title: Efficiency of the health extension programme in Tigray, Ethiopia: a data envelopment analysis.
abstract: BACKGROUND
  Since 2004, the government of Ethiopia has made a bold decision to strengthen and expand its primary health care system by launching the Health Extension Program (HEP). While the scaling up of the HEP is necessary to achieve the aim of universal access to primary health care, close attention should be paid to the performance of the program. Using a data envelopment analysis this study aimed at (i) to estimate the technical efficiency of a sample of health posts in rural Tigray, ii) to identify those factors which might be explaining the efficiency results.
  
  
  METHODS
  Efficiency was measured using a data envelopment analysis model. A Tobit model was performed to identify factors associated with efficiency. Seven rural districts (out of 35) were purposely chosen. Input/output information was collected from the database of the Tigray Health Bureau during July 2007-June 2008. Information was also collected on environmental factors that might influence the efficiency outcomes through a structured questionnaire from the correspondent district health officers.
  
  
  RESULTS
  Analysis was based on data from 60 health posts. The mean scores for technical and scale efficiency were 0.57 (SD = 0.32) and 0.95 (SD = 0.11) respectively. Out of the 60 health posts, 15 (25.0%) were found to be technically efficient constituting the best practice frontier. Thirty eight (63.3%) were operating at their most productive scale size. In the regression analysis, none of the variables was significantly associated with the efficiency outcome.
  
  
  CONCLUSIONS
  There is a need to review the management of the health information system in the region. The findings have also revealed that only a quarter of the health posts are working efficiently and pointed the need for improvement. A closer monitoring of the health extension programme is required in order to achieve the best possible performance.
authors.affiliation: Umeå International School of Public Health, Department of Public Health and Clinical Medicine, Umeå university, SE-901 85 Umeå, Sweden. miguel.sansebastian@epiph.umu.se.
authors.forename: Miguel San
authors.initials: MS
authors.lastname: Sebastian
authors.forename: Hailemariam
authors.initials: H
authors.lastname: Lemma