Technical efficiency of the Nairobi City Council health facilities

Abstract

The Nairobi city council (NCC) and the Ministry of Health (MoH) manage the health facilities within the NCe. Currently, the NCC/MoH facilities are managed under the Nairobi Health Management Board (NHMB) who ensures the collaboration runs smoothly and efficiently. The NCC provides the infrastructure while the MoH provides personnel and supplies. However, despite serving a large population, the health facilities run by the NCC have not been able to meet the needs of the residents. , Anecdotal evidence indicates that most of the facilities are not operating efficiently, hence why the utilization of the services is low. Although in Kenya a few studies have been done to assess the efficiency of rural public health facilities, to the best of my knowledge, these studies excluded primary health facilities run by the city and municipal councils. This study therefore bridges this gap by estimating the efficiency of primary health facilities run by the Nairobi City Council. The study applied Data Envelopment Analysis (DEA) to estimate the efficiency levels of the health centres and dispensaries while a Tobit regression model was used to determine the causes of inefficiency. For the DEA model, the outputs estimated include the number of curative outpatients, the number of children attending the clinic and the number of antenatal clients seen. The inputs used include the number of clinical officers/number of nursing officers and the number of support staff in each dispensary/health centre. The results showed that the overall average level of technical efficiency among the Nairobi City Council health facilities is 75.9%. Under pure technical efficiency 8 out of the 15 health facilities are relatively efficient in 2006 compared to 7 (46.7%) in 2007. On scale efficiency, 6 out of 15 health facilities (40%) were scale inefficient. However for the health facilities to be technically efficient they should have an input target. The study also revealed that there was an excess of 50 nurses/ clinical officers and 24 support staff while the deficits included 11 clinical officers/ nurses and 4.9 support staff. Due to inefficiency, target output, was not realized, a deficit 11,277.6 of the patient from the children clinic, 46,580.3 antenatal visits and 482,569 curative patients was identified. These findings would provide policy planners with information to determine the level of inefficiency and guide them to allocate the optimal inputs for efficient production of the maximum output expected.