title: Technical efficiency of women's health prevention programs in Bucaramanga, Colombia: a four-stage analysis.
abstract: Primary Health Care (PHC) is an efficient strategy to improve health outcomes in populations. Nevertheless, studies of technical efficiency in health care have focused on hospitals, with very little on primary health care centers. The objective of the present study was to use the Data Envelopment Analysis to estimate the technical efficiency of three women's health promotion and disease prevention programs offered by primary care centers in Bucaramanga, Colombia.
  
  
  
  Efficiency was measured using a four-stage data envelopment analysis with a series of Tobit regressions to account for the effect of quality outcomes and context variables. Input/output information was collected from the institutions' records, chart reviews and personal interviews. Information about contextual variables was obtained from databases from the primary health program in the municipality. A jackknife analysis was used to assess the robustness of the results.
  
  
  
  The analysis was based on data from 21 public primary health care centers. The average efficiency scores, after adjusting for quality and context, were 92.4 %, 97.5 % and 86.2 % for the antenatal care (ANC), early detection of cervical cancer (EDCC) and family planning (FP) programs, respectively. On each program, 12 of the 21 (57.1 %) health centers were found to be technically efficient; having had the best-practice frontiers. Adjusting for context variables changed the scores and reference rankings of the three programs offered by the health centers.
  
  
  
  The performance of the women's health prevention programs offered by the centers was found to be heterogeneous. Adjusting for context and health care quality variables had a significant effect on the technical efficiency scores and ranking. The results can serve as a guide to strengthen management and organizational and planning processes related to local primary care services operating within a market-based model such as the one in Colombia.
authors.affiliation: Departamento de Salud Pública, Universidad Industrial de Santander, Carrera 32 No. 29-31 oficina 301, Bucaramanga, Colombia.
authors.forename: Myriam
authors.initials: M
authors.lastname: Ruiz-Rodriguez
authors.affiliation: Departamento de Salud Pública, Universidad Industrial de Santander, Carrera 32 No. 29-31 oficina 301, Bucaramanga, Colombia. laurovi@uis.edu.co.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Rodriguez-Villamizar
authors.affiliation: Instituto de Salud Pública de Mexico, Universidad 655, Santa María Ahuacatitlán, CP 62100, Cuernavaca, Morelos, Mexico.
authors.forename: Ileana
authors.initials: I
authors.lastname: Heredia-Pi
mesh_terms: D003105:Colombia; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D017598:Efficiency, Organizational; D005193:Family Planning Services; D005260:Female; D006761:Hospitals; D006801:Humans; D008485:Medical Audit; D011315:Preventive Medicine; D011320:Primary Health Care / Q000458:organization & administration; D011787:Quality of Health Care; D016387:Women's Health
keywords: Colombia; Data Envelopment Analysis; Prevention; Primary health care; Technical efficiency; Women