社区卫生系统运行效率低下：以埃塞俄比亚西南部的卫生所为例。

Significant inefficiency in running community health systems: The case of health posts in Southwest Ethiopia.

机构信息

Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia.

Department of Pediatrics and Child Health, Institute of Health, Jimma University, Jimma, Ethiopia.

出版信息

PLoS One. 2021 Feb 19;16(2):e0246559. doi: 10.1371/journal.pone.0246559. eCollection 2021.

DOI:10.1371/journal.pone.0246559

PMID:33606733

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7895414/

Abstract

BACKGROUND

Although much has been documented about the performance of the health extension program, there is a lack of information on how efficiently the program is running. Furthermore, the rising cost of health services and the absence of competition among publicly owned health facilities demands strong follow up of efficiency. Therefore, this study aimed to assess the technical efficiency of the health posts and determinants in Southwestern Ethiopia.

METHODS AND MATERIALS

We used data for one Ethiopian fiscal year (from July 2016 to June 2017) to estimate the technical efficiency of health posts. A total of 66 health posts were included in the analysis. We employed a two-stage data envelopment analysis to estimate technical efficiency. At the first stage, technical efficiency scores were calculated using data envelopment analysis program version 2.1. Predictors of technical efficiency were then identified at the second stage using Tobit regression, with STATA version 14.

RESULTS

The findings revealed that 21.2% were technically efficient with a mean technical efficiency score of 0.6 (± 0.3), indicating that health posts could increase their service volume by 36% with no change made to the inputs they received. On the other hand, health posts had an average scale efficiency score of 0.8 (± 0.2) implying that the facilities have the potential to increase service volume by 16% with the existing resources. The regression model has indicated average waiting time for service has negatively affected technical efficiency.

CONCLUSION

More than three-quarters of health posts were found inefficient. The technical efficiency score of more than one-third of the health posts is even less than 50%. Community mobilization to enhance the uptake of health services at the health posts coupled with a possible reallocation of resources in less efficient health posts is a possible approach to improve the efficiency of the program.

摘要

背景

尽管已经有很多关于卫生拓展计划绩效的文献，但对于该计划的运行效率却缺乏信息。此外，医疗服务成本的上升和公有制医疗设施之间缺乏竞争，都要求对效率进行强有力的后续跟踪。因此，本研究旨在评估埃塞俄比亚西南部卫生所的技术效率及其决定因素。

方法与材料

我们使用了一个埃塞俄比亚财政年度（2016 年 7 月至 2017 年 6 月）的数据来估计卫生所的技术效率。共有 66 个卫生所纳入了分析。我们采用两阶段数据包络分析（DEA）来估计技术效率。在第一阶段，使用 DEA 程序版本 2.1 计算技术效率得分。然后，在第二阶段，使用 STATA 版本 14 中的 Tobit 回归确定技术效率的预测因素。

结果

研究结果表明，21.2%的卫生所具有技术效率，平均技术效率得分为 0.6（±0.3），这意味着卫生所可以在不改变所接受投入的情况下，将其服务量增加 36%。另一方面，卫生所的平均规模效率得分为 0.8（±0.2），这意味着这些设施有可能在现有资源的基础上，将服务量增加 16%。回归模型表明，服务的平均等待时间对技术效率产生了负面影响。