Are public hospitals in Kwazulu-Natal Province of South Africa technically efficient?

Abstract

Generally, policy-makers and researchers in South Africa acknowledge that hospitals absorb a disproportionate share of health sector resources. The latter, to a certain extent, have failed to provide evidence needed to guide the former's decisions. Albeit in an ad hoc manner, the post-apartheid policy-makers have been reducing hospital budgets to avail the resources needed to strengthen the hitherto neglected primary health care system. Since political will exists to reduce (if not eliminate) wastage of resources within the hospitals, micro-efficiency analyses (like the one reported here) are needed to guide the policy-makers. This study employs Data Envelopment Analysis (DEA) methodology to identify and measure individual hospital's inefficiencies. The key results are as follows. Forty percent of the hospitals had some degree of technical inefficiency. Fifty eight percent were scale-inefficient. In total, the following inputs are currently wasted and not utilized in the production of hospital outputs in Kwazulu-Natal public hospitals: 117.4 doctors (8.0%); 2709 nurses (11.9%); 61 paramedics (11.5% ); 58 Technician (13.1%); 295 Administrative staff (11.1%); 835 General staff (11.3%); 1,193 Labour provisioning staff (14.3%); 38 Other staff (10.7 %); and 1,752 Beds (7.1%). Those are the specific input reductions required to make inefficient hospitals become technically efficient. In conclusion, the DEA results constitute a strong guide to health care decision making, especially with regard to practical always of increasing efficiency and rational use of health care resources.