[Paper Review] Evaluating the Financial Factors Influencing Maternal, Newborn, and Child Health in Africa

Youssef Er-Rays, Meriem M’dioud|arXiv (Cornell University)|Feb 22, 2024

Global Health Care IssuesHealth Professions3 citations

TL;DR

This study evaluates financial and human resource factors affecting maternal, newborn, and child health (MNCH) service efficiency across 46 African countries using Data Envelopment Analysis (DEA) with variable returns to scale and Tobit regression. It finds only 26% of countries achieve technical efficiency, with current health expenditure, per capita spending, and comprehensive coverage index negatively impacting efficiency—highlighting systemic inefficiencies requiring policy reevaluation of financial and human resource allocation.

ABSTRACT

The study investigated the impact of healthcare system efficiency on the delivery of maternal, newborn, and child services in Africa. Data Envelopment Analysis and Tobit regression were employed to assess the efficiency of 46 healthcare systems across the continent, utilizing the Variable Returns to Scale model with Input orientation to evaluate technical efficiency. The Tobit method was utilized to explore factors contributing to inefficiency, with inputs variables including hospital, physician, and paramedical staff, and outputs variables encompassing maternal, newborn, and child admissions, cesarean interventions, functional competency, and hospitalization days. Results revealed that only 26% of countries exhibited efficiency, highlighting a significant proportion of 74% with inefficiencies. Financial determinants such as current health expenditures, comprehensive coverage index, and current health expenditure per capita were found to have a negative impact on the efficiency of maternal-child services. These findings underscore a marginal deficiency in technical efficiency within Africa's healthcare systems, emphasizing the necessity for policymakers to reassess the roles of both human resources and financial dimensions in enhancing healthcare system performance.

Motivation & Objective

• To assess the technical efficiency of maternal, newborn, and child health (MNCH) service delivery across 46 African countries.
• To identify financial and human resource determinants influencing inefficiencies in MNCH service systems.
• To evaluate the impact of current health expenditures, per capita spending, and comprehensive coverage index on healthcare system performance.
• To inform policy by diagnosing structural inefficiencies in Africa’s MNCH service delivery frameworks.

Proposed method

• Data Envelopment Analysis (DEA) with variable returns to scale (VRS) and input-oriented model to measure technical efficiency of 46 African healthcare systems.
• Tobit regression model used to analyze factors contributing to inefficiency, accounting for censored dependent variables.
• Inputs included hospital, physician, and paramedical staff; outputs included maternal, newborn, and child admissions, cesarean interventions, functional competency, and hospitalization days.
• The study employed a multi-country comparative approach using aggregated national-level health data.
• Statistical models were calibrated to isolate the impact of financial variables on technical efficiency.
• The analysis used data from national health reports and international databases, with robustness checks applied to model validity.

Experimental results

Research questions

• RQ1 What is the level of technical efficiency in maternal, newborn, and child health service delivery across 46 African countries?
• RQ2 How do financial inputs such as current health expenditure and per capita spending influence the efficiency of MNCH services?
• RQ3 To what extent does the comprehensive coverage index affect the performance of African healthcare systems in delivering MNCH services?
• RQ4 Which human resource inputs are most strongly associated with inefficiencies in MNCH service delivery?
• RQ5 What policy-relevant insights can be drawn from the relationship between financial inputs and technical efficiency in African healthcare systems?

Key findings

• Only 26% of African countries demonstrated technical efficiency in maternal, newborn, and child health service delivery, indicating that 74% face significant inefficiencies.
• Current health expenditure and current health expenditure per capita were found to have a statistically significant negative impact on technical efficiency.
• The comprehensive coverage index also showed a negative and significant relationship with efficiency, suggesting that higher coverage does not necessarily translate into better performance.
• The study identifies a marginal deficiency in technical efficiency across Africa’s healthcare systems, particularly in resource allocation and human resource utilization.
• Financial inputs alone do not improve efficiency; misallocation or inefficiency in spending may worsen performance despite increased funding.
• The findings underscore the need for targeted reforms in financial management and human resource planning to enhance MNCH service delivery outcomes.