Assessing the Efficiency of Health-care Facilities in Sub-Saharan Africa: A Systematic Review

Background: The provision of health-care services is dependent on the effective and efficient functioning of various components of a health-care system. It is therefore important to evaluate the functioning of these various components. Hence, the aim of this study was to review studies on health-care facilities efficiency in sub-Saharan Africa (SSA) with respect to the methodologies used as well as outcomes and factors influencing efficiency. Methods: The review was conducted through a comprehensive search of electronic databases which included PubMed, Web of science, academic search complete via EBSCOhost, Science Direct, and Google scholar. A search was also conducted by looking into citations in the reference list of selected articles and through gray literature. Studies were screened by examining their titles, abstracts, and full-text based on stated inclusion and exclusion criteria. The concurrent screening and data extraction were conducted by the two authors. Results: A total of 40 studies were shortlisted for the review. The majority (90.0%) of the studies employed the data envelopment analysis technique for their efficiency measurements. The input and output variables utilized by most of the studies were predominantly human resources and health-related services respectively. The outcome from majority of the studies showed that less than 40% of the studied facilities were efficient. The leading influencing factors reported by the studies were catchment population, facility ownership, and location. Conclusions: The review showed that there was a marked degree of inefficiency across the health-care facilities. Consequently, due to severe resource constraints facing SSA, there is a need to determine how to use the available resources optimally to improve health systems performance.