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Data Envelopment Analysis has been widely used to analyze the efficiency of health sector in developed countries, since 1978, while in Africa, only a few studies have attempted to apply DEA in the health organizations. In this paper we measure technical efficiency of public health centers in Kenya. Our finding suggests that 44% of public health centers are inefficient. Therefore, the objectives of this study are: to determine the degree of technical efficiency of individual primary health care facilities in Kenya; to recommend the performance targets for inefficient facilities; to estimate the magnitudes of excess inputs; and to recommend what should be done with those excess inputs. The authors believe that this kind of studies should be undertaken in the other countries in the World Health Organization (WHO) African Region with a view to empowering Ministries of Health to play their stewardship role more effectively.

In Sub-Saharan Africa (SSA), there is a huge knowledge gap of health facilities performance. The objective of this study is to measure relative technical efficiencies of 54 public hospitals in Kenya using Data Envelopment Analysis (DEA) technique. 14 (26%) of the public hospitals were found to be technically inefficient. The study singled out the inefficient hospitals and provided the magnitudes of specific input reductions or output increases needed to attain technical efficiency.

Poor countries can ill-afford ineffective health care. An effective disease intervention is one which produces a net improvement in beneficiaries' quality of life and/or increases life expectancy. Unlike developed countries, very little research has been done in developing countries on the measures of the ultimate output of health care. The objectives of this study were to: (i) apply the existing health-related quality of life (HRQoL) methods in eliciting health state valuations from farmers, teachers and health professionals living and working in the schistosomiasis endemic Mwea Irrigation Scheme in Kenya; (ii) determine whether there is significant difference between average health states valuations from the three main groups of people at risk of schistosomiasis infection; and (iii) assess the relative effect of different respondent characteristics and health states prognosis on valuations. The instrument consists of seven health state descriptions-each defined along six functional dimensions: self-care, mobility, livelihood activities, energy, social participation and pain. Cardinal health state values were measured using a visual-analogue-scale (VAS). Values were elicited from three random samples of farming general public, medical professionals and teachers. The Kruskal-Wallis one-way ANOVA test showed that there is significant difference in the average health state values (for mild, moderate, severe, very severe and comatose states) obtained from the three samples. Generally, except for the valuation of the immediately following state, the other explanatory variables are not statistically significant determinants of valuations for the mild, moderate, severe and very severe states. The results suggest that VAS valuations are primarily affected by prognosis. There is urgent need for more representative and systematic HRQoL studies to test the relevance of the Western-based generic instruments in African countries contexts, with a view to developing more appropriate tool(s) if necessary.

Objective: To calculate the costs at Kilifi District Hospital (KDH) and Malindi Sub-district Hospital (MSH) of treating paediatric malaria admissions including three common presentations of severe paediatric malaria, i.e. cerebral malaria, severe malaria anaemia and malaria-associated seizures; and to estimate the implications for hospital expenditure of a reduction in paediatric malaria admissions., Methods: Patient data were obtained from hospital records. All costs were allocated to departments that provided direct patient care by a four-stage step-down procedure. Laboratory and drug costs of treating paediatric malaria admissions were separately identified., Result: Unit recurrent costs per admission in KDH ranged from US $57 for 'other' paediatric malaria to US $105 for cerebral malaria, and in MSH from US $33 to US $44 for the same categories. The annual recurrent cost of treating all paediatric malaria admissions to KDH prior to the trial was estimated at US $78 900. Adjusting for preintervention differences in malaria admission rates and age between intervention and control areas, the ITBN trial found a 41% reduction in paediatric malaria admissions. The reduction in admissions resulted in an estimated saving of US $6240 in the cost of treating paediatric malaria admissions from the intervention area., Conclusion: There would be a substantial reduction in costs of treating paediatric malaria admissions if the intervention were introduced in the whole catchment area of the hospital. Actual savings would depend on the proportion of potential savings that can in practice be realised, and on the effectiveness of the intervention when routinely implemented.

The limited resources allocated to Schistosomiasis Control Programme in Kenya are not adequate to implement and sustain all technically efficacious interventions simultaneously. This fact has dawned upon both policy-makers and medical personnel who hitherto advocated a multi-faceted approach to 'eradicate' schistosomiasis. Given that Kenya cannot afford to implement all interventions that might conceivably be of some benefit, it is necessary to establish priorities based on considerations of both costs and benefits. An important part of the benefit of any health intervention is its effect on health (quality and quantity of life) of potential beneficiaries. The objectives of this study were to: identify relevant types of data needed in estimating impacts of schistosomiasis interventions on health status; develop an instrument which can be used to obtain subjective probabilistic impacts of interventions; test its operational feasibility; develop a conceptual framework within which impacts of interventions can be estimated; illustrate how the probabilities could be used in calculating the 'expected quality adjusted life years' (EQALY); and identify obstacles that need to be overcome within a developing country context. In this study, a 'modified Delphi' approach was used to elicit expert subjective judgements on the effectiveness of ten schistosomiasis interventions. The paper compares and contrasts the expected quality adjusted life years estimated using values obtained from two local schistosomiasis experts with those obtained from a foreign expert. The panelists appeared to be consistent in their ranking of the effectiveness of treatment vs. non-treatment options. However, there were large differences in the magnitudes of estimates obtained from the local and the foreign experts. Given that the Delphi technique has been widely and fruitfully used in industry and commerce (among other areas) in developed countries, African countries health policy-makers cannot possibly do worse (than the current practice where decisions to commit resources are based on 'what we did last time' and 'gut feelings') by using systematic decision analyses based on data from such a technique.