Department of Competency Development and Evaluation for Policy Analyst, Center of Policy Analyst Reinforcement, The National Institute of Public Administration, Jakarta, Indonesia.
Department of Sociology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands.
Int J Health Policy Manag. 2022 Jul 1;11(7):1197-1207. doi: 10.34172/ijhpm.2021.19. Epub 2021 Apr 13.
The decentralization of the Indonesian healthcare system, launched in the year 2000, allowed the authorities of local community health centers (CHCs) to tailor their services to the needs of their clients. Many observers see this as an opportunity to increase CHC efficiency. Building on the Context Design Performance Framework, this paper assesses the extent to which efficiency variations between CHCs can be explained by the degree of fit between their organizational design characteristics and aspects of the communities in which they are embedded.
Data envelopment analysis (DEA) was applied to construct a measure of CHC efficiency for a sample of 598 CHCs in 2011, drawn from a publicly available Ministry of Health (MoH) dataset. Tobit regression analysis was applied to assess the impact of organization design and community characteristics and their interplay on efficiency.
Large variations in CHC efficiency were discovered, suggesting that not all CHCs are equally capable of finding the optimal design to operate most efficiently. A significant inverted U-shape relationship was found for the organization design-efficiency link: efficiency is highest for CHCs with 1-2 horizontal units and decreases for CHCs exceeding or not reaching this number. No significant association was found between community characteristics (proportion of poor people, remote location of CHC) and CHC efficiency.
Organizational design matters for CHC efficiency, but no evidence was found for the hypothesis that a better fit between community characteristics and CHC design increases efficiency. A potential reason for this might be that CHC management's main design challenge is how to cope with the scarce availability of well-trained health personnel.
印度尼西亚医疗保健系统于 2000 年开始去中心化，允许地方社区卫生中心（CHC）的当局根据客户的需求调整其服务。许多观察家认为，这是提高 CHC 效率的机会。本文以情境设计绩效框架为基础，评估了 CHC 之间效率差异在多大程度上可以通过其组织设计特征与嵌入其中的社区方面的匹配程度来解释。
数据包络分析（DEA）用于构建 2011 年从卫生部公开数据集抽取的 598 个 CHC 的 CHC 效率衡量标准。Tobit 回归分析用于评估组织设计和社区特征及其相互作用对效率的影响。
发现 CHC 效率存在很大差异，这表明并非所有 CHC 都具有同样的能力找到最佳设计以实现最高效率。组织设计与效率之间存在显著的倒 U 形关系：具有 1-2 个水平单位的 CHC 效率最高，而超过或未达到此数量的 CHC 效率则降低。社区特征（贫困人口比例、CHC 偏远位置）与 CHC 效率之间没有显著关联。
组织设计对 CHC 效率很重要，但没有证据支持社区特征与 CHC 设计之间更好的匹配会提高效率的假设。造成这种情况的一个潜在原因可能是 CHC 管理层面临的主要设计挑战是如何应对稀缺的、训练有素的卫生人员的供应。
