Technical efficiency, efficiency change, technical progress and productivity growth in the national health systems of continental African countries

Abstract

In May 2006, the Ministers of Health of all the countries on the African
continent, at a special session of the African Union, undertook to
institutionalise efficiency monitoring within their respective national health
information management systems. The specific objectives of this study
were: (i) to assess the technical efficiency of National Health Systems
(NHSs) of African countries for measuring male and female life
expectancies, and (ii) to assess changes in health productivity over time with
a view to analysing changes in efficiency and changes in technology.
The analysis was based on a five-year panel data (1999-2003) from all
the 53 countries of continental Africa. Data Envelopment Analysis (DEA) −
a non-parametric linear programming approach − was employed to assess
the technical efficiency. Malmquist Total Factor Productivity (MTFP) was
used to analyse efficiency and productivity change over time among the 53
countries' national health systems. The data consisted of two outputs (male
and female life expectancies) and two inputs (per capital total health
expenditure and adult literacy).
The DEA revealed that 49 (92.5%) countries' NHSs were run
inefficiently in 1999 and 2000; 50 (94.3%), 48 (90.6%) and 47 (88.7%)
operated inefficiently in 2001, 2002, and 2003 respectively. All the 53
countries' national health systems registered improvements in total factor
productivity attributable mainly to technical progress. Fifty-two countries
did not experience any change in scale efficiency, while thirty (56.6%)
countries' national health systems had a Pure Efficiency Change (PEFFCH)
index of less than one, signifying that those countries' NHSs pure efficiency
contributed negatively to productivity change.
All the 53 countries' national health systems registered improvements in
total factor productivity, attributable mainly to technical progress. Over half
of the countries' national health systems had a pure efficiency index of less
than one, signifying that those countries' NHSs pure efficiency contributed
negatively to productivity change. African countries may need to critically
evaluate the utility of institutionalising Malmquist TFP type of analyses to
monitor changes in health systems economic efficiency and productivity
over time.

East African Social Science Research Review Vol. 23 (2) 2007: pp. 19-40