Technical efficiency of peripheral health units in Pujehun district of Sierra Leone: a DEA application

This study applied the Data Envelopment Analysis approach to investigate the TE and SE among a sample of 37 PHUs in Sierra Leone.Twenty-two (59%) of the 37 health units analysed were found to be technically inefficient, with an average score of 63% (standard deviation = 18%). On the other hand, 24 (65%) health units were found to be scale inefficient, with an average scale efficiency score of 72% (standard deviation = 17%).It is concluded that with the existing high levels of pure technical and scale inefficiency, scaling up of interventions to achieve both global and regional targets such as the MDG and Abuja health targets becomes far-fetched. In a country with per capita expenditure on health of about US$7, and with only 30% of its population having access to health services, it is demonstrated that efficiency savings can significantly augment the government's initiatives to cater for the unmet health care needs of the population. Therefore, we strongly recommend that Sierra Leone and all other countries in the Region should institutionalise health facility efficiency monitoring at the Ministry of Health headquarter (MoH/HQ) and at each health district headquarter."Public health is the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort." [1]Located in West Africa, Sierra Leone has a population of 4.6 million and a total fertility rate of 6.5. Its health indicators are poor. For example, life expectancy at birth is 34.2 years; the probability of dying (per 1000 live births) before the age of 5 years is 313 and between 15 and 59 years is 619 [2]. The number of maternal deaths per 100000 live births is 2000 [3]. These dismal health indicators are a reflection of poor governance [4], poor macroeconomic performance [5] and poor national health system performance [6].The total expenditure on health as a percentage of the gross domestic product (GDP) increased from 2.6% in 1996 to 4.3% in 2000 [2