title: Health system productivity change in Zambia: A focus on the child health services.
abstract: Efficiency and productivity improvement have become central in global health debates. In this study, we explored productivity change, particularly the contribution of technological progress and efficiency gains associated with improvements in child survival in Zambia (population 15 million). Productivity was measured by applying the Malmquist productivity index on district-level panel data. The effect of socioeconomic factors was further analyzed by applying an ordinary least squares regression technique. During 2004-2009, overall productivity in Zambia increased by 5.0 per cent, a change largely attributed to technological progress rather than efficiency gains. Within-country productivity comparisons revealed wide heterogeneity in favor of more urbanized and densely populated districts. Improved cooking methods, improved sanitation, and better educated populations tended to improve productive gains, whereas larger household size had an adverse effect. Addressing such district-level factors and ensuring efficient delivery and optimal application of existing health technologies offer a practical pathway for further improving population health.
authors.affiliation: Department of Global Health, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. tachoki@uw.edu.|Centre for Pharmaceutical Policy and Regulation, Utrecht University, Utrecht, The Netherlands. tachoki@uw.edu.
authors.forename: Tom
authors.initials: T
authors.lastname: Achoki
authors.affiliation: Faculty of Health, University of Canberra, Canberra, Australia.
authors.forename: Yohannes
authors.initials: Y
authors.lastname: Kinfu
authors.affiliation: Department of Global Health, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.|Department of Economics, University of Zambia, Lusaka, Zambia.
authors.forename: Felix
authors.initials: F
authors.lastname: Masiye
authors.affiliation: Centre for Pharmaceutical Policy and Regulation, Utrecht University, Utrecht, The Netherlands.
authors.forename: Geert W J
authors.initials: GWJ
authors.lastname: Frederix
authors.affiliation: Centre for Pharmaceutical Policy and Regulation, Utrecht University, Utrecht, The Netherlands.
authors.forename: Anke
authors.initials: A
authors.lastname: Hovels
authors.affiliation: Centre for Pharmaceutical Policy and Regulation, Utrecht University, Utrecht, The Netherlands.
authors.forename: Hubert G
authors.initials: HG
authors.lastname: Leufkens
mesh_terms: D002648:Child; D002662:Child Health Services / Q000191:economics / Q000458:organization & administration*; D046688:Child Mortality; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000458:organization & administration; D017598:Efficiency, Organizational; D061889:Healthcare Financing; D006801:Humans; D009936:Organizational Innovation; D012041:Regional Medical Programs / Q000458:organization & administration; D015024:Zambia / Q000453:epidemiology
keywords: Malmquist index; efficiency; health system performance; health technology; productivity change; public health