Efficiency of health systems in developing countries: the case of the member countries of the Economic Community of West African States

Developing countries are faced with numerous health challenges such as lack of funding, increasing frequency and magnitude of epidemic risks, organizational and socio-cultural difficulties. In this context, we developed this study to assess for the first time the efficiency of health systems in the countries of the West African sub-region, firstly, to identify the systems that best adapt to these challenges and secondly, to highlight the factors that influence the health production process. To achieve this, we used the World Bank's worldwide governance indicators database, supplemented by data from the World Health Organization from 2000 to 2018. We used the stochastic fixed-effect frontier method of Kumbhakar et al. (2014) to account forunobservable heterogeneity in the estimates. We used a novel multiple imputation approach to deal with missing data, while determining the fractions of missing information in the estimates.The results show that the average relative efficiency for all countries in the subregion is 74%. Countries in the West African sub-region could theoretically increase life expectancy at birth by an average of 26 percentage points or 19.7 life years, with the same level of resources used. The results also show that health systems in these countries have higher permanent inefficiency than temporal inefficiency, suggesting that they mainly face structural challenges.Per capita health expenditure, gross domestic product per capita, literacy rate, and quality of governance are positively associated with the efficiency of their health systems.