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This paper attempts a sub-state level analysis of health system efficiency, focusing on West Bengal, a low income Indian state. Using a stochastic frontier model, it provides an idealized yardstick for evaluation. Our results suggest that overall efficiency of the public health delivery system remains low due to considerable disparities across districts. This is owing to differentials in availability and utilization of inputs such as the per capita availability of hospitals, beds, and manpower, and adversely affects life expectancy. Overcoming these factoral disparities may help the deficient districts to improve life expectancy. It may require a considerable increase in medical and public health expenditure in rural areas in the state and especially calls for resource mobilization to improve infrastructure facilities and maintain essential supplies at primary health centers. This could be attempted partly through funds from the National Rural Health Mission (NRHM) and by improving rural sanitation in poorer districts. [ABSTRACT FROM AUTHOR]

In recent years, there has been renewed emphasis on efficiency in resource utilization in the healthcare sector. Most studies in the Indian context have focused on state level analysis. This paper explores sub-state level health system efficiency in Orissa, a low-income state in India. Our analysis estimates the efficiency of the healthcare system at sub-state level using 2012 district level data. We explore the reasons for relative performance of different districts using a frontier estimation technique. There is a substantial difference in performance between the most efficient district of Jharsuguda and the least efficient district of Balangir, resulting from inadequate utilization of available health care resources. Our study also identifies complementarity of private health care resources and the role of other factors, such as sanitation facilities, village electrification, and rural population growth. Our results suggest a need for better utilization of budgetary resources, both under the state department of health and the National Rural Health Mission, to increase health manpower and improve quality through training and better management resources in order to improve district health systems in Orissa. [ABSTRACT FROM AUTHOR]