Can Access to Health Services and Universal Health Coverage Improve the Efficiency of Health Systems in Sub-Saharan African Countries? A Study Based on a Two-Stage Dynamic Data Envelopment Analysis (DEA) Model

Abstract

Health systems, which are dynamic and open systems, have a long-term production process by being affected by investments made in the past periods and/or some negative health indicators. Due to this feature of health systems, more reliable findings can be obtained by using dynamic models that also take into account inter-period effects in efficiency performance analyses. The objective of this study is to evaluate the efficiency of health systems in Sub-Saharan African (SSA) countries using the Dynamic Data Envelopment Analysis (DEA) approach and to identify the key factors influencing their efficiency performance. As a result of Dynamic DEA, SSA average overall efficiency score was calculated as 0.8194 under the input-oriented constant return assumption and 0.8427 under the input-oriented variable return assumption. The highest average efficiency score in SSA countries was in 2015, and the lowest average efficiency score was in 2005. In terms of periods, while the efficiency scores increased from 2005 to 2015, it was observed that it decreased in the last period (2020) compared to the previous period. As a result of Tobit regression, it was found that UHC and HAQ indexes have a positive effect on health system performance, while SDI has a negative effect. Given these findings, policymakers in SSA countries should prioritize strengthening UHC frameworks and improving healthcare access and quality to enhance system efficiency. Additionally, targeted interventions are needed to mitigate the adverse effects of socio-demographic challenges, such as rapid population growth and disease burdens. (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)/(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic).(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic).(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(DEA)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(SSA)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic).(sic)(sic)(sic)(sic)DEA(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), SSA(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic) 0.8194, (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), SSA(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)0.8427.(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)2015(sic), (sic)(sic)(sic)(sic)(sic)2005(sic).(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)2005(sic)(sic)2015(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic) (2020(sic)) (sic)(sic)(sic)(sic).Tobit(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(UHC)(sic)(sic)(sic)(sic)(sic)(sic)(HAQ)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(SDI)(sic)(sic)(sic)(sic)(sic)(sic).(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic).(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic) ((sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic)) (sic)(sic)(sic)(sic)(sic)(sic)(sic). Los sistemas de salud, din & aacute;micos y abiertos, tienen un proceso de producci & oacute;n a largo plazo al verse afectados por las inversiones realizadas en per & iacute;odos anteriores y/o por algunos indicadores de salud negativos. Debido a esta caracter & iacute;stica, se pueden obtener resultados m & aacute;s fiables mediante el uso de modelos din & aacute;micos que tambi & eacute;n consideran los efectos interperiodos en los an & aacute;lisis de eficiencia. El objetivo de este estudio es evaluar la eficiencia de los sistemas de salud en los pa & iacute;ses de & Aacute;frica subsahariana (ASS) mediante el enfoque del An & aacute;lisis Envolvente de Datos Din & aacute;micos (ADE) e identificar los factores clave que influyen en su eficiencia. Como resultado del DEA Din & aacute;mico, la puntuaci & oacute;n media de eficiencia general en & Aacute;frica subsahariana se calcul & oacute; en 0,8194 bajo el supuesto de rendimiento constante orientado a los insumos y en 0,8427 bajo el supuesto de rendimiento variable orientado a los insumos. El puntaje promedio de eficiencia m & aacute;s alto en los pa & iacute;ses del & Aacute;frica Subsahariana se registr & oacute; en 2015 y el m & aacute;s bajo en 2005. Si bien los puntajes de eficiencia aumentaron entre 2005 y 2015, se observ & oacute; una disminuci & oacute;n en el & uacute;ltimo per & iacute;odo (2020) en comparaci & oacute;n con el per & iacute;odo anterior. Como resultado de la regresi & oacute;n Tobit, se encontr & oacute; que los & iacute;ndices de cobertura sanitaria universal (CSU) y de calidad de la atenci & oacute;n (HAQ) tienen un efecto positivo en el desempe & ntilde;o del sistema de salud, mientras que el & iacute;ndice de desarrollo social (SDI) tiene un efecto negativo. Ante estos hallazgos, los responsables de la formulaci & oacute;n de pol & iacute;ticas en los pa & iacute;ses del & Aacute;frica Subsahariana deber & iacute;an priorizar el fortalecimiento de los marcos de cobertura sanitaria universal (CSU) y la mejora del acceso y la calidad de la atenci & oacute;n m & eacute;dica para optimizar la eficiencia del sistema. Adem & aacute;s, se necesitan intervenciones espec & iacute;ficas para mitigar los efectos adversos de los desaf & iacute;os sociodemogr & aacute;ficos, como el r & aacute;pido crecimiento demogr & aacute;fico y la carga de morbilidad.