The efficiency of routine infant immunization services in six countries: a comparison of methods

Abstract

Background: Few studies have systematically examined the efficiency of routine infant immunization services. Using a representative sample of infant immunization sites in Benin, Ghana, Honduras, Moldova, Uganda and Zambia (316 total), we estimated average efficiency levels and variation in efficiency within each country, and investigated the properties of published efficiency estimation techniques. Methods: Using a dataset describing 316 immunization sites we estimated site-level efficiency using Data Envelopment Analysis (DEA), Stochastic Frontier Analysis (SFA), and a published ensemble method combining these two approaches. For these three methods we operationalized efficiency using the Sheppard input efficiency measure, which is bounded in (0, 1), with higher values indicating greater efficiency. We also compared these methods to a simple regression approach, which used residuals from a conventional production function as a simplified efficiency index. Inputs were site-level service delivery costs (excluding vaccines) and outputs were total clients receiving DTP3. We analyzed each country separately, and conducted sensitivity analysis for different input/ output combinations. Results: Using DEA, average input efficiency ranged from 0.40 in Ghana and Moldova to 0.58 in Benin. Using SFA, average input efficiency ranged from 0.43 in Ghana to 0.69 in Moldova. Within each country scores varied widely, with standard deviation of 0.18-0.23 for DEA and 0.10-0.20 for SFA. Input efficiency estimates generated using SFA were systematically higher than for DEA, and the rank correlation between scores ranged between 0.56-0.79. Average input efficiency from the ensemble estimator ranged between 0.41-0.61 across countries, and was highly correlated with the simplified efficiency index (rank correlation 0.81-0.92) as well as the DEA and SFA estimates. Conclusions: Results imply costs could be 30-60% lower for fully efficient sites. Such efficiency gains are unlikely to be achievable in practicesome of the apparent inefficiency may reflect measurement errors, or unmodifiable differences in the operating environment. However, adapted to work with routine reporting data and simplified methods, efficiency analysis could triage low performing sites for greater management attention, or identify more efficient sites as models for other facilities.

Data envelopment analysis on the efficiency of vaccination services and its influencing factors in Beijing, China

“…Our result indicated that the mean efficiency of immunization in Beijing is 0.6000 (DEA) and 0.4314 (SBM DEA). Compared with the previous research, the efficiency is higher than that of developing countries [ 11 ] in Africa, Latin America, and Europe, but relatively lower than that of developed countries such as Australia [ 10 ]. The reason for our lower results may be that the previous studies only calculated the number of vaccinations for children, whereas our studies included the number of vaccinations for adults and children.…”

“…( 1 ), this paper developed input indicators from the three dimensions: capital (K), labor (L), and technology (T). In addition, in terms of output indicators (Y), referring to other scholars' studies [ 11 ], we used the amounts of vaccination. …”

“…Among the limited studies, Hollingsworth et al [ 10 ] calculated the efficiency of child immunization programs in Australia using the DEA method and found that urban areas were more efficient than rural areas [ 10 ]. Besides, Menzies et al, [ 11 ] calculated the efficiency of childhood vaccination in six countries using the DEA method and the SFA method separately and found that within each country, efficiency varied widely and that the result of SFA was systematically higher than DEA [ 11 ]. Moreover, Lobo et al [ 12 ] used the DEA method to evaluate the efficiency of the Brazilian National Immunization Program (NIP) [ 12 ].…”

Dependent, Poorer, and More Care-Demanding? An Analysis of the Relationship between Being Dependent, Household Income, and Formal and Informal Care Use in Spain

“…Still, public bodies were limited to provide LTC services only in cases where household income was not enough to cover such needs and if the older adult in need of care had a high grade of functional limitations [ 29 ]. However, a recent study showed that only 10% of the informal care time provided by family caregivers was eventually covered by the government [ 51 ]. Our findings confirm that the moderate and severe functionally-limited older adults have a higher use of formal and informal care services, regardless of the household income group and the time period.…”

Health care seeking behaviour among rural women in Telangana: A cross sectional study

“…study conducted on tribal women of Telangana state found an association between preference choices of health service with the distance from home to health facilities and in another study conducted by Nakovics MI, et al ., in rural Malawi, it was observed that increasing distance to the health facility significantly decreased the likelihood of utilizing formal care. [ 15 16 ] These observations indicate the need to improve the accessibility to essential health services in rural areas. Though majority (69%) of the study participants in the current study were aware of nearby functioning health centers, it is not an encouraging finding this, it is essential to take necessary measures in order to identify the felt needs of the rural women and sensitization them regarding the available health centers.…”