A First Look at the Efficiency-Quality Nexus in Soum Health Centers in Mongolia: Insights from Two Surveys

This Working Paper explores whether technical efficiency and quality of care are aligned in Mongolia's Soum Health Centers (SHCs), which are central to rural primary health care and universal health coverage (UHC). Using 2018 data from two studies—one assessing SHC efficiency with DEA (Simar & Wilson double bootstrap), the other measuring service perceived quality with SERVQUAL and potential quality with SARA—the authors analyse 31 SHCs across seven regions (aïmags). Average technical efficiency is 0.73, implying that SHCs could, in principle and in average, maintain current output levels with about 27% fewer inputs, freeing resources for other PHC priorities. Perceived quality, however, is modest (mean SERVQUAL 0.49), and the correlation between efficiency and perceived quality is negative, including for most SERVQUAL dimensions. By contrast, efficiency shows only weak and statistically non-significant associations with SARA-based availability, readiness and a composite "Potential Effective Quality" index. The paper discusses behavioural and institutional mechanisms behind this disconnect, stressing that perceived quality is a major driver of demand, while SARA captures capacity rather than actual quality care. It concludes with policy recommendations aimed at enabling authorities to make informed decisions about aligning efficiency and quality of care: updating and expanding sample and metrics, assessing real healthcare quality in high- and low-efficiency SHCs, explicitly integrating efficiency drivers and contextual factors when analysing quality issues, and systematically feeding back findings to managers, frontline team and central decisionmaking levels.