................................................. 96Average fixed cost for Kathera Health Centre ......................... 98Average variable cost for Kathera Health Centre..................... 99Average total cost of Kathera Health Centre........................... 100Average and marginal costs of Kathera Health Centre ......... 102Kathera Health Centre long-run average costs as an envelop of short-run average total cost curves ...................... 103Kathera Health Centre long-run average cost function ......... 104Kathera Health Centre total cost function ............................... 104
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Figure 4.21
Figure 4.22
Figure 4.23
Figure 4.24
Figure 4.25Figure 4.26Figure 5.1
Figure 5.2Figure 5.3Figure 6.1Figure 7.1Figure 7.2Figure 8.1
Figure 11.1
Figure 11.2Figure 12.1Figure 14.1Figure 14.2Figure 15.1Figure 17.1Figure 17.2
Figure 19.1
Kathera Health Centre long-run marginal cost (LMC) function......................................................................................... 105Technical efficiency or efficiency of production of a HIV/AIDS prevention community-based programme ........ 107Output-oriented technical efficiency measure of a community-based condom distribution programme............ 109Community health centre output-oriented technical and allocative efficiencies........................................................... 110Efficiency frontier graph for 11 health centres in Kenya ....... 115Output distance functions.......................................................... 128Relationship between inputs and the production process and resulting outputs ................................................... 143DEA Models................................................................................. 144Production possibilities frontier graph .................................... 146DEA models ................................................................................. 163DEA ratio model.......................................................................... 175Input-oriented DEA model ....................................................... 176Relationship between inputs and the production process and resulting outputs ................................................... 192Relationship between inputs and the production process and resulting outputs outputs..................................... 249DEA models ................................................................................. 250Health centre technical and allocative efficiencies ................. 273Technical efficiency..................................................................... 316Output-based Malmquist productivity index ......................... 320Hospital technical efficiency ...................................................... 341Concept and measurement of technical efficiency ................. 398Frequency distribution of technical efficiency scores of national health systems in Africa (1999-2003) ......................... 404Production process for a hospital ............................................. 454
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Table 3.1
Table 3.2
Table 3.3
Table 3.4
Table 3.5Table 4.1
Table 4.2
Table 4.3
Table 4.4Table 4.5Table 4.6Table 4.7
Table 4.8Table 4.9
Table 4.10Table 4.11Table 4.12Table 4.13Table 4.14
Table 4.15
Table 4.16Table 4.17
Table 4.18
List of Tables Distribution of global health workforce across the six WHO regions (2006) ......................................................................... 46Estimated critical shortages of doctors, nurses, and midwives by WHO region (2006) .................................................. 46Relative efficiency of health districts in Kibari State with one input and one output ................................................................ 56Relative efficiency of health districts in Kibari State with one input and two outputs .............................................................. 57Technical efficiency of Kibari health districts ............................... 63Output of children immunised when various numbers of nurses are applied to a fixed health centre space of 300 sq. ft.............................................................................................. 72Average and marginal product of labour (nurses) at Kathera Health Centre ..................................................................... 74Alternative combinations of two inputs that yield the same level of total output for a representative health centre................ 75Production function of a health promotion programme............. 87Regression results ............................................................................. 88Derivation of the production possibility curve............................. 93Short-run costs for Kathera Health Centre in Kathera dollars (K$) ........................................................................................ 95Derivation of average fixed cost for Kathera Health Centre....... 97Derivation of average variable cost for Kathera Health Centre ................................................................................................. 98Derivation of average total cost of Kathera Health Centre ....... 100Derivation of marginal cost of Kathera Health Centre............. 101Health centre performance ............................................................ 113Input and output data for selected health centres in Kenya ..... 114Estimation of technical and scale efficiency among health centres with multiple inputs and multiple outputs ................... 119Data needs for estimating cost efficiency for selected health centres in Zambia................................................................ 122DEAP efficiency summary output ............................................... 123Health systems’ inputs and outputs for the Njuri-Ncheke Health Centre for 2000 and 2007.................................................. 125Outputs and inputs in selected municipal hospitals in Angola .............................................................................................. 130
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