Examination on Level of Scale Efficiency In Public Hospitals In Tanzania

Abstract Purpose: Tanzania has implemented policies that aim at improving health sector performance as well as the general health status of citizens. Establishment of community insurance fund, increase government budget allocation in health sector, establishment of institutions for critical and special diseases like Tanzania Ocean road cancer institute, Muhimbili Orthopaedic Institute and many other that aim at improving sector efficiency. These efforts and policies had a direct impact on improving the health sector and achieving Sustainable Development Goals (SDGs). Despite these improvement efforts, the health sector continues to face enormous challenges. Among the major challenges identified is the level of inefficiencies in healthcare delivery. It is for this reason; this paper examines the scale efficiency level in Tanzania’s public hospitals.Methods: Using data from the Ministry of Health, this paper employs the Data Envelopment Analysis (DEA) to examine Tanzania’s public hospital efficiency levels.Results: Findings showed that the average scale efficiency was 78.6%. and 72.9% for regional and district hospitals respectively. Additionally, 43.8% of the regional referral hospitals attained the most productive scale size compared to 21.05% in district hospitals.Conclusion: The study concludes that there is dire need for the ministry of health to consider resource reallocation across public hospitals. Periodic re-estimation of efficiency levels coupled with increased health care input injection is of urgent need.

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Examination on level of scale efficiency in public hospitals in Tanzania

Cost Effectiveness and Resource Allocation ◽

10.1186/s12962-021-00305-4 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Fatuma Fumbwe ◽

Robert Lihawa ◽

Felician Andrew ◽

George Kinyanjui ◽

Eliaza Mkuna

Keyword(s):

Healthcare Delivery ◽

Health Sector ◽

Public Hospitals ◽

Scale Efficiency ◽

Insurance Fund ◽

Ministry Of Health ◽

District Hospitals ◽

Referral Hospitals ◽

Using Data ◽

Most Productive Scale Size

Abstract Purpose Tanzania has implemented policies that aim at improving health sector performance as well as the general health status of citizens. Establishment of community insurance fund, increase government budget allocation in health sector, establishment of institutions for critical and special diseases like Tanzania Ocean road cancer institute, Muhimbili Orthopaedic Institute and many other that aim at improving sector efficiency. These efforts and policies had a direct impact on improving the health sector and achieving Sustainable Development Goals (SDGs). Despite these improvement efforts, the health sector continues to face enormous challenges. Among the major challenges identified is the level of inefficiencies in healthcare delivery. It is for this reason; this paper examines the scale efficiency level in Tanzania’s public hospitals. Methods Using data from the Ministry of Health, this paper employs the Input based Data Envelopment Analysis (DEA) to examine Tanzania’s public hospital efficiency levels. DEA has been applied because it can handle multiple inputs and output that can have different units simultaneously. Results Findings showed that the average scale efficiency was 78.6%.and 72.9%for regional and district hospitals respectively. Additionally, 43.8% of the regional referral hospitals attained the most productive scale size compared to 21.05% in district hospitals. Conclusion The study concludes that there is dire need for the ministry of health to consider resource reallocation across public hospitals. Periodic re-estimation of efficiency levels coupled with increased health care input injection is of urgent need.

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Examination On Level Of Scale Efficiency In Public Hospitals In Tanzania

10.21203/rs.3.rs-42431/v2 ◽

2021 ◽

Author(s):

Fatuma Fumbwe ◽

Robert Lihawa ◽

Felician Andrew ◽

George Kinyanjui ◽

Eliaza Mkuna

Keyword(s):

Healthcare Delivery ◽

Health Sector ◽

Public Hospitals ◽

Scale Efficiency ◽

Insurance Fund ◽

Ministry Of Health ◽

District Hospitals ◽

Referral Hospitals ◽

Using Data ◽

Most Productive Scale Size

Abstract Purpose:Tanzania has implemented policies that aim at improvinghealth sector performance as well as the general health status of citizens. Establishment of community insurance fund, increase government budget allocation in health sector, establishment of institutions for critical and special diseases like Tanzania Ocean road cancer institute, Muhimbili Orthopaedic Institute and many other that aim at improving sector efficiency. These efforts and policies had a direct impact on improving the health sector and achieving Sustainable Development Goals (SDGs). Despite these improvement efforts, the health sector continues to face enormous challenges. Among the major challenges identified is the level of inefficiencies in healthcare delivery. It is for this reason; this paper examines the scale efficiency level in Tanzania’s public hospitals.Methods:Using data from the Ministry of Health, this paper employs the Data Envelopment Analysis (DEA) to examine Tanzania’s public hospital efficiency levels.Results:Findings showed that the average scale efficiency was 78.6%.and 72.9%for regional and district hospitals respectively. Additionally, 43.8% of the regional referral hospitals attained the most productive scale size compared to 21.05% in district hospitals.Conclusion: The study concludes that there is dire need for the ministry of health to consider resource reallocation across public hospitals. Periodic re-estimation of efficiency levels coupled with increased health care input injection is of urgent need.

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(A234) Disasters as an Opportunity to Train and Prepare for Future Disasters

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11002202 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s64-s64

Author(s):

T. Ranasinghe ◽

E.K. Vithana ◽

H. Herath ◽

L. Pattuwage

Keyword(s):

Sri Lanka ◽

Disaster Preparedness ◽

Health Workers ◽

Healthcare Delivery ◽

Health Sector ◽

Ground Level ◽

Health Staff ◽

Ministry Of Health ◽

Non Governmental Organizations

Asian tsunami in 2004 had a tremendous impact on the health system of Sri Lanka leaving many healthcare institutions damaged in the costal provinces and destabilizing the healthcare delivery network. Immediately after the tsunami, health authorities in Sri Lanka realized, health workers should be prepared well if they are to face any future disasters successfully. In this background, the Ministry of Health set its agenda to train all levels of health cadres on disaster preparedness and mitigation whenever there are opportunities. Ministry of Health established the Tsunami Rehabilitation Unit (TRU), later renamed as Disaster Preparedness and Response Unit (DPRU) and mandated it to prepare the health sector for future disasters. During a disaster, well trained health cadre is an asset to any health manager facing the burden of the emergency at the ground level. Trained health personnel on disaster management become a human resource multiplier to fill the gaps of scarce skilled health staff in the field operations. We reviewed the Ministry of Health reports, plans, meeting minutes, reports of training institutions, routine reporting from Ministry of Health departments and reports from health sector partners to compile and then analyze to construct this case study. We provide an overview of how DPRU coordinated and used the opportunities following Tsunami 2004 and then during the humanitarian crisis at the end of 30 years of armed conflict in 2009 to train the health staff. This case study also describes how DPRU networked with government and non governmental organizations to train the different categories of government health staff.

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Efficiency Estimates of Public Health Center II Facilities in Southwestern Uganda

Journal of Economics and Behavioral Studies ◽

10.22610/jebs.v10i4(j).2414 ◽

2018 ◽

Vol 10 (4(J)) ◽

pp. 135-151

Author(s):

Kenneth Tindimwebwa ◽

Asmerom Kidane ◽

Silas Joel

Keyword(s):

Public Health ◽

Management Practices ◽

Health Centre ◽

Scale Up ◽

Healthcare Delivery ◽

Health Sector ◽

Policy Implications ◽

Scale Efficiency ◽

Public Health Centre ◽

Southwestern Uganda

The study estimates the efficiency of public health centre II (HCII) facilities in Southwestern Uganda. Specifically, it determines the level of technical efficiency (TE), scale efficiency (SE) and estimates the economic savings required to make inefficient public health facilities efficient. An output-oriented Data Envelopment Analysis (DEA) is employed in the estimation of TE and SE. It was found out that 73 % of the HCIIs were technically inefficient while 27% were technically efficient. Mean TE stood at 72.3% implying that an average HCII could potentially improve its efficiency by increasing its outputs by 27.7%. In addition, 77% of the facilities were SE implying that they obtained the most productive scale size given the input-output combination. 23% of the facilities were scaled inefficient implying that they have more input waste attributable to their size. There is great potential for economic savings shown by different magnitudes of input reductions and output augmentations required to make inefficient facilities efficient. The study has important policy implications. The health sector should embark on rigorous periodic research and development to enhance healthcare delivery efficiently. Since the health units are small, there is a need to augment their scale sizes and improve on their management practices so as to enhance their overall productivity and efficiency. Stakeholders should scale up efforts to attract, align skills with needs and improve retention and motivation of the health workforce. Holistic investment in resource inputs is essential. A comprehensive monitoring and evaluation plan with key verifiable indicators to monitor the overall health sector performance is required.

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Efficiency evaluation of public hospitals in Saudi Arabia: an application of data envelopment analysis

BMJ Open ◽

10.1136/bmjopen-2019-031924 ◽

2020 ◽

Vol 10 (1) ◽

pp. e031924 ◽

Cited By ~ 2

Author(s):

Ahmed D Alatawi ◽

Louis Wilhelmus Niessen ◽

Jahangir A M Khan

Keyword(s):

Saudi Arabia ◽

Data Envelopment Analysis ◽

Health Services ◽

Production Capacity ◽

Efficiency Score ◽

Current Level ◽

Public Hospitals ◽

Scale Efficiency ◽

Data Envelopment ◽

Ministry Of Health

ObjectiveIn this study, we assess the performance of public hospitals in Saudi Arabia. We detect the sources of inefficiency and estimate the optimal levels of the resources that provide the current level of health services. We enrich our analysis by employing locations and capacities of the hospitals.DesignWe employ data envelopment analysis (DEA) to measure the technical efficiency of 91 public hospitals. We apply the input-oriented Charnes, Cooper and Rhodes, and Banker, Charne, Cooper models under Constant and Variable Returns-to-Scale. The assessment includes four inputs, and six output variables taken from the Ministry of Health databases for 2017. We conducted the assessment via PIM-DEA V.3.2 software.SettingMinistry of health-affiliated hospitals in the Kingdom of Saudi Arabia.ResultsFindings identified 75.8% (69 of 91) of public hospitals as technically inefficient. The average efficiency score was 0.76, indicating that hospitals could have reduced their inputs by 24% without reduction in health service provision. Small hospitals (efficiency score 0.79) were more efficient than medium-sized and large hospitals. Hospitals in the central region were more efficient (efficiency score 0.83), than those located in other geographical locations. More than half of the hospitals (62.6%) were operating suboptimally in terms of the scale efficiency, implying that to improve efficiency, they need to alter their production capacity. Performance analysis identified overuse of physician’s numbers and shortage of health services production, as major causes of inefficiency.ConclusionMost hospitals were technically inefficient and operating at suboptimal scale size and indicate that many hospitals may improve their performance through efficient utilisation of health resources to provide the current level of health services. Changes in the production capacity are required, to facilitate optimal use of medical capacity. The inefficient hospitals could benefit from these findings to benchmarking their system and performance in light of the efficient hospital within their capacity and geographical location.

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Technical Inefficiency of District Hospitals in Côte d'Ivoire: Measurement, Causes and Consequences

International Journal of Economics and Finance ◽

10.5539/ijef.v12n9p35 ◽

2020 ◽

Vol 12 (9) ◽

pp. 35

Author(s):

Tito N. Tiehi

Keyword(s):

Health Care ◽

Negative Impact ◽

Average Length ◽

Health Sector ◽

Productive Efficiency ◽

Public Hospitals ◽

Technical Inefficiency ◽

Parametric Data ◽

Geographical Access ◽

District Hospitals

The aim of this study is to estimate the level of inefficiency and to identify the causes and consequences of Cote d’Ivoire public hospitals inefficiency. To that effect, we are using the non-parametric Data Envelopment Analysis (DEA) and the double Bootstrap procedures to analyze the data. The analysis of data from the Ministry of Health in Cote d’Ivoire reveals that districts’ hospitals are not technically efficient. This situation has a negative impact on hospital output in the country. Thus, the health system is impacted by the inefficiency of districts’ hospitals in accommodating the demand of health care. That technical inefficiency remains dependent on environmental factors that constitute an impediment for some of the levers ((ratio of doctors per capita, malnutrition, average length of stay, geographical access, and correlation Tuberculosis / HIV) and others (number of doctors in medical staff) able to increase hospitals technical efficiency. The outcomes of this study reveal two main stakes: firstly, the need for improvement of hospitals productive efficiency and secondly, the need for a better planning and utilization of the resources allocated to the health sector. Providing adequate responses to these concerns is extremely important for the country’s ambition to establish a universal health insurance system and improve the quality of health care services.

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Patients’ perceptions of healthcare quality in Ghana

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-10-2017-0200 ◽

2019 ◽

Vol 32 (1) ◽

pp. 176-190 ◽

Cited By ~ 3

Author(s):

Peter Anabila ◽

Desmond Kwadjo Kumi ◽

Janet Anome

Keyword(s):

Positive Relationship ◽

Healthcare Delivery ◽

Health Sector ◽

Policy Decision ◽

Policy Formulation ◽

Public Hospitals ◽

Healthcare Sector ◽

Content Type ◽

Significant Positive Relationship ◽

Private And Public

Purpose The purpose of this paper is to investigate the role of service quality (SQ), customer satisfaction (CS) and customer loyalty (CL) in Ghana’s health sector and a comparative analysis of private and public hospital SQ. Design/methodology/approach A convenient sample of 1,236 respondents was generated from both private and public hospitals. The study utilises an asymptotic distribution free estimation technique in CB-SEM using LISREL to test the relationships, while Wilcoxon–Mann–Whitney test was used to determine the differences in SQ performances between private and public hospitals. Findings The study found a significant positive relationship between SQ and CS. Also, the study found a significant positive relationship between CS and CL. Finally, SQ was found to be better in private hospitals, resulting higher CS and CL. Practical implications The study highlights the significant role SQ plays in generating CS and CL to guide healthcare provider policy decision making to improve healthcare delivery. It also serves as a guide to patients to make informed decisions regarding the choice of alternative hospitals. Originality/value The study provides a useful guide to strategy and policy formulation in the healthcare sector by exploring the potential viability of SERVQUAL-related model as a relevant tool for assessing SQ in Ghana’s health sector. The results also identified SQ gap between private and public hospitals and thus have implications on how hospitals should strategise to improve their SQ.

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Surgical Care Capacity in Uganda: Government Versus Private Sector Investment

International Surgery ◽

10.9738/intsurg-d-16-00153.1 ◽

2017 ◽

Vol 102 (7-8) ◽

pp. 387-393

Author(s):

Unwanaobong Nseyo ◽

Meena N. Cherian ◽

Michael M. Haglund ◽

Jessica Hudson ◽

Olive Sentumbwe-Mugisa ◽

...

Keyword(s):

Low Income ◽

Tertiary Care ◽

Surgical Care ◽

Health Care Facilities ◽

Health Facilities ◽

Public Hospitals ◽

Analysis Tool ◽

Running Water ◽

District Hospitals ◽

Referral Hospitals

Background: Uganda is a low-income country with blended, tiered government health care facilities and private/non-governmental (NGO)/mission hospitals. The population is 84% rural; 100% of referral hospitals and majority of specialist physicians are urban. Summary of background data: This project compared various levels of government hospitals with private/NGO hospitals to determine adequacy to deliver emergency and essential surgical care (EESC) and anesthesia. Methods: Using the WHO Situational Analysis Tool, a representative selection of 38 hospitals (25% of Ugandan hospitals) was assessed for capacity to deliver surgical, anesthetic and obstetric care in 4 domains: infrastructure, human resources, surgeries performed or referred, and equipment. Results: In all facilities, laboratory availability was 86%; anesthesia machines, 66%; generators, 55%; and continuous running water, 42%; oxygen, 32%; and electricity, 26%. Resuscitator bags and mask/tubing were present less than 50% of health facilities. Only 84% of all health facilities had a stethoscope; sterilizers only at 50%. This situation was much more dismal in district hospitals. Surgeons were found at 71% of public hospitals and 63% of NGO/mission hospitals; 60% surgeons, and over 50% of anesthesiologists were only in teaching hospitals; obstetricians almost exclusively in higher-level hospitals. Conclusions: The infrastructure for surgical services and anesthesia were noticeably absent at district hospital level and below, yet were readily available at the tertiary care center level. Overall national and regional referral hospitals were better equipped than NGO facilities, suggesting the government is capable of fully equipping hospitals to provide surgical care. These surveys highlight potential for improvement in surgical care at all levels.

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THE QUALITY OF PUBLIC HOSPITALS IN CAN THO CITY, 2016

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.6.10 ◽

2018 ◽

Vol 8 (6) ◽

pp. 76-81

Author(s):

Chu Cao Minh ◽

Thang Vo Van ◽

Dat Nguyen Tan ◽

Hung Vo Thanh

Keyword(s):

Hospital Medicine ◽

Secondary Data ◽

Quality Criterion ◽

Quality Criteria ◽

Public Hospitals ◽

Ministry Of Health ◽

Cross Sectional ◽

Significant Difference ◽

Can Tho City

Background: The criteria set of assessing hospital quality in Vietnam in 2016 was revied from the criteria set in 2013 by the Ministry of Health in order to help hospitals to self-assess towards improvinge quality of hospitals in the international integration context. The study aimed to assess the quality of public hospitals in Can Tho City according to the revised criteria set of the Ministry of Health in 2016 and compare the quality among three hospital ranks (including grade I, grade II, and grade III) via to 5 groups of quality criteria. Methods: A cross-sectional study, using secondary data analysis was applied to assess the service quality of 7 general public hospitals in Can Tho City. Results: The average total score of 7 hospitals is 245 and the average for the criteria of 7 hospitals is 2.99, which is just satisfactory. In the criterion of quality, criterion D and E had the lowest scores compared to the other three groups. There was no statistically significant difference (p = 0.076) among the mean scores for the three hospital categories. Conclusion: The quality of public hospitals in Can Tho city in 2016 only reached moderately good level (2.99). Interventions should be developed to improve the quality of hospitals, with particular emphasis on improving the quality of criteria groups D and E. Key words: Quality, hospital, medicine, health, public, Can Tho

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Detailed cost of robotic-assisted surgery in the Australian public health sector: from implementation to a multi-specialty caseload

BMC Health Services Research ◽

10.1186/s12913-021-06105-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kate McBride ◽

Daniel Steffens ◽

Christina Stanislaus ◽

Michael Solomon ◽

Teresa Anderson ◽

...

Keyword(s):

Public Sector ◽

Health Sector ◽

Public Hospitals ◽

Fixed Costs ◽

Tertiary Referral Hospital ◽

Robotic Assisted ◽

The Public ◽

Robotic Assisted Surgery ◽

Specific Implementation ◽

Theatre Utilisation

Abstract Background A barrier to the uptake of robotic-assisted surgery (RAS) continues to be the perceived high costs. A lack of detailed costing information has made it difficult for public hospitals in particular to determine whether use of the technology is justified. This study aims to provide a detailed description of the patient episode costs and the contribution of RAS specific costs for multiple specialties in the public sector. Methods A retrospective descriptive costing review of all RAS cases undertaken at a large public tertiary referral hospital in Sydney, Australia from August 2016 to December 2018 was completed. This included RAS cases within benign gynaecology, cardiothoracic, colorectal and urology, with the total costs described utilizing various inpatient costing data, and RAS specific implementation, maintenance and consumable costs. Results Of 211 RAS patients, substantial variation was found between specialties with the overall median cost per patient being $19,269 (Interquartile range (IQR): $15,445 to $32,199). The RAS specific costs were $8828 (46%) made up of fixed costs including $4691 (24%) implementation and $2290 (12%) maintenance, both of which are volume dependent; and $1848 (10%) RAS consumable costs. This was in the context of 37% robotic theatre utilisation. Conclusions There is considerable variation across surgical specialties for the cost of RAS. It is important to highlight the different cost components and drivers associated with a RAS program including its dependence on volume and how it fits within funding systems in the public sector.

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