Research article

Technical efficiency of peripheral health units in Pujehun district of Sierra Leone: a DEA application

Ade Renner¹ , Joses M Kirigia² , Eyob A Zere³ , Saidou P Barry² , Doris G Kirigia⁴ , Clifford Kamara⁵ and Lenity HK Muthuri⁶

¹  World Health Organization, Country Office, Freetown, Sierra Leone

²  World Health Organization, Regional Office for Africa, B.P. 06, Brazzaville, Congo

³  World Health Organization, Country Office, Windhoek, Namibia

⁴  University of New South Wales, School of Public Health and community medicine, Australia

⁵  Department of Planning and Information, Ministry of Health and Sanitation, Freetown, Sierra Leone

⁶  School of Public Health, Department of Health Sciences, Kenyatta University, Nairobi, Kenya

author email corresponding author email

BMC Health Services Research 2005, 5:77doi:10.1186/1472-6963-5-77

Published:	14 December 2005

Abstract

Background

The Data Envelopment Analysis (DEA) method has been fruitfully used in many countries in Asia, Europe and North America to shed light on the efficiency of health facilities and programmes. There is, however, a dearth of such studies in countries in sub-Saharan Africa. Since hospitals and health centres are important instruments in the efforts to scale up pro-poor cost-effective interventions aimed at achieving the United Nations Millennium Development Goals, decision-makers need to ensure that these health facilities provide efficient services. The objective of this study was to measure the technical efficiency (TE) and scale efficiency (SE) of a sample of public peripheral health units (PHUs) in Sierra Leone.

Methods

This study applied the Data Envelopment Analysis approach to investigate the TE and SE among a sample of 37 PHUs in Sierra Leone.

Results

Twenty-two (59%) of the 37 health units analysed were found to be technically inefficient, with an average score of 63% (standard deviation = 18%). On the other hand, 24 (65%) health units were found to be scale inefficient, with an average scale efficiency score of 72% (standard deviation = 17%).

Conclusion

It is concluded that with the existing high levels of pure technical and scale inefficiency, scaling up of interventions to achieve both global and regional targets such as the MDG and Abuja health targets becomes far-fetched. In a country with per capita expenditure on health of about US$7, and with only 30% of its population having access to health services, it is demonstrated that efficiency savings can significantly augment the government's initiatives to cater for the unmet health care needs of the population. Therefore, we strongly recommend that Sierra Leone and all other countries in the Region should institutionalise health facility efficiency monitoring at the Ministry of Health headquarter (MoH/HQ) and at each health district headquarter.