Efficiency of the health extension programme in Tigray, Ethiopia: a data envelopment analysis

Efficiency was measured using a data envelopment analysis model. A Tobit model was performed to identify factors associated with efficiency. Seven rural districts (out of 35) were purposely chosen. Input/output information was collected from the database of the Tigray Health Bureau during July 2007-June 2008. Information was also collected on environmental factors that might influence the efficiency outcomes through a structured questionnaire from the correspondent district health officers.Analysis was based on data from 60 health posts. The mean scores for technical and scale efficiency were 0.57 (SD = 0.32) and 0.95 (SD = 0.11) respectively. Out of the 60 health posts, 15 (25.0%) were found to be technically efficient constituting the best practice frontier. Thirty eight (63.3%) were operating at their most productive scale size. In the regression analysis, none of the variables was significantly associated with the efficiency outcome.There is a need to review the management of the health information system in the region. The findings have also revealed that only a quarter of the health posts are working efficiently and pointed the need for improvement. A closer monitoring of the health extension programme is required in order to achieve the best possible performance.The last World Health Report (2008) has made a strong call to all the countries to direct their health systems towards the values of primary health care reflected in the Alma Ata declaration 30 years ago: social justice and the right to better health for all, participation and solidarity. Primary health care is considered to offer a comprehensive framework about how health systems can become more equitable, inclusive and fair [1]. To achieve these goals, good performing health systems regarding quality, access and efficiency are required.Being the principal objective of a health system to improve people's health, one of the chief functions the system needs to perform is to deliver health services. It