Efficiency measurement in health facilities: Literature review in low- and middle-income countries

Limited health care resources and budget restrictions in low-and middle- income countries (LMICs) have led policy makers to improve efficiency. Therefore, it is essential to understand how efficiency has been measured in the LMICs setting. To date, no systematic review has been conducted to assess efficiency measurement in health facilities in LMICs. This paper synthesises studies of efficiency measurement in health facilities in LMICs. A systematic search of Embase, MEDLINE, Econlit and Global Health identified 4944 articles with a further 15 articles identified through manual searching. A total of 95 papers were eligible for inclusion. These covered a wide range type of health facilities with more than half of the studies (61%) were hospitals. Most studies (67%) employed Data Envelopment Analysis (DEA,) as efficiency measurement method. Studies usually included physical and financial inputs while they used the number of outpatients, inpatients, or bed-days as outputs. We identified main internal and external contextual factors applied to explore the determinant of health facility efficiency. Most studies suggested policies focused on input optimisation, rather than increasing production. The paper concludes by highlighting the need for routine benchmarking as a monitoring and evaluation tool to improve efficiency