Technical efficiency of under-five children health service provision in public health centers in North Gondar zone Amhara Region Ethiopia 2023

Abstract

Background: In Ethiopia, higher mortality rates were reported among neonates and under-five children in case of scarcity and inefficient utilization of health services resources(1). However, the country has limited information on the health facilities’ experience regarding efficient resource utilization. This study therefore attempts to provide some evidence on the extent and causes of technical efficiency that may exist in public health facilities, especially health centers in the North Gondar zone in the Amhara National Region State of Ethiopia. Objective: The study’s aimed to assess the technical efficiency of under- five children’s health services provision and associated factors in public health centers in North Gondar zone Amhara National Region State, Ethiopia in 2023. Methods and Materials: A facility-based cross-sectional study was conducted among five district randomly selected health centers located in the North Gondar zone Amhara national regional state, Ethiopia, from March to April 2023. Using a secondary data collection procedure, input data (non-salary recurrent expenses, salary expenses and the number of beds) and the output data (Fully immunization, outpatient visits, nutritional screening and referrals of under-five children) were collected. The data were collected using self-administered questionnaire and document review entered into Epi- Data version 4.6. The data was obtained for the 2014 Ethiopian fiscal Year report. The Data Envelopment Analysis was used to estimate the efficiency scores, and the Tobit regression model was employed to identify the predictor variables at a 0.05 significance level. Results: The study revealed that eleven (84.6%) of the health center were pure technical efficiency and only seven (53.8%) of health centers were scaled efficient. The mean (±SD) of pure technical efficiency and scale efficiency scores of the health centers were 0.981 (±0.212) and 0.936 (±0.097), respectively. Increase in Years of service in the health center, there is a 29.1% (95% CI: 0.0474-0.5346) increase in the technical efficiency score for the institutional-based under-five children health service in the health center. Total catchment population, incentive packages for the clinical staff, XI

service year of the managers and the educational status of the manager were positively associated with the technical efficiency of health centers. Conclusions: In this study revealed that most of the public health centers were pure technically efficient is high and more than half of them were technical efficient. The presence of inefficiencies indicates that the health center had excess inputs or insufficient outputs compared to that efficient health center with regard to determinants of technical inefficiency(2). These results also indicated that introducing the performance-based provision of incentive packages for clinical staff and employing degree and above-educated health professionals as a manager might improve the efficient utilization of resources in public health centers