Evaluating the technical efficiency of primary health facilities in delivering adolescent mental, sexual and reproductive health services in Burkina Faso

Background: Adolescence is a critical phase of life, with sexual, reproductive, and mental health being essential to overall well-being. Despite global and national initiatives to improve adolescent health, substantial gaps persist in service delivery, especially in low-resource settings like Burkina Faso. Primary healthcare (PHC) facilities play a pivotal role in addressing adolescent mental, sexual, and reproductive health (AMSRH) needs. However, evidence on the technical efficiency of these facilities in delivering AMSRH services remains limited. This study evaluates the technical efficiency of PHC facilities in Burkina Faso in providing AMSRH services and identifies key factors influencing efficiency. Methods: A cross-sectional survey was conducted in 132 PHC facilities across the West-Central and Hauts Bassins regions of Burkina Faso from September to October 2022. Data on facility characteristics, resource availability, and service delivery were collected. Technical efficiency of ASRH services was assessed using Stochastic Frontier Analysis (SFA) with a Translog production function, while a truncated regression identified determinants of efficiency. The analysis included inputs such as laboratory tests, consultation rooms, and trained providers, with efficiency scores ranging from 0 to 1. Data analysis was performed using STATA 16. Results: Of the surveyed facilities, 77% were in rural areas, and 23% were in urban areas. While all facilities offered adolescent sexual and reproductive health (ASRH) services, only 42% provided adolescent mental health (AMH) services, which were excluded from efficiency analysis due to low adolescent consultation numbers. Average technical efficiency was 0.66, with urban facilities (0.73) and those with electricity (0.71) showing higher efficiency. Access to electricity (Coef. = 0.061, p = 0.004) and laboratories (Coef. = 0.053, p = 0.020) significantly enhanced efficiency. These findings highlight critical infrastructure gaps and the need for targeted investments to optimize service delivery. Conclusion: This study highlights critical gaps in AMH service availability within PHC facilities in Burkina Faso. Key determinants of technical efficiency in delivering adolescent sexual and reproductive health ASRH services included access to electricity, laboratories, and trained providers. Conversely, longer facility manager tenure negatively impacted efficiency, emphasizing the need for dynamic leadership. Targeted investments in infrastructure, capacity-building initiatives, and digital health adoption are essential. Expanding AMH services and aligning with national guidelines are urgent priorities for optimizing AMSRH service delivery and improving adolescent health outcomes.