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Leveraging existing program data for routine efficiency measurement in Zambia.

Rick Homan1, John Bratt1, Gregory Marchand2

  • 1Health Services Research, FHI 360, Durham, North Carolina, 27701, USA.

Gates Open Research
|May 28, 2019
PubMed
Summary

Routine Efficiency Monitoring System (REMS) improves health resource allocation for HIV/AIDS services. This system provides crucial unit expenditure data, enabling better efficiency measurement and targeted interventions for sustainable health programs.

Keywords:
Zambiadashboardsefficiencyroutinesite-levelunit expenditure

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Area of Science:

  • Health economics
  • Public health systems
  • Health informatics

Background:

  • Global donor funding for HIV/AIDS is stagnating, necessitating improved resource utilization within national health systems.
  • Program managers and planners lack routine data on unit expenditures and resource use at the facility level, hindering efficiency assessment.
  • Measuring technical efficiency and evaluating interventions to improve it are challenging without granular cost and output data.

Purpose of the Study:

  • To develop and implement a Routine Efficiency Monitoring System (REMS) to estimate unit expenditures per service at the facility level.
  • To measure the technical efficiency of Ministry of Health resources used for HIV/AIDS service delivery in Zambia.
  • To provide data for identifying inefficiencies and guiding resource allocation decisions.

Main Methods:

  • Developed REMS, a relational database, to integrate existing budget, expenditure, and output data.
  • Configured REMS for 326 facilities in Zambia, focusing on HIV/AIDS services, in collaboration with the Government of the Republic of Zambia (GRZ) and Avencion.
  • Utilized facility assessments and key informant interviews to develop REMS allocation algorithms, drawing data from IFMIS and DHIS-2.
  • Delivered REMS outputs via user-friendly, web-based dashboards for trained users.

Main Results:

  • REMS provides quarterly site-level estimates of unit expenditure per service, enabling measurement of technical efficiency.
  • District health managers can identify "outlier" facilities for targeted performance improvement interventions.
  • Provincial and national planners gain insights to direct resources to areas of greatest need and identify potential savings.

Conclusions:

  • REMS significantly enhances data availability for managers and planners on resource transformation into services.
  • The GRZ is seeking national expansion of REMS to cover all major disease areas.
  • Improved technical efficiency through REMS supports the goal of a sustainable HIV/AIDS response.