Technical Efficiency of Public District Hospitals and Health Centres in Ghana: a Pilot Study

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Cost Effectiveness and Resource Allocation
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BioMed Central

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Technical efficiency of public district hospitals and health centres in Ghana: a pilot study Daniel Osei1, Selassi d'Almeida2, Melvill O George2, Joses M Kirigia*3, Ayayi Omar Mensah3 and Lenity H Kainyu4 Address: 1Planning and Budget Unit, PPME, Ghana Health Service, Accra, Ghana, 2WHO Country Office, Accra, Ghana, 3World Health Organization, Regional Office for Africa, Brazzaville, Congo and 4Department of Health Sciences, School of Public Health, Kenyatta University, Nairobi, Kenya Email: Daniel Osei - oseid@hotmail.com; Selassi d'Almeida - dalmeidas@whoghana.org; Melvill O George - GeorgeM@whoghana.org; Joses M Kirigia* - kirigiaj@afro.who.int; Ayayi Omar Mensah - mensaho@afro.who.int; Lenity H Kainyu - kainyulh@yahoo.com * Corresponding author

Published: 27 September 2005 Cost Effectiveness and Resource Allocation 2005, 3:9 doi:10.1186/1478-7547-3-9

Received: 16 May 2005 Accepted: 27 September 2005

This article is available from: http://www.resource-allocation.com/content/3/1/9 © 2005 Osei et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract
Background: The Government of Ghana has been implementing various health sector reforms (e.g. user fees in public health facilities, decentralization, sector-wide approaches to donor coordination) in a bid to improve efficiency in health care. However, to date, except for the pilot study reported in this paper, no attempt has been made to make an estimate of the efficiency of hospitals and/or health centres in Ghana. The objectives of this study, based on data collected in 2000, were: (i) to estimate the relative technical efficiency (TE) and scale efficiency (SE) of a sample of public hospitals and health centres in Ghana; and (ii) to demonstrate policy implications for health sector policy-makers. Methods: The Data Envelopment Analysis (DEA) approach was used to estimate the efficiency of 17 district hospitals and 17 health centres. This was an exploratory study. Results: Eight (47%) hospitals were technically inefficient, with an average TE score of 61% and a standard deviation (STD) of 12%. Ten (59%) hospitals were scale inefficient, manifesting an average SE of 81% (STD = 25%). Out of the 17 health centres, 3 (18%) were technically inefficient, with a mean TE score of 49% (STD = 27%). Eight health centres (47%) were scale inefficient, with an average SE score of 84% (STD = 16%). Conclusion: This pilot study demonstrated to policy-makers the versatility of DEA in measuring inefficiencies among individual facilities and inputs. There is a need for the Planning and Budgeting Unit of the Ghana Health Services to continually monitor the productivity growth, allocative efficiency and technical efficiency of all its health facilities (hospitals and health centres) in the course of the implementation of health sector reforms.

Background
The strategic health objectives of Vision 2020 in Ghana envisage: a significant reduction in the rates of infant,

child and maternal mortality; effective control of the risk factors that expose individuals to major communicable diseases; increased access to health services, especially in

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Cost Effectiveness and Resource Allocation 2005, 3:9

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rural areas; establishment of a health system effectively reoriented toward delivery of public health services; and effective and efficient management of the health system [1]. The Ministry of Health, following the thrust of Vision 2020, developed its current policy and strategy guidelines in 1995 in the Medium-Term Health Strategy...
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