School of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia.
BMC Health Serv Res. 2024 Aug 24;24(1):980. doi: 10.1186/s12913-024-11431-z.
Priority-setting becomes more difficult for decision-makers when the demand for health services and health care resources rises. Despite the fact that the Ethiopian healthcare system places a strong focus on the efficient utilization and allocation of health care resources, studies of efficiency in healthcare facilities have been very limited. Hence, the study aimed to evaluate efficiency and its determinants in public health centers.
A cross-sectional study was conducted in the East Wollega zone, Oromia Regional State, Ethiopia. Ethiopian fiscal year of 2021-2022 data was collected from August 01-30, 2022 and 34 health centers (decision-making units) were included in the analysis. Data envelope analysis was used to analyze the technical efficiency. A Tobit regression model was used to identify determinants of efficiency, declaring the statistical significance level at P < 0.05, using 95% confidence interval.
The overall efficiency score was estimated to be 0.47 (95% CI = 0.36-0.57). Out of 34 health centers, only 3 (8.82%) of them were technically efficient, with an efficiency score of 1 and 31 (91.2%) were scale-inefficient, with an average score of 0.54. A majority, 30 (88.2%) of inefficient health centers exhibited increasing return scales. The technical efficiency of urban health centers was (β = -0.35, 95% CI: -0.54, -0.07) and affected health centers' catchment areas by armed conflicts declined (β = -0.21, 95% CI: -0.39, -0.03) by 35% and 21%, respectively. Providing in-service training for healthcare providers increased the efficiency by 27%; 95% CI, β = 0.27(0.05-0.49).
Only one out of ten health centers was technically efficient, indicating that nine out of ten were scale-inefficient and utilized nearly half of the healthcare resources inefficiently, despite the fact that they could potentially reduce their inputs nearly by half while still maintaining the same level of outputs. The location of health centers and armed conflict incidents significantly declined the efficiency scores, whereas in-service training improved the efficiency. Therefore, the government and health sector should work on the efficient utilization of healthcare resources, resolving armed conflicts, organizing training opportunities, and taking into account the locations of the healthcare facilities during resource allocation.
当医疗服务需求和医疗保健资源增加时，决策者进行优先级设置变得更加困难。尽管埃塞俄比亚医疗保健系统非常注重医疗资源的有效利用和分配，但对医疗设施效率的研究却非常有限。因此，本研究旨在评估公共卫生中心的效率及其决定因素。
本研究采用横断面研究设计，在埃塞俄比亚奥罗米亚州东沃莱加地区进行。本研究于 2022 年 8 月 1 日至 30 日收集了埃塞俄比亚 2021-2022 财年的数据，共纳入 34 个卫生中心（决策单位）进行分析。采用数据包络分析（DEA）方法来分析技术效率。采用 Tobit 回归模型来确定效率的决定因素，使用 95%置信区间，宣布统计显著性水平为 P<0.05。
总体效率得分为 0.47（95%CI=0.36-0.57）。在 34 个卫生中心中，仅有 3 个（8.82%）技术上有效，效率得分为 1，31 个（91.2%）规模无效，平均得分为 0.54。大多数（88.2%）无效卫生中心表现出递增回报规模。城市卫生中心的技术效率为（β=-0.35，95%CI：-0.54，-0.07），受武装冲突影响的卫生中心服务范围减少（β=-0.21，95%CI：-0.39，-0.03）分别为 35%和 21%。为医疗保健提供者提供在职培训将效率提高了 27%；95%CI，β=0.27（0.05-0.49）。
只有十分之一的卫生中心在技术上是有效的，这表明十分之九的卫生中心规模无效，近一半的医疗保健资源利用效率低下，尽管他们有可能将投入减少近一半，同时保持相同的产出水平。卫生中心的位置和武装冲突事件显著降低了效率得分，而在职培训提高了效率。因此，政府和卫生部门应努力提高医疗资源的利用效率，解决武装冲突，组织培训机会，并在资源分配时考虑医疗设施的位置。
