By: Kiddus Yitbarek (MPH) Technical Efficiency of Public Hospitals in the Provision of Maternal Health Services in Selected Zones of Oromia Regional State, Ethiopia By: Kiddus Yitbarek (MPH)

Outline Introduction Objectives Methods and Participants Result and Discussion Limitation Conclusion References

Introduction Technical efficiency implies the maximum possible output from a given set of inputs. (Worthington 2004) The health systems in SSA faced critical resource constraints in extending maternal health services of acceptable quality. (Lilongwe 2008) Wise use of the available health resources is a priority agenda to attain the goal of reducing maternal mortality in Ethiopia. (FMOH 2015)

Objectives General Objective: To assess the technical efficiency of public hospitals in the provision of maternal health services in six zones of Oromia regional state 2014/2015 (2007 EFY) Specific Objectives To determine the pure technical efficiency of public hospitals To determine the scale efficiency of public hospitals To verify if there is a need for increasing output or decreasing input to improve efficiency To identify determinants that affect technical efficiency of public hospitals

Methods and Participants Health facility based cross-sectional study was conducted from March 25 to April 18, 2016. Data were collected from 11 primary and 3 general hospitals. A structured and pretested checklist based interview and document review were used to collect data. Two stage DEA was performed with input orientation and variable returns to scale assumptions. Technical efficiency scores were computed at the first stage and predictors were determined using tobit regression.

Result and Discussion Figure 1: Efficiency of hospitals in maternal health service provision in six zones of the Oromia Regional State, Ethiopia (2016) 14.29% of the hospitals were pure technically inefficient and 35.71% hospitals were scale inefficient

Result cont… In Eritrea, 32% hospitals were pure technically inefficient and 58% scale inefficient (Kirigia & Asbu 2013). In Ghana 47% hospitals were pure technically inefficient and 59% hospitals were scale inefficient (Osei et al. 2005) A study in 37 health units of Sierra Leone found that 59% were pure technically inefficient, and 65% were scale inefficient (Renner et al. 2005)

Result cont… The difference in efficiency might be: In Addis Ababa and selected Oromia health centers 33% found to be pure technically inefficient and 60% scale inefficient (Balcha 2002). The difference in efficiency might be: The study was conducted for maternal health service that has more client flow Currently government and other concerned bodies have given concern for maternal health service utilization and the service is free of charge The hospitals included in the study are few in number

Result cont… Inputs Used by Efficient and Inefficient Hospitals Figure 2: Mean inputs used by efficient and inefficient hospitals, in six zones of Oromia regional state, Ethiopia (2016)

Result cont… Clients Served by Efficient and Inefficient Hospitals Figure 3: Mean outputs produced by efficient and inefficient hospitals, in six zones of Oromia regional state, Ethiopia (2016)

Result cont… Table 1: Factors affecting hospitals efficiency in maternal health service provision in six zones of the Oromia Regional State, Ethiopia (2016) Variables Coefficient P-value [95% CI] Level of the hospital (Secondary hospital) 1.15 0.03* 0.16 2.15 Service years of the hospital 0.02 0.003 0.03 Catchment population of the hospital 5.68E-07 0.04* 4.60E-08 1.09E-06 Availability of nearby health facility 0.14 0.46 -0.28 0.56 Availability of allowance for the employees 0.15 0.33 -0.19 0.49 Benefits packages for the employees of the organization 0.30 -0.13 0.73 Average waiting time for maternal health service -0.03 0.01* -0.05 -0.008 constant -1.72 0.09 -3.79 0.35 *significant at p< 0.05

Result cont… This is similar with a study conducted in Addis Ababa found teaching status and years in operation were found significantly associated with efficiency (Seid 2006) Catchment population and average waiting time for maternal health service found different for this study. Limitations The study did not give due consideration to social, cultural and behavioral inputs, which can strongly influence the outputs of health systems Given the general inputs, to get a specific figure for maternal health service, led to estimate proportionally

Conclusion Most of the hospitals were technically efficient. Around two third of the hospitals were operating as scale efficient in maternal health service. The inefficiency was a result of excess technical and administrative staff, beds, non-salary expenses and class rooms. Allocation of more resources to older secondary hospitals with larger catchment population could improve efficient use of resources for maternal health service delivery.

References Balcha, T., 2002. Technical Efficiency of Publec Health Centers: the Case of Addis Ababa and Selected Health Centers of Oromia. , (Addis Ababa). Federal Democratic Republic of Ethiopia Ministry of Health, 2015. Health Sector Transformation Plan, Addis Ababa, Ethiopia. Kirigia, J.M. & Asbu, E.Z., 2013. Technical and scale efficiency of public community hospitals in Eritrea: an exploratory study. Health Economics Review, 3(6). Lilongwe, 2008. Technical efficiency of district hospitals in Malawi An exploratory assessment using data envelopment analysis Osei, D. et al., 2005. Cost Effectiveness and Resource Technical efficiency of public district hospitals and health centres in Ghana : a pilot study. Cost Effectiveness and Resource Allocation, 3(9). Renner, A. et al., 2005. Technical efficiency of peripheral health units in Pujehun district of Sierra Leone: a DEA application. Health Services Research, 5(77). Seid, A.K., 2006. Technical efficiency of selected hopitals in addis ababa: data envelopment analysis approach 1st ed., Addis Ababa, Ethiopia. Worthington, A.C., 2004. Frontier Efficiency Measurement in Healthcare : A Review of Empirical Techniques and Selected Applications. Medical Care Research and Review, 61(2), pp.135–170.

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