Efficiency of health systems in developing countries: the case of West African countries

Developing countries are faced with numerous health challenges such as lack of funding, increasing frequency and magnitude of epidemic risks, organizational and socio-cultural difficulties. In this context, we developed this study to assess for the first time the efficiency of health systems in the countries of the West African sub-region, firstly, to identify the systems that best adapt to these challenges and secondly, to highlight the factors that influence the health production process. To achieve this, we used the World Bank’s, Worldwide Development Indicators and Worldwide Governance Indicators databases, from 2000 to 2022. We applied the stochastic fixed-effect frontier method of Kumbhakar et al. (2014) to account for unobservable heterogeneity in the estimates. We used a novel multiple imputation approach to deal with missing data, while determining the fractions of missing information in the estimates. The results show that the average relative efficiency for all countries in the sub-region is 89.7%. Countries in the West African sub-region could theoretically increase life expectancy at birth by an average of 10.3%, which represents 6.5 years, with the same level of resources used. The results also show that health systems in these countries have higher permanent inefficiency than temporal inefficiency, suggesting that they mainly face structural challenges. Per capita health expenditure, gross domestic product per capita, out-of-pocket expenditure per capita, literacy rate, poverty gap and voice and accountability were positively associated with the efficiency of their health systems.