Health system productivity in sub-Saharan Africa: tuberculosis control in high burden countries.

Background: Sixteen of the 30 countries with a high tuberculosis (TB) burden are in Sub-Saharan Africa (SSA). Over 25% of TB deaths occur in the Africa region. This study aims to estimate the productivity changes of TB programs in 16 SSA countries where TB is endemic. Methods: We used Hicks-Moorsteen index to compute and decompose Total factor productivity (TFP), and the β-convergence and σ-convergence tests to check for convergence patterns among SSA countries. Results: We found that technological change has been the main driver of the TFP growth, and that increasing technical efficiency may be the first objective in efforts to improve TFP of TB programs. Moreover, the convergence tests reveal significant homogeneity in terms of TFP change between SSA countries studied. Conclusion: The findings suggest that improving technical efficiency of TB programs mainly calls for better resource allocation, capacity building in governance and management of programs, improved training of the health providers and stronger prevention policies. Policymakers must design models for integration of TB treatment under the universal health insurance schemes. Highlights: Sixteen of the 30 countries with a high tuberculosis (TB) burden are in Sub-Saharan Africa (SSA). The main objective of this study is to estimate the productivity change of TB programs in Sub-Saharan Africa (SSA). We used Hicks-Moorsteen index to compute total factor productivity. We also provide findings on productivity changes in terms of convergence. Increasing technical efficiency of TB programs is the first objective in improving overall factor productivity. An efficient use of funds will arguably reduce the number of tuberculosis cases and TB burden. Action for Strengthening Good Governance of TB programs in SSA is imperative. Policymakers must design models for integration of TB services under the universal health insurance schemes. [ABSTRACT FROM AUTHOR]