Department of Global Community Health & Behavioral Sciences, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA.
RSSH and RMNCAH Team, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.
Health Syst Reform. 2020;6(1):1-14. doi: 10.1080/23288604.2019.1617026. Epub 2019 Sep 30.
The World Health Report 2010 encourages countries to reduce wastage and increase efficiency to achieve Universal Health Coverage (UHC). This research examines the efficiency of divisions (sub-provincial geographic units) in Pakistan in moving towards UHC using Data Envelop Analysis. We have used data from the Pakistan National Accounts 2011-12 and the Pakistan Social Living and Measurement Survey 2012-13 to measure per capita pooled public health spending in the divisions as inputs, and a set of UHC indicators (health service coverage and financial protection) as outputs. Sensitivity analysis for factors outside the health sector influencing health outcomes was conducted to refine the main model specification. Spider radar graphs were generated to illustrate differences between divisions with similar public spending but different performances for UHC. Pearson product-moment correlation was used to explore the strength and direction of the associations between proxy health systems organization variables and efficiency scores.The results showed a large variation in performance of divisions for selected UHC outputs. The results of the sensitivity analysis were also similar. Overall, divisions in Sindh province were better performing and divisions in Balochistan province were the least performing. Access to health care, the responsiveness of health systems, and patients' satisfaction were found to be correlated with efficiency scores.This research suggests that progress towards UHC is possible even at relatively low levels of public spending. Given the devolution of health system responsibilities to the provinces, this analysis will be a timely reference for provinces to gauge the performance of their divisions and plan the ongoing reforms to achieve UHC.
《2010 年世界卫生报告》鼓励各国减少浪费，提高效率，实现全民健康覆盖。本研究采用数据包络分析方法，考察了巴基斯坦各行政区（次省级地理单位）在实现全民健康覆盖方面的效率。我们使用了 2011-12 年巴基斯坦国家账户和 2012-13 年巴基斯坦社会生活和衡量调查的数据，将各行政区的人均公共卫生支出汇总作为投入，并用一系列全民健康覆盖指标（卫生服务覆盖和财务保护）作为产出。我们还进行了敏感性分析，以研究卫生部门以外影响卫生结果的因素，从而对主要模型规格进行细化。我们生成了蜘蛛雷达图，以说明公共支出相似但全民健康覆盖表现不同的行政区之间的差异。我们还使用皮尔逊积矩相关系数来探讨代理卫生系统组织变量与效率得分之间的关联强度和方向。结果表明，各行政区在选定的全民健康覆盖产出方面的表现存在较大差异。敏感性分析的结果也类似。总体而言，信德省的行政区表现较好，俾路支省的行政区表现最差。我们发现，获得医疗保健、卫生系统的反应能力和患者满意度与效率得分相关。本研究表明，即使在公共支出相对较低的情况下，实现全民健康覆盖也是可能的。鉴于卫生系统责任已下放到各省，因此，该分析将为各省衡量其行政区的绩效并计划进行持续改革以实现全民健康覆盖提供及时的参考。
