Determinants of technical efficiency of health systems in African least developed countries: A two-stage data envelopment analysis (DEA) approach

Abstract

The objective of this study is to assess factors influencing the technical efficiency of health systems in African least developed countries (LDCs) for the 2008-2018 period. Following the two-stage data envelopment analysis (DEA) approach, DEA and the panel Tobit model are used to assess the technical efficiency of health systems and factors affecting the technical efficiency of health systems. Using panel data from the World Health Organisation, the World Bank, and the United Nations Educational, Scientific and Cultural Organisation, the inputs included out-of-pocket health expenditure, domestic private health expenditure, domestic general government health expenditure, and external health expenditure while the outputs were life expectancy at birth, maternal mortality ratio, under five mortality rate, and infant mortality rate. Several socio-economic and governance factors were also adopted in the assessment of factors affecting the technical efficiency of health systems. The health systems of sixteen African LDCs were technically efficient, while thirteen were technically inefficient. The technical efficiency of health systems in African LDCs was reduced by political stability, voice and accountability and prevalence of HIV while it was increased by gross national income. African LDCs with technically inefficient health systems are recommended to benchmark the practices of African LDCs with technically efficient health systems. They also need to improve political stability, create a conducive environment for accountability and step up the fight against HIV/AIDs.