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Determinants of technical efficiency of health systems in African least developed countries: A two-stage data envelopment analysis (DEA) approach

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  • E. Musoke

    (Makerere University)

  • B.L. Yawe

    (Makerere University)

  • J.D. Ssentamu

    (Makerere University)

Abstract

The objective of this study is to assess factors influencing the technical efficiency of health systems in African least developed countries (LDCs)for the 2008-2018 period. Following the two-stage data envelopment analysis (DEA) approach, DEA and the panel Tobit model are used to assess the technical efficiency of health systems and factors affecting the technical efficiency of health systems. Using panel data from the World Health Organisation, the World Bank, and the United Nations Educational, Scientific and Cultural Organisation, the inputs included out-of-pocket health expenditure, domestic private health expenditure, domestic general government health expenditure, and external health expenditure while the outputs were life expectancy at birth, maternal mortality ratio, under five mortality rate, and infant mortality rate. Several socio-economic and governance factors were also adopted in the assessment of factors affecting the technical efficiency of health systems. The health systems of sixteen African LDCs were technically efficient, while thirteen were technically inefficient. The technical efficiency of health systems in African LDCs was reduced by political stability, voice and accountability and prevalence of HIV while it was increased by gross national income. African LDCs with technically inefficient health systems are recommended to benchmark the practices of African LDCs with technically efficient health systems. They also need to improve political stability, create a conducive environment for accountability and step up the fight against HIV/AIDs.

Suggested Citation

  • E. Musoke & B.L. Yawe & J.D. Ssentamu, 2023. "Determinants of technical efficiency of health systems in African least developed countries: A two-stage data envelopment analysis (DEA) approach," Journal of Economic Policy and Management Issues, JEPMI, vol. 2(1), pages 59-75.
    • Handle: RePEc:beg:journl:v:2:y:2023:i:1:p:59-75
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    1. repec:rre:publsh:v:38:y:2008:i:3:p:381-93 is not listed on IDEAS
    2. Badi H. Baltagi, 2008. "Forecasting with panel data," Journal of Forecasting, John Wiley & Sons, Ltd., vol. 27(2), pages 153-173.
    3. Dan Lupu & Ramona Tiganasu, 2022. "COVID-19 and the efficiency of health systems in Europe," Health Economics Review, Springer, vol. 12(1), pages 1-15, December.
    4. Daxin Sun & Haksoon Ahn & Tomas Lievens & Wu Zeng, 2017. "Evaluation of the performance of national health systems in 2004-2011: An analysis of 173 countries," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-13, March.
    5. G. S. Maddala, 1987. "Limited Dependent Variable Models Using Panel Data," Journal of Human Resources, University of Wisconsin Press, vol. 22(3), pages 307-338.
    6. John Anyanwu & Andrew E. O. Erhijakpor, 2009. "Health Expenditures and Health Outcomes in Africa," African Development Review, African Development Bank, vol. 21(2), pages 400-433.
    7. David M. Drukker, 2003. "Testing for serial correlation in linear panel-data models," Stata Journal, StataCorp LLC, vol. 3(2), pages 168-177, June.
    8. Vasanthakumar Bhat, 2005. "Institutional arrangements and efficiency of health care delivery systems," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(3), pages 215-222, September.
    9. Girmay Tsegay Kiross & Catherine Chojenta & Daniel Barker & Deborah Loxton, 2020. "The effects of health expenditure on infant mortality in sub-Saharan Africa: evidence from panel data analysis," Health Economics Review, Springer, vol. 10(1), pages 1-9, December.
    10. Embrett, Mark G. & Randall, G.E., 2014. "Social determinants of health and health equity policy research: Exploring the use, misuse, and nonuse of policy analysis theory," Social Science & Medicine, Elsevier, vol. 108(C), pages 147-155.
    11. Mustapha D. Ibrahim & Sahand Daneshvar & Mevhibe B. Hocaoğlu & Olasehinde-Williams G. Oluseye, 2019. "An Estimation of the Efficiency and Productivity of Healthcare Systems in Sub-Saharan Africa: Health-Centred Millennium Development Goal-Based Evidence," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 143(1), pages 371-389, May.
    12. Sharon Hadad & Yossi Hadad & Tzahit Simon-Tuval, 2013. "Determinants of healthcare system’s efficiency in OECD countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 253-265, April.
    13. Simar, Leopold & Wilson, Paul W., 2007. "Estimation and inference in two-stage, semi-parametric models of production processes," Journal of Econometrics, Elsevier, vol. 136(1), pages 31-64, January.
    14. Israa A. El Husseiny, 2022. "The efficiency of healthcare systems in the Arab countries: a two-stage data envelopment analysis approach," Journal of Humanities and Applied Social Sciences, Emerald Group Publishing Limited, vol. 5(4), pages 339-358, August.
    15. Iyad Dhaoui, 2019. "Healthcare system efficiency and its determinants: A two-stage Data Envelopment Analysis (DEA) from MENA countries," Working Papers 1320, Economic Research Forum, revised 21 Aug 2019.
    16. Eddy Adang & George Borm, 2007. "Is there an association between economic performance and public satisfaction in health care?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(3), pages 279-285, September.
    17. Lewin, Arie Y & Morey, Richard C & Cook, Thomas J, 1982. "Evaluating the administrative efficiency of courts," Omega, Elsevier, vol. 10(4), pages 401-411.
    18. Kleine, A., 2004. "A general model framework for DEA," Omega, Elsevier, vol. 32(1), pages 17-23, February.
    19. Wagner, Janet M. & Shimshak, Daniel G., 2007. "Stepwise selection of variables in data envelopment analysis: Procedures and managerial perspectives," European Journal of Operational Research, Elsevier, vol. 180(1), pages 57-67, July.
    20. ANANG, Benjamin Tetteh, 2022. "Two-stage DEA estimation of technical efficiency: comparison of different estimators," Review of Agricultural and Applied Economics (RAAE), Faculty of Economics and Management, Slovak Agricultural University in Nitra, vol. 25(01), March.
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