Challenges in the Era of Globalization - iaabd

Proceedings of the 12th Annual Conference © 2011 IAABD
choice of input or output orientation does not affect efficiency status of healthcare units. That is, if a unit
is inefficient, it will be identified as such by either an input or output oriented model. The CRS model
was used to obtain efficiency scores and then the VRS model was run and then the scale efficiency of
each facility was computed by dividing its CRS efficiency score by its VRS technical efficiency score.
Although many more statistics, such as target inputs, target outputs and benchmarks are provided by the
DEA model, we will present and focus here only on technical efficiency and scale efficiency.
Table 3. Efficiency scores
Small Size facilities Medium size facilities Large size facilities
Mean efficiency score 0.75 0.81 0.77
% of technically inefficient units 68% 70% 66%
% of scale inefficient units 69% 91% 65%
Table 3 above shows that a large number of units are inefficient. Overall, about 68% of the facilities are
technically inefficient and about 75% of them are scale inefficient. Also the overall mean efficiency score
is around 77%. These results are very similar to the findings obtained in the other 15 studies. Likewise,
resources are not rationally exploited. Moreover, optimal target inputs show that if the inefficient units
were to operate as efficiently as their peers on the efficient frontier, the same outputs could be produced
with about 25% less paramedical personnel, 33% less medical personnel, 32% less administrative
personnel, and 25% less beds on average. This clearly confirms the waste of valuable scarce resources.
Discussion and Conclusion
Although health expenditures as a percentage of GDP were higher in Africa than in South-East Asia and
the Eastern Mediterranean region and were comparable to the Western Pacific region, health indicators
were much lower in Africa than in any other region of the world. Also, different mortality rates were
higher in Africa. One of the main reasons of this state of affairs is the existence of large inefficiencies in
the healthcare delivery system. The first step to take to remedy this situation is to audit healthcare
facilities and find out the extent and the magnitude of these inefficiencies. Moreover, there is a need for
African healthcare policy makers and facility administrators to adopt modern mathematical techniques to
assess operational efficiency. The literature shows that the DEA is the most frequently used methodology
for that. A summary of the findings of fifteen efficiency studies conducted in South Africa, Kenya,
Ghana, Sierra Leone, Zambia, Angola, Bostwana, Namibia, Benin and Sudan; was presented. The first
five studies were carried out in South Africa and then Kenya between 2000 and 2004 and the ten other
studies were done between 2005 and 2010. All these studies reported very high levels of inefficiencies. In
fact results show that the percentage of technically inefficient healthcare facilities varies between 26%
and 87% and the percentage of scale inefficient units is between 13% and 88%. This clearly indicates that
resources to deliver health care in Africa are not rationally exploited. The authors of this article conducted
a similar study in Algeria, which used a sample of 175 healthcare facilities. The results were very similar.
Findings revealed that overall, about 68% of the facilities are technically inefficient and about 75% of
them are scale inefficient. Also the overall mean efficiency score is around 77%. With low GDP and low
per capita expenditure on health for many African countries, the efficiency savings and rationalization of
the deployment of exiting resources will improve governments’ initiatives to provide for more health care
needs of the population. The DEA results can help administrators focus on the operating aspects of the
healthcare facilities. What is important from a managerial perspective is how inefficient healthcare
facilities should orient strategies to become better performers and to optimize the use of available
resources. The DEA model identifies, for each inefficient unit, a references set of efficient facilities
(benchmarks) as well as target input and output levels. This provides guidance to the administrators of
these facilities on how to improve their operational efficiency. In addition, the findings can be used to
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