Amare Tsegaw, Yitayal Mezgebu, Amare Getasew
Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Risk Manag Healthc Policy. 2020 Dec 24;13:3135-3146. doi: 10.2147/RMHP.S285045. eCollection 2020.
Ethiopian health expenditure as a share of total government expenditure increased from 7.6% in 2013/14 to 8.1% in 2016/17. But it remained low even for the low-income country average expected share of 8.7%. It signifies the efficient use of scarce resources in the health sector is still critical to achieving sustainable development goals. But little evidence is available about public hospitals' technical efficiency in providing maternal health services. Therefore, the aim of this study was to assess the technical efficiency of maternal health services provision of public hospitals in Northwest Ethiopia.
Facility-based cross-sectional study was conducted among twelve randomly selected public hospitals. Input data (salary expenditure, non-salary expenditure, and the number of beds) and maternal health services output data (antenatal care, skilled delivery, and postnatal care) for a 2011 Ethiopian fiscal year (July 2018 to June 2019) were collected and entered into Epi-Data 3.1. We used both primary and secondary data collection procedures to determine independent variables and the dependent variable, respectively. We also used a two-stage input-oriented data envelopment analysis with variable returns to scale assumption.
The study showed that hospitals included in this study wasted US$ 6833.50 for salary and US$ 3886.8 for non-salary expenditures. The study also revealed that the mean pure technical efficiency of public hospitals for maternal health service provision was 0.92±0.142, and their scale efficiency was 0.795±0.24. The hospital manager's experience year, the educational level of the manager, and the hospital service year associated positively with the technical efficiency. However, the catchment population and distance of another health facility associated negatively with technical efficiency.
The public hospitals' pure technical efficiency in the provision of maternal health services in Northwest Ethiopia was high. More than half of the public hospitals were technically efficient. The wasted amount of expenditures could be used for satisfying the unmet health services need of the population. Therefore, it is better to monitor the health facilities for the wise use of the existing resources for their best performance.
埃塞俄比亚卫生支出占政府总支出的比例从2013/14年度的7.6%增至2016/17年度的8.1%。但即便与低收入国家平均预期占比8.7%相比，这一比例仍较低。这表明在卫生部门有效利用稀缺资源对于实现可持续发展目标依然至关重要。但关于公立医院在提供孕产妇保健服务方面的技术效率，现有证据很少。因此，本研究的目的是评估埃塞俄比亚西北部公立医院提供孕产妇保健服务的技术效率。
在12家随机选取的公立医院开展了基于机构的横断面研究。收集了2011埃塞俄比亚财政年度（2018年7月至2019年6月）的投入数据（工资支出、非工资支出和床位数）以及孕产妇保健服务产出数据（产前保健、熟练接生和产后保健），并录入Epi-Data 3.1。我们分别采用了初级和二级数据收集程序来确定自变量和因变量。我们还采用了具有规模报酬可变假设的两阶段投入导向型数据包络分析。
研究表明，本研究纳入的医院在工资方面浪费了6833.50美元，在非工资支出方面浪费了3886.8美元。研究还显示，公立医院提供孕产妇保健服务的平均纯技术效率为0.92±0.142，规模效率为0.795±0.24。医院管理者的工作年限、管理者的教育水平以及医院服务年限与技术效率呈正相关。然而，服务人口和另一家医疗机构的距离与技术效率呈负相关。
埃塞俄比亚西北部公立医院在提供孕产妇保健服务方面的纯技术效率较高。超过半数的公立医院在技术上是有效率的。浪费的支出金额可用于满足人群未得到满足的卫生服务需求。因此，最好对卫生机构进行监测，以便明智地利用现有资源，实现最佳绩效。
