Technical Efficiency of Comprehensive Emergency Obstetric and New-Born Care Centres in Tamil Nadu

Abstract

Background: The state government of Tamil Nadu in India has been implementing various health sector reforms to bring down maternal and infant deaths. One such significant step was to set up Comprehensive Emergency Obstetric and New-born Care (CEmONC) centres all over Tamil Nadu under the World Bank-funded Tamil Nadu Health Systems Project (TNHSP) in 2005. However, to date, except for the pilot study reported in this article, no attempt has been made to make an estimate of the efficiency of the CEmONC centres in Tamil Nadu. The objective of this study, based on data on performance indicators collected by the TNHSP for the period April 2009 to March 2010 was to estimate the relative technical efficiency (TE) and scale efficiency (SE) of Phase 1 CEmONC centres in Tamil Nadu using the DEA method. Methods: The Data Envelopment Analysis (DEA) method was used to estimate the efficiency of 48 Phase 1 CEmONC centres operating in secondary hospitals across Tamil Nadu. This is an exploratory study. Results: 10 (out of 48) centres were technically efficient, with an average TE score for inefficient centres of 72.3 per cent and a standard deviation (STD) of 15 per cent under the constant returns to scale assumption. Nineteen centres were technically efficient under variable returns to scale assumption with an average score of 81 per cent (STD of 14 per cent). Thirty-eight centres were scale inefficient with 84 per cent (STD of 11.79 per cent). Discussion: This pilot study demonstrates to the policy-makers the versatility of DEA in measuring inefficiencies among CEmONC centres. A key limitation of this study is that it has not accounted for quality of care. Further research is required to examine why certain centres out-perform others.