TECHNICAL EFFICIENCY OF NEONATAL HEALTH SERVICES PROVISION AND ASSOCIATED FACTORS IN PRIMARY HOSPITALS OF SOUTHWEST AMHARA NATIONAL REGIONAL STATE, ETHIOPIA, 2021

Abstract

Abstract Introduction: In Ethiopia, higher mortality rates were reported among neonates and children due to scarcity and the inefficient utilization of health service resources. However, Information on the experience of health facilities regarding efficient resource utilization is limited in the country. Therefore, the aim of this study was to assess the technical efficiency of neonatal health services provision and associated factors in primary hospitals of Southwest Amhara national regional state, Ethiopia. Methods: Facility-based cross-sectional quantitative study was conducted among 15 randomly selected primary hospitals from March 17 to April 17, 2021. Input data (non-salary recurrent expenses, salary expenses, and number of beds) and output data (neonatal admissions, outpatient visits, and referrals) of one year (2019/20) were collected. The data were collected using a selfadministered questionnaire

and document reviews and entered into Epi-Data 4.6. Input oriented data envelopment analysis with a variable return to scale assumption was used to estimate the efficiency scores and Tobit regression model was employed to identify the associated factors. Results: The study showed that 12 (80%) of the primary hospitals were pure technical efficient and seven (46.67%) were scale efficient. All the scale inefficient hospitals were operating below from their scale. The mean of pure technical efficiency and scale efficiency of the primary hospitals was 0.948±0.113 and 0.887±0.143, respectively. Total catchment population, presence of incentive packages for the clinical staff, and educational status of the head with masters and above were positively associated with the technical efficiency of hospitals with coefficients of 3.42e- 07 , 0.19, and 0.16, respectively. On the other hand, technical efficiency was negatively associated with the presence of a health facility that provide neonatal health services near to the hospital and distance of the head’s residence to the hospital with less than 2km with coefficients of -0.21 and -0.14, respectively. Conclusions: Though most of the primary hospitals in the Southwest Amhara national regional state, Ethiopia were pure technical efficient, more than half of them were scale inefficient. The existing resources in the technical inefficient hospitals could be used to serve additional clients. Keywords: Technical efficiency, data envelopment analysis, neonatal health services, Tobit regression model.