Data envelopment analysis cross-efficiency of primary health care in Lagos metropolis, Nigeria

Abstract

The goal of this study is to assess primary healthcare's efficiency and ranking throughout the Lagos metropolis, Nigeria. These centers are responsible for delivering primary healthcare services. Primary and secondary data collection methods were used to collect 2019 data from fifteen primary healthcare facilities (PHCs) on four input variables (beds, medical and non-medical staff, outpatients and inpatients), and three output values (antenatal, deliveries, and quality of care), as well as from the Lagos State Primary Health Care Board (LSPHCB). Three models were used to assess the effectiveness of PHC in the Lagos metropolis: CCR (Charnes, Cooper, and Rhodes) Data Envelopment Analysis (DEA), Cross-efficiency (Aggressive and Benevolent) model, and the Maverick index. An R software code was written to solve the models. The results indicate that nine PHCs were efficient and six were inefficient, with cross-efficiency ratings ranging from 0.2491 to 0.6815 for aggressive PHCs and 0.3977 to 0.9206 for benevolent PHCs, respectively. Aina-ajobo, Ogundimu, and Odunmbaku obtained the highest rank in the aggressive model with cross-efficiency 0.6815, 0.6269, 0.5321; and Ogundimu, Aina-ajobo, and Odunmbaku obtained the highest rank in the benevolent model with cross-efficiency 0.9206, 0.9190, 0.8357; while Dopemu, powerline, and Shoretire obtained the lowest rank in the benevolent model Aina-ajobo and Ogundimu achieved the best outcomes across all models. Additionally, the Maverick index indicates that all the PHC are maverick in the aggressive with nine false positive efficiency and eleven maverick in the benevolent, with six false positive efficiency. From the analysis of the three models, none of the PHC in Lagos metropolis is operating efficiently. The cross-efficiency analysis fully discriminates between all PHCs; the scores are unique and give comparable rankings; and the overall performance objective is met.