Assessment of productivity of hospitals in Botswana: a DEA application

Abstract

BackgroundBotswana national health policy states that the Ministry of Health shall from time to time review and revise its organization and management structures to respond to new developments and challenges in order to achieve and sustain a high level of efficiency in the provision of health care. Even though the government clearly views assuring efficiency in the health sector as one of its leadership and governance responsibilities, to date no study has been undertaken to measure the technical efficiency of hospitals which consume the majority of health sector resources. The specific objectives of this study were to quantify the technical and scale efficiency of hospitals in Botswana, and to evaluate changes in productivity over a three year period in order to analyze changes in efficiency and technology use.MethodsDEAP software was used to analyze technical efficiency along with the DEA-based Malmquist productivity index which was applied to a sample of 21 non-teaching hospitals in the Republic of Botswana over a period of three years (2006 to 2008).ResultsThe analysis revealed that 16 (76.2 percent), 16 (76.2 percent) and 13 (61.9 percent) of the 21 hospitals were run inefficiently in 2006, 2007 and 2008, with average variable returns to scale (VRS) technical efficiency scores of 70.4 percent, 74.2 percent and 76.3 percent respectively. On average, Malmquist Total Factor Productivity (MTFP) decreased by 1.5 percent. Whilst hospital efficiency increased by 3.1 percent, technical change (innovation) regressed by 4.5 percent. Efficiency change was thus attributed to an improvement in pure efficiency of 4.2 percent and a decline in scale efficiency of 1 percent. The MTFP change was the highest in 2008 (MTFP = 1.008) and the lowest in 2007 (MTFP = 0.963).ConclusionsThe results indicate significant inefficiencies within the sample for the years under study. In 2008, taken together, the inefficient hospitals would have needed to increase the number of outpatient visits by 117627 (18 percent) and inpatient days by 49415 (13 percent) in order to reach full efficiency. Alternatively, inefficiencies could have been reduced by transferring 264 clinical staff and 39 beds to health clinics, health posts and mobile posts. The transfer of excess clinical staff to those facilities which are closest to the communities may also contribute to accelerating progress towards the Millennium Development Goals related to child and maternal health.Nine (57.1 percent) of the 21 hospitals experienced MTFP deterioration during the three years. We found the sources of inefficiencies to be either adverse change in pure efficiency, scale efficiency and/or technical efficiency.In line with the report Health financing: A strategy for the African Region, which was adopted by the Fifty-sixth WHO Regional Committee for Africa, it might be helpful for Botswana to consider institutionalizing efficiency monitoring of health facilities within health management information systems.

How efficient are referral hospitals in Uganda? A data envelopment analysis and tobit regression approach

“…Also, the study included 17 out of the 18 (94 %) regional referral hospitals active during the study period. The sample size for a similar study in Eritrea [4] comprised 19 out of 20 hospitals (95 %) this number is not very much different from the sample size in our study.…”

“…Since 2000 studies have been undertaken in a number of countries, including Angola [2], Namibia [3], Botswana [4], Zambia [5] Kenya [6, 26], Benin [27], Burkina Faso [28], Ethiopia [29], Ghana [30–32], Nigeria [33], Seychelles [34], Sierra Leone [35, 36], South Africa [7, 37], Uganda [18] and Eritrea [38]. These studies demonstrate that DEA is an important tool for policy advice.…”

Assessing performance of Botswana’s public hospital system: the use of the World Health Organization Health System Performance Assessment Framework

“…This is due to the inability of this methodology to identify the underlying causes of inefficiencies. In Botswana, there are few studies assessing efficiency of public hospitals (10,11). Using DEA, Tlotlego et al (11) concluded that over 70% of the hospitals were run inefficiently between 2006 and 2008.…”

“…In Botswana, there are few studies assessing efficiency of public hospitals (10,11). Using DEA, Tlotlego et al (11) concluded that over 70% of the hospitals were run inefficiently between 2006 and 2008. An earlier study by Ramanathan et al (10) identified inefficient health districts and hospitals.…”

Determining the Technical Efficiency of Hospitals in Tabriz City Using Data Envelopment Analysis for 2013-2014

“…Technical efficiency is defined as the ratio of personnel output to input.It deals with a combination of data which produce certain output. Concerning this type of efficiency‚ the main question to be asked is if the highest degree of output is obtained considering each personnel output to input (Tlotlego et al‚ 2010). …”