Journal of Medical Systems

, Volume 30, Issue 6, pp 473–481 | Cite as

Efficient Management of Health Centres Human Resources in Zambia

  • Felix Masiye
  • Joses M. Kirigia
  • Ali Emrouznejad
  • Luis G. Sambo
  • Abdou Mounkaila
  • Davis Chimfwembe
  • David Okello
Original Paper


This study uses Data Envelopment Analysis (DEA) to estimate the degree of technical, allocative and cost efficiency in individual public and private health centres in Zambia; and to identify the relative inefficiencies in the use of various inputs among individual health centers. About 83% of the 40 health centres were technically inefficient; and 88% of them were both allocatively and cost inefficient. The privately owned health centers were found to be more efficient than public facilities.


Health centers mangement Data envelopment analysis Technical efficiency Zambia health 



The author would like to express their thanks to anonymous reviewers for their carefully prepared report. All their points have been considered and the papers have been edited accordingly.


  1. 1.
    WHO, The World Health Report 2000: Improving Health Systems Peformance, WHO, Geneva, 2000a.Google Scholar
  2. 2.
    WHO, The Bulletin of the World Health Organization, WHO, Geneva, 2000b.Google Scholar
  3. 3.
    Murray, C. J. L., and Frenk, J., A framework for assessing the performance of health systems. Bull. WHO. 78(6):717–731, 2000.Google Scholar
  4. 4.
    Williams, A., Science or Marketing at WHO? A commentary on ‘World Health 2000’. Health Econ. 10(93):93–100, 2000.Google Scholar
  5. 5.
    Wagstaff, A., Measuring equity in health care financing: reflections on and alternatives to the World Health Organizations fairness of financing index. Development Research Group and Human Development Network, World Bank, 2001.Google Scholar
  6. 6.
    Shaw, R. P., World Health Report 2000 “Financial Fairness Indicator”. Useful compass or crystal ball? Int. J. Health Serv. 32(1):195–203, 2002.CrossRefGoogle Scholar
  7. 7.
    Pedersen, K. M., The World Health Report 2000: dialogue of the deaf. Health Econ. 11:93–101, 2002.CrossRefGoogle Scholar
  8. 8.
    UNDP, The Human Development Report 2002, Oxford University Press, Oxford, 2002.Google Scholar
  9. 9.
    Masiye, F., Ndulo, M., Roos, P., and Odegaard, K., A comparative analysis of hospitals in Zambia: a pilot study on efficiency measurement and monitoring. In: Seshamani, V., Mwikisa, C. N., and Odegaard, K. (eds.), Zambias Health Reforms Selected Papers 19952000 Chapter 7, Sweden, Lund, pp. 95–107, 2002.Google Scholar
  10. 10.
    WHO, World Health Report 2001, WHO, Geneva, 2001a.Google Scholar
  11. 11.
    UNDP, The Human Development Report 2001, Oxford University, Oxford, 2001.Google Scholar
  12. 12.
    United Nations, The millenium international development goals, United Nations, New York, 2000.Google Scholar
  13. 13.
    WHO, Regional Office for Africa, Health-for-all policy for the 21st century in the African Region: agenda 2020, WHO, Harare, 2000.Google Scholar
  14. 14.
    WHO, Macroeconomics and Health: Investing in Health for Economic Development, World Health Organization, Geneva, 2001b.Google Scholar
  15. 15.
    New Partnership for Africas Development, Human Development Programme: Health. Republic of South Africa, Pretoria, 2000.Google Scholar
  16. 16.
    Mooney, G. H., Economics, medicine and health care, Harvester Wheatsheaf, New York, 1986.Google Scholar
  17. 17.
    Culyer, A. J., The morality of efficiency in health care: some uncomfortable implications. Health Econ. 1(1):7–18, 1992.Google Scholar
  18. 18.
    Saltman, R. B., and Ferrousier-Davis, O., The concept of stewardship in health policy. Bulletin World Health Organ. 78(6):732–739, 2001.Google Scholar
  19. 19.
    Chattopadhy, S., and Ray, C. S., Technical, Scale, and Size efficiency in Nursing home care: a nonparametric analysis of Connecticut homes. Health Econ. 5:363–373, 1996.CrossRefGoogle Scholar
  20. 20.
    Shroff, H. F. E., Gulledge, T. R., Haynes, K. E., and Oneill, M. K., Siting efficiency of long-term health care facilities. Socioecon. Plann. Sci. 32(1):25–43, 1998.CrossRefGoogle Scholar
  21. 21.
    Hollingsworth, B., and Parkin, D., The efficiency of the delivery of neonatal care in the UK. J. Public Health Med. 23(1):47–50, 2001.CrossRefGoogle Scholar
  22. 22.
    Jacobs, R., Alternative methods to examine hospital efficiency: data envelopment analysis and stochastic frontier analysis. Health Care Manag. Sci. 4:103–115, 2001.CrossRefGoogle Scholar
  23. 23.
    Ersoy, K., Kavuncubasi, S., Ozcan, Y. A., and Harris, I. I. J. M., Technical efficiencies of Turkish hospitals: DEA Approach. J. Med. Syst. 21(2):67–74, 1997.CrossRefGoogle Scholar
  24. 24.
    Linna, M., Nordblad, and Koivu, M., Technical and cost efficiency of oral health care provision in Finnish health centres. Soc. Sci. Med., 2002.Google Scholar
  25. 25.
    Chang, H., Determinants of hospital efficiency: the case of central government-owned hospitals in Taiwan. Omega Int. J. Manag. Sci. 26(2):307–317, 1998.CrossRefGoogle Scholar
  26. 26.
    Wan, T. T. H., Hsu, N., Feng, R., Ma, A., Pan, S., and Chou, M., Technical efficiency of Nursing Units in a tertiary care hospital in Taiwan. J. Med. Sys. 26(1):21–27, 2002.CrossRefGoogle Scholar
  27. 27.
    Kirigia, J. M., Lambo, E., and Sambo, L. G., Are public hospitals in Kwazulu-Natal Province of South Africa technically efficient? African J. Health Sci. 7(3–4):25–32, 2000.Google Scholar
  28. 28.
    Kirigia, J. M., Sambo, L. G., and Scheel, H., Technical efficiency of public clinics in Kwazulu-Natal province of South Africa. East African Med. J. 78(3):S1–S13, 2001.Google Scholar
  29. 29.
    Zere, E. A., Addison, T., and McIntyre, D., Hospital efficiency in Sub-Saharan Africa: Evidence from South Africa. South African J. Econ. 2000.Google Scholar
  30. 30.
    Kirigia, J. M., Emrouznejad, A., and Sambo, L. G., Measurement of technical efficiency of public hospitals in Kenya: using Data Envelopment Analysis. J. Med. Sys. 26(1):39–45, 2002a.CrossRefGoogle Scholar
  31. 31.
    Emrouznejad, A., An alternative DEA measure: A case of OCED countries. Appl. Econ. Lett. 10:779–782, 2003.CrossRefGoogle Scholar
  32. 32.
    Emrouznejad, A., Measurement efficiency and productivity in SAS/OR. J. Comput. Oper. Res. 32(7) 1665–1683, July 2005, 2004.Google Scholar
  33. 33.
    Emrouznejad, A., and Thanassoulis, E., A mathematical model for dynamic efficiency using data envelopment analysis. J. Appl. Math. Comput. 160(2):363–378, 14 January, 2005, 2004.CrossRefGoogle Scholar
  34. 34.
    Emrouznejad, Ali, and Victor, Podinovski, Data Envelopment Analysis and Performance management, Warwick Print, Coventry, UK, ISBN: 0 90268373 X, 2004.Google Scholar
  35. 35.
    Coelli, T. J., A guide to DEAP Version 2.1: A Data Envelopment Analysis (Computer) Program. Working Paper No. 8/96. Centre for Efficiency and Productivity Analysis (CEPA), Department of Econometrics, University of New England, Armidale, Australia, 1996.Google Scholar
  36. 36.
    Farrell, M. J., The measurement of productive efficiency. J. Royal Stat. Soc. Series A 120(III):253–281, 1957.CrossRefGoogle Scholar
  37. 37.
    Charnes, A., Cooper, W. W., and Rhodes, E., Measuring efficiency of decision making units. Eur. J. Oper. Res. 2–6:429–444, 1978.MathSciNetCrossRefGoogle Scholar
  38. 38.
    Emrouznejad, A., Ali Emrouznejad's DEA HomePage, Warwick Business School, Coventry CV4 7AL, UK, 1995–2003.Google Scholar
  39. 39.
    Morey, R. C., Fine, D. J., and Loree, S. W., Comparing the allocative efficiencies of hospitals. OMEGA Int. J. Manag. Sci. 18(1):71–83, 1990.CrossRefGoogle Scholar
  40. 40.
    Ozcan, A., and Luke, R. D., A national study of the efficiency of hospitals in Urban Markets. Health Serv. Res. 27(6):719–739, 1993.Google Scholar
  41. 41.
    Lynch, J. R., and Ozcan, Y., Hospital closure: an efficiency analysis. Hospital Health Serv. Admin. 39(2):205–220, 1994.Google Scholar
  42. 42.
    Ozcan, Y., and Cotter, J. J., As assessment of efficiency of area agencies on aging in Virginia through data envelopment analysis. The Gerontologist 34(3):363–370, 1994.Google Scholar
  43. 43.
    Laura, H. T., Ozcan, Y. A., and Wogan, S. E., Mental health case management and technical efficiency. J. Med. Syst. 19(5):413–423, 1995.CrossRefGoogle Scholar
  44. 44.
    Ozcan, Y., Efficiency of hospital service production in local markets: the balance sheet of U.S. medical armament. Socioecon Plann. Sci. 29(2):139–150, 1995.CrossRefGoogle Scholar
  45. 45.
    White, K. R., Fache, R. N., and Ozcan, Y., Church ownership and hospital efficiency. Hospital Health Serv. Admin. 41(3):297–310, 1996.Google Scholar
  46. 46.
    Pai, C., Ozcan, Y. A., and Jiang, H. J., Regional variation in physician practice pattern: an examination of technical and cost efficiency for treating sinusitis. J. Med. Sys. 24(2):103–117, 2000.CrossRefGoogle Scholar
  47. 47.
    Harris, II J., Ozgen, H., and Ozcan, Y., Do mergers enhance the performance of hospital efficiency? J. Oper. Res. Soc. 51:801–811, 2000.zbMATHCrossRefGoogle Scholar
  48. 48.
    Rollins, J., Lee, K., Xu, Y., and Ozcan, Y., Longitudinal study of health maintenance organization efficiency. Health Serv. Manage. Res. 14:249–262, 2001.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Felix Masiye
    • 1
  • Joses M. Kirigia
    • 2
  • Ali Emrouznejad
    • 3
  • Luis G. Sambo
    • 2
  • Abdou Mounkaila
    • 4
  • Davis Chimfwembe
    • 5
  • David Okello
    • 6
  1. 1.Department of EconomicsUniversity of ZambiaLusakaZambia
  2. 2.World Health OrganizationRegional Office for AfricaBrazzavilleCongo
  3. 3.Operations & Information ManagementAston Business School, Auston UniversityBirminghamUK
  4. 4.EpidemiologistJSI/MEASURE/EvalutionArlingtonUSA
  5. 5.Planning and Policy DevelopmentMinistry of HealthLusakaZambia
  6. 6.World Health OrganizationMbabaneSwaziland

Personalised recommendations