Department of Accounting and Finance, Ghana Institute of Management and Public Administration, Accra, Ghana.
Department of Management Science, Ghana Institute of Management and Public Administration, Accra, Ghana.
PLoS One. 2023 Nov 16;18(11):e0294653. doi: 10.1371/journal.pone.0294653. eCollection 2023.
Non-communicable diseases (NCDs) remain a major public health concern globally, threatening the achievement of sustainable development goal 3.4 (SDG 3.4), which seeks to reduce premature NCD-related deaths by one-third by 2030. According to the World Health Organization (WHO), improving the efficiency of NCD spending (i.e., maximizing the impact of every dollar spent on NCDs) is one of the strategic approaches for achieving SDG target 3.4. This study aims to assess the efficiency and productivity of NCDs spending in 34 sub-Saharan African (SSA) countries from 2015 to 2019.
The study employed the data envelopment analysis (DEA) double-bootstrap truncated and Tobit regressions, one-stage stochastic frontier analysis (SFA) model, the Malmquist productivity index (MPI), and spatial autocorrelation analysis to estimate NCDs spending efficiency, identify the context-specific environmental factors that influence NCDs spending efficiency, evaluate total productivity change and identify its components, and assess the spatial interdependence of the efficiency scores.
The estimated average DEA bias-corrected NCD spending efficiency score was 87.3% (95% CI: 86.2-88.5). Additionally, smoking per capita, solid fuel pollution, alcohol use, governance quality, urbanization, GDP per capita, external funding for NCDs, and private domestic funding for NCDs healthcare services were found to be significantly associated with NCDs spending efficiency. The study also revealed a decline of 3.2% in the MPI, driven by a 10.6% technical regress. Although all countries registered growth in efficiency, except for the Central Africa Republic and DR Congo, the growth in efficiency was overshadowed by the decline in technical change. Global Moran's I test indicated the existence of significant positive spatial autocorrelation in the efficiency of NCDs spending across SSA countries.
The study underscores the importance of efficient use of resources in NCDs treatment and prevention and increased investment in NCDs research and development in achieving the SDG target 3.4.
非传染性疾病（NCDs）仍然是全球主要的公共卫生关注点，威胁着可持续发展目标 3.4（SDG 3.4）的实现，该目标旨在到 2030 年将与 NCD 相关的过早死亡人数减少三分之一。根据世界卫生组织（WHO）的说法，提高 NCD 支出效率（即最大限度地提高每一元 NCD 支出的影响）是实现 SDG 目标 3.4 的战略方法之一。本研究旨在评估 2015 年至 2019 年期间撒哈拉以南非洲（SSA）34 个国家的 NCD 支出效率和生产力。
本研究采用数据包络分析（DEA）双 bootstrap 截断和 Tobit 回归、单阶段随机前沿分析（SFA）模型、Malmquist 生产力指数（MPI）和空间自相关分析来估计 NCD 支出效率，确定影响 NCD 支出效率的具体环境因素，评估总生产力变化并确定其组成部分，以及评估效率得分的空间相关性。
估计的平均 DEA 偏误校正 NCD 支出效率得分为 87.3%（95%置信区间：86.2-88.5）。此外，人均吸烟量、固体燃料污染、酒精使用、治理质量、城市化、人均 GDP、NCD 外部资金和 NCD 国内私人医疗保健服务资金与 NCD 支出效率显著相关。研究还表明，MPI 下降了 3.2%，原因是技术退步了 10.6%。尽管除中非共和国和刚果民主共和国外，所有国家的效率都有所提高，但技术进步的下降掩盖了效率的提高。全球 Moran's I 检验表明，SSA 国家 NCD 支出效率存在显著的正空间自相关。
本研究强调了在 NCD 治疗和预防方面有效利用资源的重要性，并呼吁增加对 NCD 研究和开发的投资，以实现 SDG 目标 3.4。
