Analysis of the Technical Efficiency of Public Hospitals in Togo: A Non-Parametric Approach
Most health facilities in Togo are poorly equipped. Consequently, the rate of post-natal consultation remains low and varies between 9.5% and 39.4%. Barely half of all deliveries (47.1%) take place in health facilities. In this study, we analysed technical efficiency scores of 139 Togolese public hospitals over the period 2008–2010, and then identified the determinants of this efficiency. Double bootstrap data envelopment analysis was used to draw consistent inferences. We first estimated bootstrapped efficiency scores. Then, bootstrapped truncated regression was used to identify the determinants of public hospitals efficiency. The results indicate that, on average, small-sized hospitals (periphery care units) investigated, had the highest efficiency scores. The University Teaching Hospitals and regional hospitals which have significant material, human and financial resources were associated with lower efficiency. The most significant and robust factors of technical efficiency are per capita income, competition, hospital’s balance, types of contract, and medical density. We found that income constraint and accessibility to health facilities are obstacles to efficiency. According to our results, we can infer that non-competitive public provision of health services is likely to be inefficient. Another important practical implication is that Togo must vigorously promote reform of the management system in public hospitals which regards corporate quality governance as the core. We hypothesize that if subsidies are allocated according to performance, they can positively affect efficiency. Policy makers should consider tying grant revenues to performance indicators.