IDEAS home Printed from https://ideas.repec.org/a/spr/soinre/v143y2019i1d10.1007_s11205-018-1969-1.html
   My bibliography  Save this article

An Estimation of the Efficiency and Productivity of Healthcare Systems in Sub-Saharan Africa: Health-Centred Millennium Development Goal-Based Evidence

Author

Listed:
  • Mustapha D. Ibrahim

    (Eastern Mediterranean University)

  • Sahand Daneshvar

    (Eastern Mediterranean University)

  • Mevhibe B. Hocaoğlu

    (Eastern Mediterranean University)

  • Olasehinde-Williams G. Oluseye

    (Eastern Mediterranean University)

Abstract

The millennium development goals (MDGs) were designed to realign national priorities towards human development of which healthcare is the foundation. An extension of the MDGs, the sustainable development goals (SDGs), has more recently been introduced and has become the core focus for Sub-Saharan Africa (SSA) regardless of her performance vis-à-vis the MDGs. A transition into accomplishing the SDGs without identifying the efficiency and determinants of the shortfall in achieving the MDGs is a flawed approach. This paper seeks to estimate the efficiency of healthcare systems in SSA based on health focused MDGs. We estimate the technical efficiency and total factor productivity of these systems, and rank the annual performance of SSA’s healthcare systems from 2010 to 2015 using a robust data envelopment analysis (DEA) approach. Regression analysis is applied to the determinants of healthcare system efficiency. The DEA results show healthcare systems in SSA to be inefficient, with only three countries; Botswana in 2015, Rwanda in 2014 and 2015, and Tanzania in 2015; identified as efficient over the evaluated period. Failure to achieve technological advancements is the identified leading cause of a decrease in productivity. Scale inefficiency is determined to be the primary cause of technical inefficiency. The study also shows that governance measures, i.e., the rule of law and government efficacy, impact healthcare system efficiency more than public expenditure on health, indicating that the volume of resources invested in healthcare systems is not as important as the efficient management of the said resources in SSA countries.

Suggested Citation

  • 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.
    • Handle: RePEc:spr:soinre:v:143:y:2019:i:1:d:10.1007_s11205-018-1969-1
    DOI: 10.1007/s11205-018-1969-1
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s11205-018-1969-1
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s11205-018-1969-1?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Simar, Léopold & Vanhems, Anne, 2012. "Probabilistic characterization of directional distances and their robust versions," Journal of Econometrics, Elsevier, vol. 166(2), pages 342-354.
    2. Paul Marschall & Steffen Flessa, 2011. "Efficiency of primary care in rural Burkina Faso. A two-stage DEA analysis," Health Economics Review, Springer, vol. 1(1), pages 1-15, December.
    3. 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.
    4. William Greene, 2004. "Distinguishing between heterogeneity and inefficiency: stochastic frontier analysis of the World Health Organization's panel data on national health care systems," Health Economics, John Wiley & Sons, Ltd., vol. 13(10), pages 959-980, October.
    5. João Medeiros & Christoph Schwierz, 2015. "Efficiency estimates of health care systems," European Economy - Economic Papers 2008 - 2015 549, Directorate General Economic and Financial Affairs (DG ECFIN), European Commission.
    6. Afonso, Antonio & St. Aubyn, Miguel, 2005. "Non-Parametric Approaches to Education and Health Efficiency in OECD Countries," Journal of Applied Economics, Universidad del CEMA, vol. 8(2), pages 1-20, November.
    7. Antonis Adam & Manthos Delis & Pantelis Kammas, 2011. "Public sector efficiency: leveling the playing field between OECD countries," Public Choice, Springer, vol. 146(1), pages 163-183, January.
    8. 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.
    9. Per Andersen & Niels Christian Petersen, 1993. "A Procedure for Ranking Efficient Units in Data Envelopment Analysis," Management Science, INFORMS, vol. 39(10), pages 1261-1264, October.
    10. Ferreira, D.C. & Marques, R.C. & Nunes, A.M., 2018. "Economies of scope in the health sector: The case of Portuguese hospitals," European Journal of Operational Research, Elsevier, vol. 266(2), pages 716-735.
    11. Pınar Kaya Samut & Reyhan Cafrı, 2016. "Analysis of the Efficiency Determinants of Health Systems in OECD Countries by DEA and Panel Tobit," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 129(1), pages 113-132, October.
    12. Vivian G. Valdmanis & Michael D. Rosko & Hervé Leleu & Dana B. Mukamel, 2017. "Assessing overall, technical, and scale efficiency among home health care agencies," Health Care Management Science, Springer, vol. 20(2), pages 265-275, June.
    13. Bienvenido Ortega & Jesús Sanjuán & Antonio Casquero, 2017. "Determinants of efficiency in reducing child mortality in developing countries. The role of inequality and government effectiveness," Health Care Management Science, Springer, vol. 20(4), pages 500-516, December.
    14. Daraio, Cinzia & Simar, Léopold, 2014. "Directional distances and their robust versions: Computational and testing issues," European Journal of Operational Research, Elsevier, vol. 237(1), pages 358-369.
    15. Wheelock, David C. & Wilson, Paul W., 2009. "Robust Nonparametric Quantile Estimation of Efficiency and Productivity Change in U.S. Commercial Banking, 1985–2004," Journal of Business & Economic Statistics, American Statistical Association, vol. 27(3), pages 354-368.
    16. Po-Chin Wu & Tzu-Hsien Huang & Sheng-Chieh Pan, 2014. "Country Performance Evaluation: The DEA Model Approach," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 118(2), pages 835-849, September.
    17. David C. Wheelock & Paul W. Wilson, 2003. "Robust nonparametric estimation of efficiency and technical change in U.S. commercial banking," Working Papers 2003-037, Federal Reserve Bank of St. Louis.
    18. Kneip, Alois & Park, Byeong U. & Simar, Léopold, 1998. "A Note On The Convergence Of Nonparametric Dea Estimators For Production Efficiency Scores," Econometric Theory, Cambridge University Press, vol. 14(6), pages 783-793, December.
    19. Yasar A. Ozcan & Jaya Khushalani, 2017. "Assessing efficiency of public health and medical care provision in OECD countries after a decade of reform," Central European Journal of Operations Research, Springer;Slovak Society for Operations Research;Hungarian Operational Research Society;Czech Society for Operations Research;Österr. Gesellschaft für Operations Research (ÖGOR);Slovenian Society Informatika - Section for Operational Research;Croatian Operational Research Society, vol. 25(2), pages 325-343, June.
    20. Olesen, Ole Bent & Petersen, Niels Christian & Podinovski, Victor V., 2015. "Efficiency analysis with ratio measures," European Journal of Operational Research, Elsevier, vol. 245(2), pages 446-462.
    21. Richard Gearhart, 2016. "The Robustness of Cross-Country Healthcare Rankings Among Homogeneous Oecd Countries," Journal of Applied Economics, Taylor & Francis Journals, vol. 19(1), pages 113-143, May.
    22. Bruce Hollingsworth & John Wildman, 2003. "The efficiency of health production: re‐estimating the WHO panel data using parametric and non‐parametric approaches to provide additional information," Health Economics, John Wiley & Sons, Ltd., vol. 12(6), pages 493-504, June.
    23. Färe, Rolf & Margaritis, Dimitris & Rouse, Paul & Roshdi, Israfil, 2016. "Estimating the hyperbolic distance function: A directional distance function approach," European Journal of Operational Research, Elsevier, vol. 254(1), pages 312-319.
    24. R. D. Banker & A. Charnes & W. W. Cooper, 1984. "Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis," Management Science, INFORMS, vol. 30(9), pages 1078-1092, September.
    25. Retzlaff-Roberts, Donna & Chang, Cyril F. & Rubin, Rose M., 2004. "Technical efficiency in the use of health care resources: a comparison of OECD countries," Health Policy, Elsevier, vol. 69(1), pages 55-72, July.
    26. Asandului, Laura & Roman, Monica & Fatulescu, Puiu, 2013. "The Efficiency of Healthcare Systems in Europe: a Data Envelopment Analysis Approach," MPRA Paper 58954, University Library of Munich, Germany, revised Apr 2014.
    27. A L Johnson & L F McGinnis, 2009. "The hyperbolic-oriented efficiency measure as a remedy to infeasibility of super efficiency models," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 60(11), pages 1511-1517, November.
    28. Charnes, A. & Cooper, W. W. & Rhodes, E., 1978. "Measuring the efficiency of decision making units," European Journal of Operational Research, Elsevier, vol. 2(6), pages 429-444, November.
    29. Richard Gearhart, 2016. "The robustness of cross-country healthcare rankings among homogeneous OECD countries," Journal of Applied Economics, Universidad del CEMA, vol. 19, pages 113-144, May.
    30. Rajkumar, Andrew Sunil & Swaroop, Vinaya, 2008. "Public spending and outcomes: Does governance matter?," Journal of Development Economics, Elsevier, vol. 86(1), pages 96-111, April.
    31. Cazals, Catherine & Florens, Jean-Pierre & Simar, Leopold, 2002. "Nonparametric frontier estimation: a robust approach," Journal of Econometrics, Elsevier, vol. 106(1), pages 1-25, January.
    32. Jose Zofio & C. A. Knox Lovell, 2001. "Graph efficiency and productivity measures: an application to US agriculture," Applied Economics, Taylor & Francis Journals, vol. 33(11), pages 1433-1442.
    33. Culyer, A. J. & Wagstaff, Adam, 1993. "Equity and equality in health and health care," Journal of Health Economics, Elsevier, vol. 12(4), pages 431-457, December.
    34. Marianela Carrillo & Jesús M. Jorge, 2017. "DEA-Like Efficiency Ranking of Regional Health Systems in Spain," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 133(3), pages 1133-1149, September.
    35. Oliviero Carboni & Paolo Russu, 2015. "Assessing Regional Wellbeing in Italy: An Application of Malmquist–DEA and Self-organizing Map Neural Clustering," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 122(3), pages 677-700, July.
    36. Yasar A. Ozcan, 2008. "Health Care Benchmarking and Performance Evaluation," International Series in Operations Research and Management Science, Springer, number 978-0-387-75448-2, September.
    37. R. G. Chambers & Y. Chung & R. Färe, 1998. "Profit, Directional Distance Functions, and Nerlovian Efficiency," Journal of Optimization Theory and Applications, Springer, vol. 98(2), pages 351-364, August.
    38. Gitto, Simone & Mancuso, Paolo, 2012. "Bootstrapping the Malmquist indexes for Italian airports," International Journal of Production Economics, Elsevier, vol. 135(1), pages 403-411.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. 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.
    2. Sedef E. Kara & Mustapha D. Ibrahim & Sahand Daneshvar, 2021. "Dual Efficiency and Productivity Analysis of Renewable Energy Alternatives of OECD Countries," Sustainability, MDPI, vol. 13(13), pages 1-14, July.
    3. Youssef Er-Rays & Meriem M'dioud, 2024. "Evaluating the Financial Factors Influencing Maternal, Newborn, and Child Health in Africa," Papers 2402.14939, arXiv.org.
    4. Osman, Ibrahim H. & Zablith, Fouad, 2021. "Re-evaluating electronic government development index to monitor the transformation toward achieving sustainable development goals," Journal of Business Research, Elsevier, vol. 131(C), pages 426-440.
    5. Puertas, Rosa & Marti, Luisa & Guaita-Martinez, José M., 2020. "Innovation, lifestyle, policy and socioeconomic factors: An analysis of European quality of life," Technological Forecasting and Social Change, Elsevier, vol. 160(C).
    6. Awad, Atif & Albaity, Mohamed, 2022. "ICT and economic growth in Sub-Saharan Africa: Transmission channels and effects," Telecommunications Policy, Elsevier, vol. 46(8).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. 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.
    2. Léopold Simar & Paul W. Wilson, 2015. "Statistical Approaches for Non-parametric Frontier Models: A Guided Tour," International Statistical Review, International Statistical Institute, vol. 83(1), pages 77-110, April.
    3. 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.
    4. Sepideh Abolghasem & Mehdi Toloo & Santiago Amézquita, 2019. "Cross-efficiency evaluation in the presence of flexible measures with an application to healthcare systems," Health Care Management Science, Springer, vol. 22(3), pages 512-533, September.
    5. Arabmaldar, Aliasghar & Sahoo, Biresh K. & Ghiyasi, Mojtaba, 2023. "A generalized robust data envelopment analysis model based on directional distance function," European Journal of Operational Research, Elsevier, vol. 311(2), pages 617-632.
    6. Puertas, Rosa & Marti, Luisa & Guaita-Martinez, José M., 2020. "Innovation, lifestyle, policy and socioeconomic factors: An analysis of European quality of life," Technological Forecasting and Social Change, Elsevier, vol. 160(C).
    7. Kristína Kočišová & Jakub Sopko, 2020. "The Efficiency of Public Health and Medical Care Systems in EU Countries: Dynamic Network Data Envelopment Analysis," Acta Universitatis Agriculturae et Silviculturae Mendelianae Brunensis, Mendel University Press, vol. 68(2), pages 383-394.
    8. Angelo Castaldo & Maria Alessandra Antonelli & Valeria De Bonis & Giorgia Marini, 2020. "Determinants of health sector efficiency: evidence from a two-step analysis on 30 OECD countries," Economics Bulletin, AccessEcon, vol. 40(2), pages 1651-1666.
    9. Dino Rizzi & Michele Zanette, 2021. "Potential efficiency gains and expenditure savings in the Italian Regional Healthcare Systems," Politica economica, Società editrice il Mulino, issue 2, pages 187-214.
    10. Cinzia Daraio & Léopold Simar & Paul W. Wilson, 2020. "Fast and efficient computation of directional distance estimators," Annals of Operations Research, Springer, vol. 288(2), pages 805-835, May.
    11. Amir Moradi-Motlagh & Ali Emrouznejad, 2022. "The origins and development of statistical approaches in non-parametric frontier models: a survey of the first two decades of scholarly literature (1998–2020)," Annals of Operations Research, Springer, vol. 318(1), pages 713-741, November.
    12. Pınar Kaya Samut & Reyhan Cafrı, 2016. "Analysis of the Efficiency Determinants of Health Systems in OECD Countries by DEA and Panel Tobit," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 129(1), pages 113-132, October.
    13. Justyna Kujawska, 2021. "Health System Efficiency in European Countries: Network Data Envelopment Analysis Approach," European Research Studies Journal, European Research Studies Journal, vol. 0(2), pages 1095-1117.
    14. Kevork, Ilias S. & Pange, Jenny & Tzeremes, Panayiotis & Tzeremes, Nickolaos G., 2017. "Estimating Malmquist productivity indexes using probabilistic directional distances: An application to the European banking sector," European Journal of Operational Research, Elsevier, vol. 261(3), pages 1125-1140.
    15. Varabyova, Yauheniya & Müller, Julia-Maria, 2016. "The efficiency of health care production in OECD countries: A systematic review and meta-analysis of cross-country comparisons," Health Policy, Elsevier, vol. 120(3), pages 252-263.
    16. Simar, Leopold & Wilson, Paul, 2018. "Technical, Allocative and Overall Efficiency: Inference and Hypothesis Testing," LIDAM Discussion Papers ISBA 2018018, Université catholique de Louvain, Institute of Statistics, Biostatistics and Actuarial Sciences (ISBA).
    17. Caitlin O’Loughlin & Léopold Simar & Paul W. Wilson, 2023. "Methodologies for assessing government efficiency," Chapters, in: António Afonso & João Tovar Jalles & Ana Venâncio (ed.), Handbook on Public Sector Efficiency, chapter 4, pages 72-101, Edward Elgar Publishing.
    18. Andreas Behr & Katja Theune, 2017. "Health System Efficiency: A Fragmented Picture Based on OECD Data," PharmacoEconomics - Open, Springer, vol. 1(3), pages 203-221, September.
    19. Daraio, Cinzia & Simar, Leopold & Wilson, Paul, 2019. "Quality and its impact on efficiency," LIDAM Discussion Papers ISBA 2019004, Université catholique de Louvain, Institute of Statistics, Biostatistics and Actuarial Sciences (ISBA).
    20. Cheng, Gang & Zervopoulos, Panagiotis D., 2014. "Estimating the technical efficiency of health care systems: A cross-country comparison using the directional distance function," European Journal of Operational Research, Elsevier, vol. 238(3), pages 899-910.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:soinre:v:143:y:2019:i:1:d:10.1007_s11205-018-1969-1. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.