Abstract
Background: Health outcomes in Haiti can be characterized as one of the poorest in the Caribbean region. As a result, the country has one of the shortest life expectancies in the region, which is estimated to be 63 years. Haiti's poor health outcome is partly attributed to lower technical efficiency (TE) of health production. The objective of this study was to estimate the TE of health production in all health facilities in the country. Methods: We used the 2013 Haiti's Service Provision Assessment (SPA) survey data and employed the Stochastic Frontier Analysis (SFA) framework. We specified a health production model with outpatient visits as output and number of health workers and general service readiness index (GSRI) as input indicators. In addition, type of facility, location and management indicators were used as covariates to control for facility heterogeneity. The model was specified with both Cobb-Douglas (CD) and Translog (TL) functional forms. We also considered the half-normal (HN), exponential, and truncated distributions for the TE term. Results: Number of health workers and the level of service readiness of health facilities have positive and significant association with outpatient visits. Keeping other factors constant, if the number of health workers per health facility increases by 1%, then outpatient visits may increase by 0.65% per month. Similarly, if health service readiness index increases by 1%, outpatient visits can be increased by up to 2.1%. The TE of health facilities is estimated at 51%, which shows the availability of significant room for efficiency gains. Conclusions: Number of health workers and general service readiness determine facility-based health production. Outpatient visit can be increased by 0.65% and 2.1% respectively if number of health workers and GSRI each increase by 1%. However, there is also a significant waste under the current health production system. Health facilities can serve more outpatient visits which can reach up to 49% from the current figures with the available resource if they implement best practices.