An analysis of the efficiency of Uganda's public health care system: a case study of Health Centres III & IV in southwestern Uganda

Abstract

Health centres represent a significant proportion of health provision and expenditures in Uganda, accounting for about 18.5% of total health expenditure. Improving the technical efficiency of Health centres in Uganda can result in large savings which can be devoted to expand access to services and improve the quality of care. This paper explores the technical efficiency of health centres III and IV in South Western Uganda during the financial year 2012/2013. This was a cross-sectional study using secondary data. Data on Inputs and outputs of health centres III and IV were obtained from the Uganda Bureau of Statistics (UBoS) 2012/13 healthcare seeking by households for 12 public Health Centre IIIs and 4 Health Centre IVs. An output-oriented model with Variable Returns to Scale to estimate the efficiency score for each health centre was assumed using Data Envelopment Analysis (DEA) with STATA13. The study used a Tobit model, to investigate the relevance of the variables used in measuring the efficiency of the health centres. The average variable returns to scale (Pure) technical efficiency score was 81.4% and the average scale efficiency score was 89.6% while the average constant returns to scale technical efficiency score was 73%. Technically inefficient health centres could have become more efficient by accommodating about 18% increase in the average patient per day without changing the total number of inputs. Alternatively, they would achieve efficiency by for example transferring on average the excess 2 beds and 1 medical staff to other levels of the health system without changing the total number of outputs. Tobit regression indicates that significant factors in explaining hospital efficiency are: beds (p < 0.01) and medical staff (p<0.01) as well as the proportion of patient visits per day (p < 0.05). Health centres identified at the high and low extremes of efficiency should be investigated further to determine how and why production processes are operating differently at these Health centres. As policymakers gain insight into mechanisms promoting health centres services utilization in health centres with high efficiency, they can develop appropriate strategies for supporting Health centres with low efficiency. This will improve their service and thereby better address unmet needs for better health service delivery at the lower health sub-districts in Uganda.