Scaling up Maternal and Child Healthcare Delivery among Mission Hospitals in Southeast Nigeria: An Empirical Application of Data Envelopment Analysis for Setting Benchmarks and Targets
), Obinna E. Onwujekwe(2), Hyacinth E. Ichoku(3), Augustine C. Osigwe(4),
(1) Health Economics and Policy Research Unit, Department of Health Services, Alex Ekwueme Federal University Ndufu-Alike Ikwo, Ebonyi State, Nigeria1; Department of Health Administration & Management, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus,
(2) Department of Health Administration & Management, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus
(3) Department of Economics, University of Nigeria, Nsukka
(4) Department of Economics and Development Studies, Alex Ekwueme Federal University, Ndufu-Alike, Ikwo,
Corresponding Author
Abstract
The health system in many parts of Nigeria has been dysfunctional in several domains including financing, human resources, infrastructure, health management information system and hospital services. In an attempt to scale up Maternal and Child Health (MCH) services and ensure efficiency, Ebonyi State Government in Southeast Nigeria provided funding to mission hospitals
across the State as a grant. This study used nonparametric method to assess the effect of this public financing on the efficiency of the mission hospitals. Operational cost and number of hospital beds were used as the input variables, while antenatal registrations, number of immunization doses and hospital deliveries were the output variables. The hospitals were disaggregated into 15 hospital-years. The mean overall technical efficiency of the mission hospitals was 84.05 22.45%. The mean pure technical efficiency was 95.56±6.9% and the scale efficiency was 88.05±22.20%. About 46.67% of all the hospital-years were
technically and scale efficient. Although, 55.33% were generally inefficient, only 33.33% of hospital-years exhibited pure technical inefficiency. Low immunization coverage was the major cause of inefficiency. The study showed increased maternal health service output as result of public funding or intervention; however, the mission hospitals could have saved 16% of input resources if they had performed efficiently. It also shows that data envelopment analysis can be used in setting targets/benchmarks for relatively inefficient health facilities, and in monitoring impact of interventions on efficiency of hospitals over-time. (Afr J Reprod Health 2019; 23[3]: 57-67).
References
National Population Commission (NPC) [Nigeria] and
ICF International. 2014 Nigeria Demographic and
Health Survey 2013, Abuja Nigeria, and Rockville,
Maryland, USA: NPC and ICF International.
Ichoku HE, Fonta WM, Onwujekwe OE and Kirigia JM.
Evaluating the Technical Effeciency of Hospitals in
South Eastern Nigeria. European Journal of
Business and Management. ISSN 2222-1905(paper)
ISSN-2839 (online).
UNFPA. Final Report on Ebonyi State Mother and Child
care Initiative UNFPA Ebonyi State, Nigeria
Documentation, October 2010.
Bryan L, Conway M, Keesmaat T, Mc Kenna S and
Richardson B. Strengthening Sub-Saharah African‘s
health systems: A practical approach. Insight and
publications, June 2010.
Russell S and Gilson L. User Fees Policies to promote
Health Services Access for the poor: A wolf in
sheep‘s clothing? International Journal of Health
Services; 1997 Vol. 27 (2), Pages 359-379
Ebonyi State Ministry of Health; Department of
Planning, Research and Statistics (DPRS), 2014.
Bang A and Chatter J. High level expert group report on
universal health coverage for India. New Delhi:
Planning Commission of India, 2011.
Jeffrey DS. Achieving universal health coverage in lowincome
settings. Lancet 2012; 380: 944-947.
Igwe A and Chukwu B. An appraisal of open system
business policy model in the management of
mission Hospitals in the South East Nigeria.
European Journal of Business and management Vol.
, No. 14, 2012.
Masiye F. Investigating health system performance: An
application of data envelopment analysis to Zambia
hospitals. BMC Health Services Research 2007,
:58.
Porcelli F. Measurement of Technical Efficiency. A brief
survey on parametric and non-parametric
techniques. 2009, Jan; Source:
www2.warwick.ac.uk.
Xing Z, Kaoru T and Yingzhe L. Impact of the Local
Public Hospital Reform on the Efficiency of
Medium sized Hospitals in Japan: An Improved
Slacks based Measure Data Envelopment Analysis
Approach. Health Services Research, Vol 53: No.
, April 2015.
Uka F. Ebonyi gives N 100 million to mission hospitals.
Daily Independent, newspaper, 2013, December
th.
Akpa N. Ebonyi disburses N 100 million for rural
healthcare. Nigeria Health News online, 2012,
February 10th.
Opwora A, Kabere M, Molyneux S and Goodman C.
Direct facility funding as a response to user fee
reduction: Implementation and perceived impact
among Kenyan health centres and dispensaries.
Health Policy and Planning, 2010, 25:406-418.
Frederique P, Michael Van H, Rony Z, Seco G, Mit P
and Guillaume J. Abolishing user fees for children
and present woman trebled uptake of malariarelated
intervention in Kangaba, Mali. Health Policy
and planning 2011; 26:ii 72-ii83.
Bruno M, Gilson L and Abdelmajid T. User fee removal
in low-income countries: sharing knowledge to
support managed implementation. Health Policy
and Planning 2011; ii 1-ii 14.
Kirigia JM, Emrouznejad A, Cassoma B, Asbu EZ and
Barry S. A Performance Assessment Methods for
Hospitals: The case of Municipal Hospitals in
Angola. Journal of Medical System, 2008, 32(6):
-519.
Joj RJ and Miguel SS. Technical efficiency of public
district hospitals in Madhya Pradesh, India: a data
envelopment analysis. Global Health Action; 2013,
:21742
Charnes A, Cooper WW and Rhodes. Measuring the
efficiency of decision making units. European
Journals of Operational Research 2(1978) 429 –
Kruk ME and Freedman LP. Assessing Health System
Performance in developing countries: A review of
the literature. Health Policy; 2008 March, Vol. 85
Issue 3, pages 263-276.
Jill J. Data envelopment analysis and its application to the
measurement of efficiency in higher education.
Economics of Education Review 25 (2006) page
– 280.
Rowena J, Peter CS and Andrew S. Measuring
Efficiency in health care: Analytic Techniques and
Health Policy. Cambridge University Press, 2006,
page 1
Tlotlego N, Nonvignon J, Sambo LG, Asbu EZ, Kirigia
JM. Assessment of productivity of hospitals in
Botswana: A DEA application.Intl Archives of
Medicine 2010, 3(1)27.
Kirigia JM, Emrouznejad A, Sambo LG, Munguti N and
Liambila W: Using Data Envelopment Analysis to
measure the technical efficiency of public health
centres in Kenya. Journal of Medical Systems; 2004
April, 26(2):155 -166.
Marshall P and Flessa S. Efficiency of primary care in
rural Burtina Faso. Atwo-stage DEA Analysis.
Health Economics Review, Springer Open Journal
, 1:5.
Zere E, Mbeeli T, Shangula K, Mand L, Mutrirua K,
Tjivambi B and Kapenambili S. Technical
efficiency of district hospitals: Evidence from
Mamibia using Data Envelopment Analysis. Cost
Effectiveness and Resource Allocation 2006,
March, 27, 4:5
http://www.resource.allocation.com/content/4/1/5
Alison R, Hernandez and Miguel SS. Assessing the
technical efficiency of health posts in rural
Guatemala: a data envelopment analysis. Global
Health Action. Published online, 2014 Jan 20.doi:
3402/gha.v7.23190.
Jehu-Appiah C, Sekidde S, Adjuik M, Akazili J, Almeida
AD, Nyonator F, Baltussen R, Asbu EZ and Kirigia
JM. Ownership and technical efficiency of
hospitals: Evidence from Ghana. Using data
envelopment analysis. Cost Effectiveness and
Resource Allocation 2014. http://www.resource.
allocation.com/content/12/1/9.
Kirigia JM and Asbu EZ. Technical and Scale Efficiency
of public community hospitals in Eritrea: an
exploratory study. Health Economics Review, a
Springer Journal, 2013, 3:6.
Chen Y, Cook WD and Zhu J. Deriving the DEA
Frontier for Two-Stage Processes, European Journal
of Operational Research; 2010, Vol. 202, 138-142.
Osei D, George M, d‘ Almeida S, kirigia JM, Mensah
AO and Kainyu LH. Technical efficiency of public
district hospitals and health centres in Ghana: a pilot
study. Cost Effectiveness and Resource Allocation
, 3:9.
Kirigia JM, Mensah AO, Mwikisa CN, Absu EZ,
Emrouznejad A, Makoudode P and Hounnankan A.
Technical efficiency of zone hospitals in Benin. The
African health Monitor 2010, 12:30-39.
Kirigia JM, Emrouznejad A and Sambo LG.
Measurement of technical efficiency of public
hospitals in Kenya: Using Data Envelopment
Analysis. Journal of Medical System 2002,
(1):39-45.
Zere E, Mbeeli T, Shangula K, Mandhate C, Mutirua K,
Tjivambi B and Kapenambili W. Technical
efficiency of district hospitals: Evidence from
Namibia using Data Envelopment Analysis. Cost
Effectiveness and Resource Allocation 2006, 4:5.
Yawe BL and Kavuma SN: Technical efficiency in the
presence of desirable and undesirable outputs: A
case study of selected district referral hospitals in
Uganda. Health Policy and Development, 2008,
(1):37-53.
WHO: Primary health care: now ever than ever Geneva;
Abiodun AJ: Quantitative Analysis of Efficiency of
Public Health care Facilities in Nigeria: A study of
Ogun and Lagos States. Covenant University Ph. D
thesis and dissertations, School of Business, Dept of
Business Management 2011, 03.
WHO 2013. WORLD Health Report 2013: Research for
Universal coverage. Geneva: World Health
Organization.
Novignon J and Nonvignon J. Improving primary health
care facility Performance in Ghana: efficiency
analysis and fiscal space implications. MC Health
Services Research (2017) 17:399 DOI
1186/s12913-017-2347-4.
Article Metrics
Abstract View
: 1098 times
Download : 326 times
Refbacks
- There are currently no refbacks.
