Assessment of productivity of hospitals in Botswana: A DEA application

Naomi Tlotlego, Justice Nonvignon, Luis G. Sambo, Eyob Z. Asbu, Joses M. Kirigia

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

Abstract

Background: The Botswana national health policy states that the Ministry of Health shall from time to time review and revise its organisation and management structures to respond to new developments and challenges in order to achieve and sustain a high level of efficiency in the provision of health care. Even though the government clearly views assuring efficiency in the health sector as one of its leadership and governance responsibilities, to date no study has been undertaken to measure the technical efficiency of hospitals which consume the majority of health sector resources. The specific objectives of this study were to quantify the technical and scale efficiency of hospitals in Botswana and to evaluate changes in productivity over a three year period in order to analyse changes in efficiency and technology use. Methods: The DEAP software was used to analyse technical efficiency along with the DEA based Malmquist productivity index which was applied to a sample of 21 non teaching hospitals in the Republic of Botswana over a period of three years (2006 to 2008). Results: The analysis revealed that 16 (76.2%), 16 (76.2%) and 13 (61.9%) of the 21 hospitals were run inefficiently in 2006, 2007, and 2008 with average variable returns to scale (VRS) technical efficiency scores of 70.4 per cent, 74.2 per cent and 76.3 per cent respectively. On average, the Malmquist total factor productivity (MTFP) decreased by 1.5 per cent. Whilst hospital efficiency increased by 3.1 per cent, technical change (innovation) regressed by 4.5 per cent. Efficiency change was thus attributed to an improvement in pure efficiency of 4.2 per cent and a decline in scale efficiency of 1 per cent. The MTFP change was highest in 2008 (MTFP=1.008) and lowest in 2007 (MTFP=0.963). Conclusions: The results indicate significant inefficiencies within the sample for the years under study. In 2008, taken together, the inefficient hospitals would have had to increase the number of outpatient visits by 117,627 (18%) and inpatient days by 49,415 (13%) in order to reach full efficiency. Alternatively, inefficiencies could have been reduced by transferring 264 clinical staff and 39 beds to health clinics, health posts, and mobile posts. The transfer of excess clinical staff to those facilities which are closest to the communities may also contribute to accelerating progress towards the Millennium Development Goals related to child and maternal health. Nine (57.1%) of the 21 hospitals experienced MTFP deterioration during the three years. We found the sources of inefficiencies to be either adverse change in pure efficiency, scale efficiency, and/or technical efficiency. In line with the report Health financing: A strategy for the African Region, which was adopted by the fifty sixth WHO Regional Committee for Africa, it might be helpful for Botswana to consider institutionalising efficiency monitoring of health facilities within health management information systems.

Original languageEnglish
Title of host publicationEfficiency of Health System Units in Africa
Subtitle of host publicationA Data Envelopment Analysis
PublisherAfrican Books Collective
Pages367-394
Number of pages28
ISBN (Electronic)9789966792426
ISBN (Print)9966792155, 9789966792150
Publication statusPublished - 1 Jan 2013

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