Productive efficiency analysis of primary healthcare services in Afghanistan: a DEA study

Very little is known about the productive efficiency of the large scale contracting-out mechanism that delivers basic healthcare services in Afghanistan. This study analyses the relative efficiency of basic package of health services (BPHS) facilities and examines the factors associated with the efficiency of health facilities (HFs) in Afghanistan. Data envelopment analysis (DEA) model is used on the primary data, collected in 2011. Using the DEA scores in a fractional logit regression model, we estimate the effects of exogenous factors on the productive efficiency of the HFs. The level of the HF and the productive efficiency are not linearly related – the lowest level facilities are quite evenly distributed in the range of efficiency scores. This study establishes the need for a better understanding of the HF – specific management processes and the geography specific healthcare demand situation for a better policy decisions in the distribution of HFs for the country.