Technical efficiency of public hospitals in the provision of maternal health services in selected zones of Oromia Regional State, Ethiopia

Abstract

Background: Ethiopia is one of the countries in sub-Saharan Africa with markedly high maternal mortality ratio. The improvement towards achieving MDG 5 was very slow in the country. And also attaining the new SDG 3.1 is difficult if it continues at this pace. The health systems in Ethiopia faced with critical resource constraints in extending maternal health services of acceptable quality. Consequently, using the available health resources to attain maximum possible maternal health service and reduce maternal mortality is the most important activity of the health sector in the country. Objective: To assess the technical efficiency of public hospitals in selected zones of Oromia regional state, Ethiopia, in the provision of maternal health services, 2014/2015 (2007 EFY). Methods and Participants: Health facility based cross-sectional study was conducted. Data were collected from 14 primary and secondary hospitals from March 25 to April 18, 2016. A structured and pretested checklist based interview and document review was used to collect data. Two stage Data Envelopment Analysis was performed with input orientation and variable returns to scale assumptions. The data were entered in to Epi Data version 3.1, and transferred to SPSS version 20 software for descriptive analysis. Technical efficiency scores were computed using the Data Envelopment Analysis Program, version 2.1 at the first stage. And at second stage predictors were determined by tobit regression using STATA version 12.0. Result: Fourteen primary and secondary hospitals were included in the study. The assessment of maternal health service delivery efficiency among the 14 hospitals revealed that, nine (64.2%) hospitals were technically efficient with mean score of 85.1% (SD = 27.51%). Twelve (85.7%) hospitals were found to be pure technically efficient and nine hospitals were scale efficient with mean score of 99.24% (SD = 2.02%) and 85.86% (SD = 27.79%) respectively. The inefficient hospitals used excess resources like non-salary expenditure 0.97%, salary expenditures of administrative staff 2.28%, physicians 4.85%, clinical and midwife nurses 5.85%, other technical staff 4.95% and number of class rooms and beds for maternal health service 1.85% and 9.62%, respectively. Having the excess resources the hospitals could increase numbers of antenatal care users by 1.12%, deliveries by 3.22%, safe abortion service by 3.49% and post abortion service by 7.84%.The obit regression analysis showed that average waiting time for maternal health service was negatively associated with efficiency. On the other hand, level of the hospital service years of the hospitals and catchment population of the hospitals were positively associated with efficiency of the hospitals in maternal health service. Conclusion: Findings from this study showed that most of hospitals are technically efficient and around two third of the hospitals were operating as scale efficient in maternal health service. The inefficiency is a result of excess technical and administrative staff, beds, non-salary expenses and class rooms. Alternatively while taking the excess resources; the hospitals did not address maternal health service users. Level of the hospitals, catchment population, and service year’s increase; and average waiting time reduction were determinants of technical efficiency of public hospitals.