title: Technical efficiency of peripheral health units in Pujehun district of Sierra Leone: a DEA application.
abstract: BACKGROUND
  The Data Envelopment Analysis (DEA) method has been fruitfully used in many countries in Asia, Europe and North America to shed light on the efficiency of health facilities and programmes. There is, however, a dearth of such studies in countries in sub-Saharan Africa. Since hospitals and health centres are important instruments in the efforts to scale up pro-poor cost-effective interventions aimed at achieving the United Nations Millennium Development Goals, decision-makers need to ensure that these health facilities provide efficient services. The objective of this study was to measure the technical efficiency (TE) and scale efficiency (SE) of a sample of public peripheral health units (PHUs) in Sierra Leone.
  
  
  METHODS
  This study applied the Data Envelopment Analysis approach to investigate the TE and SE among a sample of 37 PHUs in Sierra Leone.
  
  
  RESULTS
  Twenty-two (59%) of the 37 health units analysed were found to be technically inefficient, with an average score of 63% (standard deviation = 18%). On the other hand, 24 (65%) health units were found to be scale inefficient, with an average scale efficiency score of 72% (standard deviation = 17%).
  
  
  CONCLUSIONS
  It is concluded that with the existing high levels of pure technical and scale inefficiency, scaling up of interventions to achieve both global and regional targets such as the MDG and Abuja health targets becomes far-fetched. In a country with per capita expenditure on health of about USD 7, and with only 30% of its population having access to health services, it is demonstrated that efficiency savings can significantly augment the government's initiatives to cater for the unmet health care needs of the population. Therefore, we strongly recommend that Sierra Leone and all other countries in the Region should institutionalize health facility efficiency monitoring at the Ministry of Health headquarter (MoH/HQ) and at each health district headquarter.
authors.affiliation: World Health Organization, Country Office, Freetown, Sierra Leone. rennera@sl.afro.who.int
authors.forename: Ade
authors.initials: A
authors.lastname: Renner
authors.forename: Joses M
authors.initials: JM
authors.lastname: Kirigia
authors.forename: Eyob A
authors.initials: EA
authors.lastname: Zere
authors.forename: Saidou P
authors.initials: SP
authors.lastname: Barry
authors.forename: Doris G
authors.initials: DG
authors.lastname: Kirigia
authors.forename: Clifford
authors.initials: C
authors.lastname: Kamara
authors.forename: Lenity H K
authors.initials: LH
authors.lastname: Muthuri
mesh_terms: D019985:Benchmarking / Q000379:methods*; D003151:Community Health Centers / Q000458:organization & administration*; D003362:Cost-Benefit Analysis; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D006291:Health Policy; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D016015:Logistic Models; D008330:Management Audit; D015233:Models, Statistical; D009937:Organizational Objectives; D011320:Primary Health Care / Q000458:organization & administration*; D011635:Public Health Administration / Q000592:standards*; D012807:Sierra Leone; D017749:Total Quality Management