Skip to main content

Advertisement

Log in

A Performance Assessment Method for Hospitals: The Case of Municipal Hospitals in Angola

  • Original Paper
  • Published:
Journal of Medical Systems Aims and scope Submit manuscript

Abstract

Over 60% of the recurrent budget of the Ministry of Health (MoH) in Angola is spent on the operations of the fixed health care facilities (health centres plus hospitals). However, to date, no study has been attempted to investigate how efficiently those resources are used to produce health services. Therefore the objectives of this study were to assess the technical efficiency of public municipal hospitals in Angola; assess changes in productivity over time with a view to analyzing changes in efficiency and technology; and demonstrate how the results can be used in the pursuit of the public health objective of promoting efficiency in the use of health resources. The analysis was based on a 3-year panel data from all the 28 public municipal hospitals in Angola. Data Envelopment Analysis (DEA), a non-parametric linear programming approach, was employed to assess the technical and scale efficiency and productivity change over time using Malmquist index.The results show that on average, productivity of municipal hospitals in Angola increased by 4.5% over the period 2000–2002; that growth was due to improvements in efficiency rather than innovation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. European Union and World Bank: Angola public expenditure in the health sector. Luanda; 2007.

  2. WHO: World Health Organization: The world health report 2006: working together for health. Geneva; 2006.

  3. UNDP: Human Development Report 2005, International cooperation at a crossroads: aid, trade and security in an unequal world. Oxford University Press, New York, 2005.

    Google Scholar 

  4. The World Bank: World Development Indicators database. Washington, D.C.; 2005. http://devdata.worldbank.org/

  5. Government of Angola: Public financing of the social sectors in Angola. Luanda; 2002.

  6. Charnes, A., Cooper, W. W., and Rhodes, E., Measuring efficiency of decision-making units. Eur. J. Oper. Res. 2–6:429–444, 1978.

    Article  MathSciNet  Google Scholar 

  7. Chang, H., Determinants of hospital efficiency: the case of central government-owned hospitals in Taiwan. Omega Int. J. Managet. Sci. 26(2):307–317, 1998.

    Article  Google Scholar 

  8. Wan, T. T. H., Hsu, N., Feng, R., Ma, A., Pan, S., and Chou, M., Technical efficiency of nursing units in a tertiary care hospital in Taiwan. J. Med. Syst. 26(1):21–27, 2002.

    Article  Google Scholar 

  9. Osei, D., George, M., d’Almeida, S., George, M., Kirigia, J. M., Mensah, A. O., and Kainyu, L. H., Technical efficiency of public district hospitals and health centres in Ghana: a pilot study. Cost Effectiveness and Resource Allocation, 2005, 3:9. http://www.resource-allocation.com/content/3/1/9

  10. Kirigia, J. M., Emrouznejad, A., Sambo, L. G., Munguti, N., and Liambila, W., Using data envelopment analysis to measure the technical efficiency of public health centers in Kenya. J. Med. Syst. 28(2):155–166, 2004.

    Article  Google Scholar 

  11. Kirigia, J. M., Emrouznejad, A., and Sambo, L. G., Measurement of Technical Efficiency of Public Hospitals in Kenya: using Data Envelopment Analysis. J. Med. Syst. 26(1):39–45, 2002.

    Article  Google Scholar 

  12. Zere, E., Mbeeli, T., Shangula, K., Mandlhate, C., Mutirua, K., Tjivambi, B., et al., Technical efficiency of district hospitals: Evidence from Namibia using Data Envelopment Analysis. Cost Effectiveness and Resource Allocation, 2006, 4:5. http://www.resource-allocation.com/content/4/1/5.

  13. Kirigia, J. M., Emrouznejad, A., Vaz, R. G., Bastiene, H., and Padayachy, J., A comparative assessment of performance and productivity of health centers in Seychelles. Int. J. Product. Perform. Manage. 57(1):72–92, 2008.

    Article  Google Scholar 

  14. Renner, A., Kirigia, J. M., Zere, A. E., Barry, S. P., Kirigia, D. G., Kamara, C., Muthuri, H. K., Technical efficiency of peripheral health units in Pujehun district of Sierra Leone: a DEA application. BMC Health Services Research, 2005, 5:77. http://www.biomedcentral.com/1472-6963/5/77.

  15. Kirigia, J. M., Sambo, L. G., and Scheel, H., Technical efficiency of public clinics in Kwazulu-Natal province of South Africa. East Afr. Med. J. 78(3):S1–S13, 2001.

    Google Scholar 

  16. Kirigia, J. M., Sambo, L. G., and Lambo, E., Are public hospitals in Kwazulu/Natal province of South Africa technically efficient? Afr. J. Health Sci. 7(3/4):24–31, 2000.

    Google Scholar 

  17. Zere, E. A., Addison, T., and McIntyre, D., Hospital efficiency in sub-Saharan Africa: evidence from South Africa. S. Afr. J. Econ. 69(2):336–358, 2001.

    Google Scholar 

  18. Masiye, F., Kirigia, J. M., Emrouznejad, A., Sambo, L. G., Mounkaila, A., Chimfwembe, D., et al., Efficient management of health centres human resources in Zambia. J. Med. Syst. 30(6):473–81, 2006.

    Article  Google Scholar 

  19. Kirigia, J. M., Asbu, Z., Greene, W., and Emrouznejad, A., Technical efficiency, efficiency change, technical progress and productivity growth in the national health systems of continental African countries. East. Afr. Soc. Sci. Res. Rev. XXIII(2):19–40, 2007.

    Article  Google Scholar 

  20. Emrouznejad, A., Parker, B., and Tavares, G., Evaluation of research in efficiency and productivity: A survey and analysis of the first 30 years of scholarly literature in DEA. Socio-Eco Plan Sci. 2008 (in press), DOI 10.1016/j.seps.2007.07.002.

  21. Emrouznejad, A., and Podinovski, V., Data Envelopment Analysis and Performance Management. Warwick University Publisher, Coventry, 2004.

    Google Scholar 

  22. Fare, R., Grosskopf, S., Norris, M., and Zhang, Z., Productivity growth, technical progress, and efficiency change in industrialized countries. Am. Econ. Rev. 84(1):66–83, 1994.

    Google Scholar 

  23. Coelli, T., Rao, D. S. P., and Battese, G., An introduction to efficiency and productivity analysis. Kluwer Academic, Boston, 1998.

    MATH  Google Scholar 

  24. Cooper, W. W., Seiford, L. M., and Zhu, J., Handbook on Data Envelopment Analysis. Kluwer Academic, Boston, MA, 2004.

    MATH  Google Scholar 

  25. Masiye, F., Ndulo, M., Roos, P., and Odegaard, K., A comparative analysis of hospitals in Zambia: a pilot study on efficiency measurement and monitoring. In: Seshamani, V., Mwikisa, C. N., Odegaard, K. (Ed.), Zambias Health Reforms Selected Papers 19952000 (pp. 95–107). Lund, Sweden, 2002.

  26. WHO Regional Office for Africa: Health promotion: a strategy for the African Region. Brazzaville; 2003.

  27. Mwabu, G., and Wang’ombe, J., Health services pricing reforms in Kenya. Int. J. Soc. Econ. 24(1–3):282–293, 1997.

    Article  Google Scholar 

  28. Kirigia, J. M., Preker, A., Carrin, G., Mwikisa, C., and Diarra-Nama, A. J., An overview of health financing patterns and the way forward in the WHO African Region. East Afr. Med. J. 83(8):S1–S28, 2006.

    Google Scholar 

  29. Jones, A. M., and Kirigia, J. M., The determinants of the use of alternative methods of contraception among South African women. Appl. Econ. Lett. 7:501–504, 2000.

    Article  Google Scholar 

  30. Murray, C. J. L., and Frenk, J., A framework for assessing the performance of health systems. Bul. W.H.O. 78(6):717–731, 2000.

    Google Scholar 

  31. WHO: The World Health Report 2000: Health systems—improving performance. Geneva, 2000.

  32. Grifell-Tatje, E., and Lovell, C. A. K., The sources of productivity change in Spanish banking. European. J. Oper. Res. 98:364–380, 1997.

    Article  MATH  Google Scholar 

  33. Graham, H. T., and Bennett, R., Human resources management. Financial Times Pitman, London, 1998.

    Google Scholar 

  34. Goddard, M., Mannion, R., and Smith, P. C., Assessing the performance of NHS Hospital Trusts: the role of ‘hard’ and ‘soft’ information. Health. Policy. 48:119–134, 1999.

    Article  Google Scholar 

  35. Goddard, M., and Smith, P. C., Performance measurement in the new NHS. Health. Policy. Matters. 3:1–8, 2001.

    Google Scholar 

  36. Saltman, R. B., and Ferrousier-Davis, O., The concept of stewardship in health policy. Bull. W.H.O. 78(6):732–739, 2001.

    Google Scholar 

Download references

Acknowledgement

The authors are immensely grateful to Jehovah Jireh for His multifaceted support at all stages of preparing this manuscript; “Felix Masiye” (Harvard School of Public Health, USA) for the constructive comments; “Patricia Akweongo” (Navrongo Health Research Centre, Ghana) for follow-up on data collection; and to the anonymous reviewers of JMS for invaluable comments and suggestions. JMK and SB appreciate the enabling intellectual environment created by Dr Alimata J. Diarra-Nama in the Division of Health Systems and Services Development, WHO/AFRO. The data collection was funded by WHO/AFRO. The manuscript contains the analyses and views of the authors only and does not represent the decisions or stated policies of the institutions they work for.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ali Emrouznejad.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kirigia, J.M., Emrouznejad, A., Cassoma, B. et al. A Performance Assessment Method for Hospitals: The Case of Municipal Hospitals in Angola. J Med Syst 32, 509–519 (2008). https://doi.org/10.1007/s10916-008-9157-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10916-008-9157-5

Keywords

Navigation