Technical Efficiency of Maternal Health Services Provision in Public Hospitals of Northwest Ethiopia: A Two-Stage Data Envelopment Analysis

Tsegaw Amare, Mezgebu Yitayal, Getasew Amare Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Getasew AmareDepartment of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO Box – 196, Gondar, EthiopiaTel +251910151944Email getasewa23@gmail.comIntroduction: Ethiopian health expenditure as a share of total government expenditure increased from 7.6% in 2013/14 to 8.1% in 2016/17. But it remained low even for the low-income country average expected share of 8.7%. It signifies the efficient use of scarce resources in the health sector is still critical to achieving sustainable development goals. But little evidence is available about public hospitals’ technical efficiency in providing maternal health services. Therefore, the aim of this study was to assess the technical efficiency of maternal health services provision of public hospitals in Northwest Ethiopia.Methods: Facility-based cross-sectional study was conducted among twelve randomly selected public hospitals. Input data (salary expenditure, non-salary expenditure, and the number of beds) and maternal health services output data (antenatal care, skilled delivery, and postnatal care) for a 2011 Ethiopian fiscal year (July 2018 to June 2019) were collected and entered into Epi-Data 3.1. We used both primary and secondary data collection procedures to determine independent variables and the dependent variable, respectively. We also used a two-stage input-oriented data envelopment analysis with variable returns to scale assumption.Results: The study showed that hospitals included in this study wasted US$ 6833.50 for salary and US$ 3886.8 for non-salary expenditures. The study also revealed that the mean pure technical efficiency of public hospitals for maternal health service provision was 0.92± 0.142, and their scale efficiency was 0.795± 0.24. The hospital manager’s experience year, the educational level of the manager, and the hospital service year associated positively with the technical efficiency. However, the catchment population and distance of another health facility associated negatively with technical efficiency.Conclusion: The public hospitals’ pure technical efficiency in the provision of maternal health services in Northwest Ethiopia was high. More than half of the public hospitals were technically efficient. The wasted amount of expenditures could be used for satisfying the unmet health services need of the population. Therefore, it is better to monitor the health facilities for the wise use of the existing resources for their best performance.Keywords: technical efficiency, maternal health service, public hospitals, data envelopment analysis, tobit model, Northwest Ethiopia