TECHNICAL EFFICIENCY OF COMPREHENSIVE HEALTH CENTERS IN AFGHANISTAN

Abstract

This study aimed to inspect the issues surrounding efficiency in the Afghanistan public health sector with specific focus on comprehensive health centres (CHC), in order to find out and evaluate the relative efficiency and also to investigate the factors that are affecting the performance of CHCs in Afghanistan. This study applied Data Envelopment Analysis (DEA) approach to observe efficiency scores of 304 sample CHCs'. Outputs of the study include: Antenatal care services, postnatal care services, Skilled birth attendance services, Family planning services, Outpatients services, Vaccination services and Tuberculosis positive case detection. And also the inputs to the study include Outreach health worker, Medical health provider, Ancillary service staff, and supportive staffs. The results disclosed that there were considerable variations of efficiency scores from the best practice frontier in either of return to scale assumptions. Such as: the mean pure technical efficiency (TEVRS) and overall technical efficiency (TECRS) were 64% and 59%, while mean scale efficiency (SE) was 92% under output oriented DEA model. However, TEVRS and TECRS were 66% and 59% and mean SE was of 87% under input oriented DEA model. According to this study 88%(270) of the CHCs found that were running inefficiently and about 70% (215) comprehensive health centres were found to be operating below their average pure technical efficiency score (64%) and 75 CHCs show scale efficient. In Addition the pattern of scale inefficiency shows that a majority (204) of the CHCs were decreasing return to scale efficiency under output oriented DEA. In addition, Tobit regression shown that catchment population positively linked and significantly affecting the technical efficiency [P-value = 0.000]. That means relatively efficient health centres are located in high catchment population areas. Furthermore, from the total explanatory variable for regression analysis only RBF-incentive shown positive link with technical efficiency while the rest of variables shown negative correlation except catchment population described before. In respect to the output oriented DEA model, majority of the CHCs are operating under decreasing return to scale, so reducing the size of those health facilities is recommended to become efficient.