Abstract
BackgroundDistrict hospitals (DHs) provide secondary level of healthcare to a wide range of population in Bangladesh. Efficient utilization of resources in these secondary hospitals is essential for delivering health services at a lower cost. Therefore, we aimed to estimate the technical efficiency of the DHs in Bangladesh.MethodsWe used input-oriented data envelopment analysis method to estimate the variable returns to scale (VRS) and constant returns to scale (CRS) technical efficiency of the DHs using data from Local Health Bulletin, 2015. In this model, we considered workforce as well as number of inpatient beds as input variables and number of inpatient, outpatient, and maternal services provided by the DHs as output variables. A Tobit regression model was applied for assessing the association of institutional and environmental characteristics with the technical efficiency scores.ResultsThe average scale, VRS, and CRS technical efficiency of the DHs were estimated to 85%, 92%, and 79% respectively. Population size, poverty headcount, bed occupancy ratio, administrative divisions were significantly associated with the technical efficiency of the DHs. The mean VRS and CRS technical efficiency demonstrated that the DHs, on an average, could reduce their input mix by 8% and 21% respectively while maintaining the same level of output.ConclusionSince the average technical efficiency of the DHs was 79%, there is little scope for overall improvements in these facilities by adjusting inputs. Therefore, we recommend to invest further in the DHs for improvement of services. The Ministry of Health and Family Welfare (MoHFW) should improve the efficiency in resource allocation by setting an input-mix formula for DHs considering health and socio-economic indicators (e.g., population density, poverty, bed occupancy ratio). The formula can be designed by learning from the input mix in the more efficient DHs. The MoHFW should conduct this kind of benchmarking study regularly to assess the efficiency level of health facilities which may contribute to reduce the wastage of resources and consequently to provide more affordable and accessible public hospital care.
Highlights
District hospitals (DHs) provide secondary level of healthcare to a wide range of population in Bangladesh
The mean variable returns to scale (VRS) and constant returns to scale (CRS) technical efficiency score of the DHs may reflect that these DHs, on an average, could reduce their input mix by 8% and 21% respectively while maintaining the same level of output
The formula can be designed by learning from the input mix in the efficient DHs
Summary
District hospitals (DHs) provide secondary level of healthcare to a wide range of population in Bangladesh. Efficient utilization of resources in these secondary hospitals is essential for delivering health services at a lower cost. Sustainable development goals (SDG), developed by the United Nations General Assembly, includes health as a major component to ensure healthy lives and promote well-being for all ages by 2030 [1]. The country had a population of 161 million in 2015. Bangladesh government is obliged to provide basic healthcare to every citizen. To ensure healthcare for the citizens, the country has built a structured health system covering different healthcare services, health education, health promotion, and rehabilitation. The health systems have a tire structure that includes primary, secondary, and tertiary level of healthcare facilities in communities, sub-districts, districts, and divisions of the country
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