TECHNICAL EFFICIENCY ASSESSMENT OF MATERNAL HEALTH SERVICES IN NEGERI SEMBILAN, MALAYSIA USING DATA ENVELOPMENT ANALYSIS

Abstract

Introduction: Primary care is the first level of contact with the health system to promote health, prevent illness, care for common illnesses, and manage on-going health problems. Maternal health services were one of the important components of primary care delivered through health clinics and community clinics. It is crucial to ensure scarce resources in health clinic were utilized efficiently. Data envelop analysis is a technique which had advantage in assessment of efficiency of primary care because the technique can handle multiple inputs and outputs in efficiency score calculation. 

Objectives: To assess technical efficiency of maternal health services and it determinants in primary care setting of health clinics in Negeri Sembilan using data envelopment analysis (DEA).

Methodology: This evaluation research employing cross-sectional study design using primary data from health district offices and health clinics in Negeri Sembilan. Sources of data includes administrative records and expenditure records from district health offices, and maternal health services utilization obtained from clinic records. The study randomly selected 16 maternal health services of health clinics as DMUs. Data for 2016 and 2017 were used in the analysis. Analysis of DEA used two-stage DEA. In the first stage DEA to efficiency score, namely: overall technical efficiency (OTE), pure technical efficiency (PTE) and scale efficiency (SE) scores.  In the second stage, four environmental variables namely location of health clinic, distance of health clinic to the nearest health facility, years of service of nurses and comorbidity of patient regressed against PTE score using Tobit regression analysis.  

Results: In 2016, average pure technical efficiency (PTE) for maternal health services were 60.50% (SD 35.50). An increased in mean PTE in 2017 for maternal health services with the score of 67.30% (SD 34.30). Maternal health services in type 2 health clinic were efficient as compared with other types of health clinic in 2016. In 2017, maternal health services in health clinic type 6 were efficient. One determinant was found to significantly affect TE (comorbidity of patient).

Conclusion: The findings from this study found that technical efficient maternal health services in Negeri Sembilan were in Health Clinic Type 5 (31.25%) and Health Clinic Type 6 (37.50%) in 2016 and 2017 respectively. Patients with more comorbidity significantly decrease technical efficiency of maternal health services.

Keywords: technical efficiency, maternal health, primary care service, health clinic, data envelopment analysis.