Abekah-Nkrumah Gordon, Ofori Charles Gyamfi, Antwi Maxwell, Attachey Alex Yao, de Wit Tobias F Rinke, Janssens Wendy, Duah James, Dieteren Charlotte, Sunkwa-Mills Gifty
Department of Health Services Management, University of Ghana Business School, Legon, P. O. Box 78, Accra, Ghana.
Department of Finance, University of Ghana Business School, Legon, P. O. Box 78, Accra, Ghana.
Cost Eff Resour Alloc. 2024 Sep 15;22(1):67. doi: 10.1186/s12962-024-00575-8.
Understanding the technical efficiency of health facilities is essential for an optimal allocation of scarce resources to primary health sectors. The COVID-19 pandemic may have further undermined levels of efficiency in low-resource settings. This study takes advantage of 2019 and 2020 data on characteristics of health facilities, health services inputs and output to examine the levels and changes in efficiency of Ghanaian health facilities. The current study by using a panel dataset contributes to existing evidence, which is mostly based on pre-COVID-19 and single-period data.
The analysis is based on a panel dataset including 151 Ghanaian health facilities. Data Envelopement Analysis (DEA) technique was used to estimate the level and changes in efficiency of health facilities across two years..
The results show a net increase of 26% in inputs, influenced mostly by increases in temporary non-clinical staff (131%) and attrition of temporary clinical staff and permanent non-clinical staff, 40% and 54% respectively. There was also a net reduction in output of 34%, driven by a reduction in in-patient days (37%), immunization (11%), outpatients visits and laboratory test of 9%. Nowithstanding the COVID-19 pandemic, the results indicate that 59 (39%) of sampled health facilities in 2020 were efficient, compared to 48 (32%) in 2019. The results also indicate that smaller-sized health facilities were less likely to be efficient compared to relatively bigger health facilities.
Based on the findings, it will be essential to examine factors that accounted for efficiency improvements in some health facilities, to enable health facilities lagging behind to learn from those on the efficiency frontier. In addition, the findings emphasise the need for CHAG to work with health facility managers to optimise inputs allocation through a redistribution of staff. Most importantly, the findings are suggestive of the resilience of CHAG health facilities in responding to a health shock such as the COVID-19 pandemic.
了解卫生设施的技术效率对于将稀缺资源优化分配到初级卫生部门至关重要。新冠疫情可能进一步削弱了资源匮乏地区的效率水平。本研究利用2019年和2020年卫生设施特征、卫生服务投入和产出的数据，来考察加纳卫生设施的效率水平及变化。本研究通过使用面板数据集，为大多基于新冠疫情前和单期数据的现有证据做出了贡献。
分析基于一个包含151家加纳卫生设施的面板数据集。采用数据包络分析（DEA）技术来估计两年间卫生设施的效率水平及变化。
结果显示投入净增加了26%，主要受临时非临床工作人员增加（131%）以及临时临床工作人员和永久非临床工作人员流失（分别为40%和54%）的影响。产出也净减少了34%，这是由住院天数减少（37%）、免疫接种减少（11%）、门诊就诊和实验室检测减少9%导致的。尽管有新冠疫情，结果表明2020年抽样的卫生设施中有59家（39%）是高效的，而2019年为48家（32%）。结果还表明，规模较小的卫生设施相比规模相对较大的卫生设施，高效的可能性更低。
基于这些发现，有必要研究一些卫生设施效率提高的因素，以使落后的卫生设施能够向处于效率前沿的设施学习。此外，研究结果强调加纳医疗协会（CHAG）需要与卫生设施管理者合作，通过人员重新分配来优化投入配置。最重要的是，研究结果表明加纳医疗协会的卫生设施在应对新冠疫情等卫生冲击方面具有恢复力。
