Technical Efficiency of Maternal Health Services Provision in Public Hospitals of Northwest Ethiopia: A Two-Stage Data Envelopment Analysis

Abstract

Introduction

Ethiopian health expenditure as a share of total government expenditure increased from 7.6% in 2013/14 to 8.1% in 2016/17. But it remained low even for the low-income country average expected share of 8.7%. It signifies the efficient use of scarce resources in the health sector is still critical to achieving sustainable development goals. But little evidence is available about public hospitals’ technical efficiency in providing maternal health services. Therefore, the aim of this study was to assess the technical efficiency of maternal health services provision of public hospitals in Northwest Ethiopia.

Methods

Facility-based cross-sectional study was conducted among twelve randomly selected public hospitals. Input data (salary expenditure, non-salary expenditure, and the number of beds) and maternal health services output data (antenatal care, skilled delivery, and postnatal care) for a 2011 Ethiopian fiscal year (July 2018 to June 2019) were collected and entered into Epi-Data 3.1. We used both primary and secondary data collection procedures to determine independent variables and the dependent variable, respectively. We also used a two-stage input-oriented data envelopment analysis with variable returns to scale assumption.

Results

The study showed that hospitals included in this study wasted US$ 6833.50 for salary and US$ 3886.8 for non-salary expenditures. The study also revealed that the mean pure technical efficiency of public hospitals for maternal health service provision was 0.92±0.142, and their scale efficiency was 0.795±0.24. The hospital manager’s experience year, the educational level of the manager, and the hospital service year associated positively with the technical efficiency. However, the catchment population and distance of another health facility associated negatively with technical efficiency.

Conclusion

The public hospitals’ pure technical efficiency in the provision of maternal health services in Northwest Ethiopia was high. More than half of the public hospitals were technically efficient. The wasted amount of expenditures could be used for satisfying the unmet health services need of the population. Therefore, it is better to monitor the health facilities for the wise use of the existing resources for their best performance.

Keywords:

• technical efficiency
• maternal health service
• public hospitals
• data envelopment analysis
• tobit model
• Northwest Ethiopia

Acknowledgments

We very much appreciated the staff of the Department of Health Systems and Policy for their invaluable support throughout the accomplishment of the thesis work. We would also thank the study facilities for their cooperation during the data collection, and finally, our gratitude goes to the data collectors.

Abbreviations

ANC, Antenatal Care; CEO, Chief Executive Officer; CRS, Constant Returns to Scale; DEA, Data Envelopment Analysis; DMU, Decision-Making Unit; DRS, Decreasing Returns to Scale; IRS, Increasing Returns to Scale; PNC, Postnatal Care; SD, Standard Deviation; SSA, Sub Saharan Africa; TE, Technical Efficiency; VRS, Variable Returns to Scale; WHO, World Health Organization.

Data Sharing Statement

The input and output data used in this study is provided as Supplementary Material. But the whole data used will be acquired on the formal request to the correspondent author.

Ethics Approval and Consent to Participate

Ethical clearance was obtained from the ethical review committee of the Institute of Public Health, the University of Gondar, with reference number IPH/837/06/12. A supporting letter was received from the Amhara Public Health Institute, where districts in Northwest Ethiopia are accounted for. We described the objective of the study and obtained written informed consent from the head of each hospital.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no conflicts of interest for this work.

Additional information

Funding

There is no funding for this manuscript.