Abstract
BackgroundDespite improvements in a number of health outcome indicators partly due to the National Health Insurance Scheme (NHIS), Ghana is unlikely to attain all its health-related millennium development goals before the end of 2015. Inefficient use of available limited resources has been cited as a contributory factor for this predicament. This study sought to explore efficiency levels of NHIS-accredited private and public health facilities; ascertain factors that account for differences in efficiency and determine the association between quality care and efficiency levels.MethodsThe study is a cross-sectional survey of NHIS-accredited primary health facilities (n = 64) in two regions in southern Ghana. Data Envelopment Analysis was used to estimate technical efficiency of sampled health facilities while Tobit regression was employed to predict factors associated with efficiency levels. Spearman correlation test was performed to determine the association between quality care and efficiency.ResultsOverall, 20 out of the 64 health facilities (31 %) were optimally efficient relative to their peers. Out of the 20 efficient facilities, 10 (50 %) were Public/government owned facilities; 8 (40 %) were Private-for-profit facilities and 2 (10 %) were Private-not-for-profit/Mission facilities. Mission (Coef. = 52.1; p = 0.000) and Public (Coef. = 42.9; p = 0.002) facilities located in the Western region (predominantly rural) had higher odds of attaining the 100 % technical efficiency benchmark than those located in the Greater Accra region (largely urban). No significant association was found between technical efficiency scores of health facilities and many technical quality care proxies, except in overall quality score per the NHIS accreditation data (Coef. = −0.3158; p < 0.05) and SafeCare Essentials quality score on environmental safety for staff and patients (Coef. = −0.2764; p < 0.05) where the association was negative.ConclusionsThe findings suggest some level of wastage of health resources in many healthcare facilities, especially those located in urban areas. The Ministry of Health and relevant stakeholders should undertake more effective need analysis to inform resource allocation, distribution and capacity building to promote efficient utilization of limited resources without compromising quality care standards.
Highlights
Despite improvements in a number of health outcome indicators partly due to the National Health Insurance Scheme (NHIS), Ghana is unlikely to attain all its health-related millennium development goals before the end of 2015
Characteristics of health facilities All 64 clinics and health centres fully participated in the study representing a return rate of 100 %
Close to 60 % of the facilities were located in rural areas; 55 % were either owned or managed by males; 55 % did not receive any form of donor funding support; 78 % had no functional computers in place and 92 % had no active complaint systems for clients
Summary
Despite improvements in a number of health outcome indicators partly due to the National Health Insurance Scheme (NHIS), Ghana is unlikely to attain all its health-related millennium development goals before the end of 2015. Under-five mortality was 69 per 1000 live births in Ghana compared to 166 in Burkina Faso and 119 in Cote d’Ivoire [2] Notwithstanding these achievements, limited health resources keep confronting the country in meeting its health targets including the health-related millennium development goals (MDGs) [3], termed sustainable development goals (SDGs). The Ministry of Health (MoH) is responsible for policy formulation and resource mobilization while the national headquarters of the Ghana Health Service (GHS) is responsible for policy implementation through the regional and district health administrations. Health centres, clinics and community-based health planning and services (CHPS) compounds are monitored and supervised by the DHMTs
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