Technical efficiency of public clinics in Kwazulu-Natal Province of South Africa

Abstract

Background: In sub Saharan Africa (SSA) much of the attention of policy makers, healthcare managers, health systems researchers, and donors is focussed almost solely on mobilising additional resources and not on efficiency in their use. Objective(s): To investigate the technical inefficiencies among 155 primary healthcare clinics in Kwazulu Natal Province of South Africa and to draw policy implications. Design: Cross sectional provincial health clinic survey. Setting: Kwazulu Natal Provincial Department of Health Clinics survey, 1996. Subjects: The analysis is based on 155 public clinics. Interventions: Non intervention data envelopment analysis (DEA) study. Main outcome measures: Technical and scale efficiency scores. Results: Forty seven (30%) public clinics were found to be technically efficient. Among the 108 (70%) technically inefficient facilities, 16% had an efficiency score of 50% or less. The presence of inefficiencies indicates that a clinic has excess inputs or insufficient outputs compared to those clinics on the efficiency frontier. To achieve technical efficiency, Kwazulu Natal clinics would, in total, have to decrease inputs by 417 nurses and 457 general staff. Alternatively, outputs would have to be increased by 115,534 antenatal visits, 1,010 births (deliveries), 179,075 childcare visits, 5,702 dental visits, 121,658 family planning visits, 36,032 psychiatric visits, 56,068 sexually transmitted disease visits, and 34,270 tuberculosis visits. Conclusion: There is need for more detailed studies in a number of the relatively efficient clinics to determine why they are efficient with a view to documenting attributes of "best practice" that other clinics can emulate. The potential benefit of replicating this kind of study in other provinces, and indeed, other SSA countries cannot be overemphasised.