Efficiency analysis of primary healthcare facilities in Afghanistan

Technical efficiency and its determinants in health service delivery of public health centers in East Wollega Zone, Oromia Regional State, Ethiopia: Two-stage data envelope analysis

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Evaluating China's primary healthcare services' efficiency and spatial correlation: a three-stage DEA-Malmquist model

Introduction

Enhancing the efficiency of primary healthcare services is essential for a populous and developing nation like China. This study offers a systematic analysis of the efficiency and spatial distribution of primary healthcare services in China. It elucidates the fundamental landscape and regional variances in efficiency, thereby furnishing a scientific foundation for enhancing service efficiency and fostering coordinated regional development.

Methods

Employs a three-stage DEA-Malmquist model to assess the efficiency of primary healthcare services across 31 provincial units in mainland China from 2012 to 2020. Additionally, it examines the spatial correlation of efficiency distribution using the Moran Index.

Results

The efficiency of primary healthcare services in China is generally suboptimal with a noticeable declining trend, highlighting significant potential for improvement in both pure technical efficiency and scale efficiency. There is a pronounced efficiency gap among provinces, yet a positive spatial correlation is evident. Regionally, efficiency ranks in the order of East > Central > West. Factors such as GDP per capita and population density positively influence efficiency enhancements, while urbanization levels and government health expenditures appear to have a detrimental impact.

Discussion

The application of the three-stage DEA-Malmquist model and the Moran Index not only expands the methodological framework for researching primary healthcare service efficiency but also provides scientifically valuable insights for enhancing the efficiency of primary healthcare services in China and other developing nations.

Infectious diseases in Afghanistan: Strategies for health system improvement

Background and Aim

Afghanistan is grappling with a severe health crisis marked by a high prevalence of infectious diseases, particularly tuberculosis, malaria, HIV, and the added strain of the COVID-19 pandemic. The nation's healthcare system, already fragile, faces formidable challenges. Socioeconomic constraints, including limited resources and financial barriers, hinder healthcare accessibility, leading to delayed or inadequate care. Environmental factors, such as poor sanitation and crowded living conditions, exacerbate the transmission of diseases, especially waterborne illnesses. Governance issues, encompassing transparency, corruption, and political instability, disrupt healthcare efficiency and resource allocation. Addressing these multifaceted issues is vital to enhance Afghanistan's healthcare system and overall well-being. The withdrawal of international support has exacerbated these challenges. The primary research goal is to deeply understand Afghanistan's health system, focusing on the major disease burdens: Tuberculosis, Malaria, AIDS, COVID-19, Measles, Hepatitis, and Cholera. The study aims to assess the feasibility and effectiveness of current approaches, presenting a comprehensive view of challenges and opportunities within the Afghan healthcare system. The research concludes by highlighting policy implications, practical implementation, and offering recommendations for future endeavors.

Methodology

This paper provides a thorough analysis of the literature concerning infectious diseases in Afghanistan and the enhancement of the healthcare system in the nation. A systematic exploration of the literature was conducted through PubMed and Google Scholar databases. The search terms used encompassed "Tuberculosis" OR "TB," "Malaria," "acquired immunodeficiency syndrome" OR "AIDS," "Human immunodeficiency virus" OR "HIV," "COVID-19," "Measles," "Hepatitis virus," "Cholera," "Health system improvement," and "Afghanistan." Additionally, external sources like UNICEF, CDC, and WHO were referenced.

Results

In conclusion, while improving access to vital medicines and vaccines is crucial for enhancing health outcomes in Afghanistan, significant challenges must be addressed to ensure the effectiveness and sustainability of such strategies. The Afghan health system's fragile governance, corruption, logistical complexities, and failure to address broader social and economic factors pose significant risks and obstacles to the implementation of proposed health strategies. Therefore, the strategies discussed in this analysis align with key Sustainable Development Goals, particularly SDG 3, and their successful implementation will have implications not only for the health and well-being of Afghanistan but also for global health.

Conclusion

Hence, by adopting a comprehensive approach with complementary interventions as discussed, we can address issues in the Afghan health system and reduce transmissible diseases' burden, thereby building a better world for all.