Technical and scale efficiency in the delivery of child health services in Zambia: results from data envelopment analysis

Tom Achoki, Anke Hovels, Felix Masiye, Abaleng Lesego, Hubert Leufkens, Yohannes KINFU

    Research output: Contribution to journalArticle

    2 Citations (Scopus)
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    Abstract

    Objective: Despite tremendous efforts to scale up key maternal and child health interventions in Zambia, progress has not been uniform across the country. This raises fundamental health system performance questions that require further investigation. Our study investigates technical and scale efficiency (SE) in the delivery of maternal and child health services in the country. Setting: The study focused on all 72 health districts of Zambia. Methods: We compiled a district-level database comprising health outcomes (measured by the probability of survival to 5 years of age), health outputs (measured by coverage of key health interventions) and a set of health system inputs, namely, financial resources and human resources for health, for the year 2010. We used data envelopment analysis to assess the performance of subnational units across Zambia with respect to technical and SE, controlling for environmental factors that are beyond the control of health system decision makers. Results: Nationally, average technical efficiency with respect to improving child survival was 61.5% (95% CI 58.2% to 64.8%), which suggests that there is a huge inefficiency in resource use in the country and the potential to expand services without injecting additional resources into the system. Districts that were more urbanised and had a higher proportion of educated women were more technically efficient. Improved cooking methods and donor funding had no significant effect on efficiency. Conclusions: With the pressing need to accelerate progress in population health, decision makers must seek efficient ways to deliver services to achieve universal health coverage. Understanding the factors that drive performance and seeking ways to enhance efficiency offer a practical pathway through which low-income countries could improve population health without necessarily seeking additional resources.

    Original languageEnglish
    Article numbere012321
    Pages (from-to)1-12
    Number of pages12
    JournalBMJ Open
    Volume7
    Issue number1
    DOIs
    Publication statusPublished - 1 Jan 2017

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    Child Health Services
    Zambia
    Health
    Universal Coverage
    Survival
    Health Resources
    Cooking
    Population
    Tissue Donors
    Databases

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    Achoki, Tom ; Hovels, Anke ; Masiye, Felix ; Lesego, Abaleng ; Leufkens, Hubert ; KINFU, Yohannes. / Technical and scale efficiency in the delivery of child health services in Zambia: results from data envelopment analysis. In: BMJ Open. 2017 ; Vol. 7, No. 1. pp. 1-12.
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    abstract = "Objective: Despite tremendous efforts to scale up key maternal and child health interventions in Zambia, progress has not been uniform across the country. This raises fundamental health system performance questions that require further investigation. Our study investigates technical and scale efficiency (SE) in the delivery of maternal and child health services in the country. Setting: The study focused on all 72 health districts of Zambia. Methods: We compiled a district-level database comprising health outcomes (measured by the probability of survival to 5 years of age), health outputs (measured by coverage of key health interventions) and a set of health system inputs, namely, financial resources and human resources for health, for the year 2010. We used data envelopment analysis to assess the performance of subnational units across Zambia with respect to technical and SE, controlling for environmental factors that are beyond the control of health system decision makers. Results: Nationally, average technical efficiency with respect to improving child survival was 61.5{\%} (95{\%} CI 58.2{\%} to 64.8{\%}), which suggests that there is a huge inefficiency in resource use in the country and the potential to expand services without injecting additional resources into the system. Districts that were more urbanised and had a higher proportion of educated women were more technically efficient. Improved cooking methods and donor funding had no significant effect on efficiency. Conclusions: With the pressing need to accelerate progress in population health, decision makers must seek efficient ways to deliver services to achieve universal health coverage. Understanding the factors that drive performance and seeking ways to enhance efficiency offer a practical pathway through which low-income countries could improve population health without necessarily seeking additional resources.",
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    author = "Tom Achoki and Anke Hovels and Felix Masiye and Abaleng Lesego and Hubert Leufkens and Yohannes KINFU",
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    Technical and scale efficiency in the delivery of child health services in Zambia: results from data envelopment analysis. / Achoki, Tom; Hovels, Anke; Masiye, Felix; Lesego, Abaleng; Leufkens, Hubert; KINFU, Yohannes.

    In: BMJ Open, Vol. 7, No. 1, e012321, 01.01.2017, p. 1-12.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Technical and scale efficiency in the delivery of child health services in Zambia: results from data envelopment analysis

    AU - Achoki, Tom

    AU - Hovels, Anke

    AU - Masiye, Felix

    AU - Lesego, Abaleng

    AU - Leufkens, Hubert

    AU - KINFU, Yohannes

    N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

    PY - 2017/1/1

    Y1 - 2017/1/1

    N2 - Objective: Despite tremendous efforts to scale up key maternal and child health interventions in Zambia, progress has not been uniform across the country. This raises fundamental health system performance questions that require further investigation. Our study investigates technical and scale efficiency (SE) in the delivery of maternal and child health services in the country. Setting: The study focused on all 72 health districts of Zambia. Methods: We compiled a district-level database comprising health outcomes (measured by the probability of survival to 5 years of age), health outputs (measured by coverage of key health interventions) and a set of health system inputs, namely, financial resources and human resources for health, for the year 2010. We used data envelopment analysis to assess the performance of subnational units across Zambia with respect to technical and SE, controlling for environmental factors that are beyond the control of health system decision makers. Results: Nationally, average technical efficiency with respect to improving child survival was 61.5% (95% CI 58.2% to 64.8%), which suggests that there is a huge inefficiency in resource use in the country and the potential to expand services without injecting additional resources into the system. Districts that were more urbanised and had a higher proportion of educated women were more technically efficient. Improved cooking methods and donor funding had no significant effect on efficiency. Conclusions: With the pressing need to accelerate progress in population health, decision makers must seek efficient ways to deliver services to achieve universal health coverage. Understanding the factors that drive performance and seeking ways to enhance efficiency offer a practical pathway through which low-income countries could improve population health without necessarily seeking additional resources.

    AB - Objective: Despite tremendous efforts to scale up key maternal and child health interventions in Zambia, progress has not been uniform across the country. This raises fundamental health system performance questions that require further investigation. Our study investigates technical and scale efficiency (SE) in the delivery of maternal and child health services in the country. Setting: The study focused on all 72 health districts of Zambia. Methods: We compiled a district-level database comprising health outcomes (measured by the probability of survival to 5 years of age), health outputs (measured by coverage of key health interventions) and a set of health system inputs, namely, financial resources and human resources for health, for the year 2010. We used data envelopment analysis to assess the performance of subnational units across Zambia with respect to technical and SE, controlling for environmental factors that are beyond the control of health system decision makers. Results: Nationally, average technical efficiency with respect to improving child survival was 61.5% (95% CI 58.2% to 64.8%), which suggests that there is a huge inefficiency in resource use in the country and the potential to expand services without injecting additional resources into the system. Districts that were more urbanised and had a higher proportion of educated women were more technically efficient. Improved cooking methods and donor funding had no significant effect on efficiency. Conclusions: With the pressing need to accelerate progress in population health, decision makers must seek efficient ways to deliver services to achieve universal health coverage. Understanding the factors that drive performance and seeking ways to enhance efficiency offer a practical pathway through which low-income countries could improve population health without necessarily seeking additional resources.

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    KW - Adult

    KW - Child Health Services/organization & administration

    KW - Child Mortality

    KW - Child, Preschool

    KW - Delivery of Health Care/organization & administration

    KW - Educational Status

    KW - Efficiency, Organizational

    KW - Female

    KW - Health Resources/statistics & numerical data

    KW - Humans

    KW - Infant

    KW - Infant, Newborn

    KW - Male

    KW - Models, Statistical

    KW - Outcome and Process Assessment (Health Care)

    KW - Rural Population/statistics & numerical data

    KW - Survival Rate

    KW - Urban Population/statistics & numerical data

    KW - Young Adult

    KW - Zambia

    KW - Scale Efficiency

    KW - Data Envelopment Analysis

    KW - Health Systems Performance

    KW - Technical Efficiency

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    UR - http://www.mendeley.com/research/technical-scale-efficiency-delivery-child-health-services-zambia-results-data-envelopment-analysis

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