2013年-世界发展银行全球_Health_Sector_Efficiency_in_Kenya___Implications_for_Fiscal_Space_44页_853kb

Summary of "HEALTH SECTOR EFFICIENCY IN KENYA: IMPLICATIONS FOR FISCAL SPACE"

Core Content

This report presents an analysis of the technical and scale efficiency of public health facilities in Kenya, including hospitals, health centres, and dispensaries, using Data Envelopment Analysis (DEA) for the fiscal year 2012. It also reviews the implementation of performance-based financing (PBF) and output-based aid (OBA) in the health sector, highlighting potential efficiency gains and policy implications for improving fiscal space and resource utilization.

Key Findings

Technical Efficiency

• Hospitals:

  • The average technical efficiency of public district hospitals was 72.6%, with 48% operating efficiently and 32% operating less efficiently.
  • Referral hospitals had a higher average efficiency of 82.1%, with 64% being technically efficient.
  • Private hospitals were generally more efficient than public hospitals, with only 1% of private hospitals having efficiency scores below 50%, compared to 33% of public hospitals.
  • Seven out of sixteen counties had inefficient hospitals that could improve their technical efficiency.
  • Most inefficient hospitals showed increasing returns to scale, suggesting they could increase output without increasing input.

• Health Centres:

  • Health centres were less efficient than hospitals, with 18% having technical efficiency below 50% and 11% having 51–80% efficiency.
  • Public health centres performed slightly better than private ones.
  • 22 out of 40 counties had health centres with 100% efficiency.

• Dispensaries:

  • Only 21% of dispensaries were technically efficient, with 58% having efficiency scores below 50%.
  • Private dispensaries were more efficient than public ones, with 18% of private dispensaries efficient compared to 48% of public dispensaries.
  • The majority of inefficient dispensaries could increase output or reduce input to become more efficient.

DEA Efficiency Ratings

• DEA efficiency scores for hospitals, health centres, and dispensaries were calculated.
• Technical and scale efficiency were separated, with scale efficiency being the ratio of constant returns to scale (CRS) efficiency to variable returns to scale (VRS) efficiency.

Review of Performance-Based Financing (PBF)

• PBF and OBA programs have shown improvements in the utilization of the safe motherhood package, with 77% of vouchers redeemed.
• These programs have led to improved quality of services and greater equity by targeting poor families.
• Competitive bidding has helped reduce the cost of running OBA components and improve service efficiency.
• The OBA program demonstrates that performance-based reimbursement can be an effective model for future policy design.

Conclusions

• The DEA method is effective in evaluating the efficiency of health facilities.
• A significant proportion of public health facilities are inefficient, using more resources than necessary.
• Productivity differences exist between public and private hospitals, with public hospitals generally less efficient.
• Efficient facilities can serve as benchmarks for improving the performance of inefficient ones.
• The study underscores the importance of efficiency in achieving universal health coverage and better value for money in a resource-constrained environment.

Policy Implications

• DEA results can guide planners and managers in improving efficiency.
• Accountability in the health sector can be enhanced through efficiency analysis, especially during the devolution process.
• Institutionalization of health management information systems (HMIS) is critical for routine data collection and regular efficiency assessments.
• Funding should be linked to performance to encourage efficient resource use.
• Further qualitative studies on efficient and inefficient facilities are needed to identify the causes of inefficiency.
• Efficiency benchmarking can help focus policy interventions on underperforming facilities and improve resource allocation.

Recommendations

• Train health economists and planners in the use of efficiency measurement tools.
• Adapt and improve efficiency data collection instruments.
• Conduct pilot studies on efficient and inefficient facilities to inform policy.
• Establish efficiency databases at the national and county levels.
• Strengthen HMIS to collect and analyze input and output data regularly.

Key Terms and Abbreviations

• DEA: Data Envelopment Analysis
• TE: Technical Efficiency
• SE: Scale Efficiency
• OBA: Output-Based Aid
• PBF: Performance-Based Financing
• HMIS: Health Management Information System
• NHIF: National Health Insurance Fund
• KIPPRA: Kenya Institute for Public Policy Research and Analysis
• IPAR: Institute of Policy Analysis and Research
• IEA: Institute of Economic Affairs
• IMF: International Monetary Fund
• WB: World Bank
• PAC: Public Accounts Committee
• PER: Public Expenditure Review
• MTEF: Medium Term Expenditure Framework
• LDC: Less Developed Country
• KRA: Kenya Revenue Authority

Methodology and Model

• The study used DEA to assess technical and scale efficiency.
• The VRS model was employed to estimate scale efficiency.
• DEA calculates efficiency scores by comparing each facility's input and output with those of its peers.
• Efficiency scores range from 0% to 100%, with 100% indicating optimal use of resources.

This report provides a comprehensive overview of the current state of efficiency in Kenya's health sector and outlines actionable policy recommendations to improve performance and resource use.