1. Surgical capacity, productivity and efficiency at the district level in Sub-Saharan Africa: A three-country study
- Author
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Zhang, M, Gajewski, J, Pittalis, C, Shrime, M, Broekhuizen, H, Ifeanyichi, M, Clarke, M, Borgstein, E, Lavy, C, Drury, G, Juma, A, Mkandawire, N, Mwapasa, G, Kachimba, J, Mbambiko, M, Chilonga, K, Bijlmakers, L, and Brugha, R
- Subjects
Data Analysis ,Malawi ,Multidisciplinary ,lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] ,Humans ,Investments ,Hospitals, District ,Tanzania - Abstract
Introduction Efficient utilisation of surgical resources is essential when providing surgical care in low-resources settings. Countries are developing plans to scale up surgery, though insufficiently based on empirical evidence. This paper investigates the determinants of hospital efficiency in district hospitals in three African countries. Methods Three-month data, comprising surgical capacity indicators and volumes of major surgical procedures collected from 61 district-level hospitals in Malawi, Tanzania, and Zambia, were analysed. Data envelopment analysis was used to calculate average hospital efficiency scores (max. = 1) for each country. Quantile regression analysis was selected to estimate the relationship between surgical volume and production factors. Two-stage bootstrap regression analysis was used to estimate the determinants of hospital efficiency. Results Average hospital efficiency scores were 0.77 in Tanzania, 0.70 in Malawi and 0.41 in Zambia. Hospitals with high efficiency scores had significantly more surgical staff compared with low efficiency hospitals (DEA score Conclusion Hospital efficiency, combining capacity measures and surgical outputs, is a better indicator of surgical performance than capacity measures, which could be misleading if used alone for surgical planning. Investment in the surgical workforce, in particular, is critical to improving district hospital surgical productivity and efficiency.
- Published
- 2022