Technical Efficiency of Ayushman Arogya Mandirs and Their Determinants in Rural Central India: A Data Envelopment...

Background Ayushman Arogya Mandirs (AAMs), formerly known as Health and Wellness Centres (HWCs), were established under the Ayushman Bharat initiative to strengthen primary healthcare delivery through Comprehensive Primary Health Care (CPHC) services in India. Assessing technical efficiency (TE) is important to understand how effectively these centres utilize available resources to deliver healthcare services and achieve desired outputs. The present study was conducted to evaluate the TE of AAMs and identify factors associated with their efficiency in a rural block of Madhya Pradesh, India. Methods The study included all 25 AAMs functioning in the Obedullaganj block of Madhya Pradesh during the 2022-2023 financial year. Secondary data on human resources, logistics, training, outpatient services, maternal and child health services, and non-communicable disease services were collected from health records and government health portals. An output-oriented Data Envelopment Analysis (DEA) model was used to estimate the TE of AAMs. A Tobit regression model was subsequently applied to identify institutional and individual factors associated with the TE scores. Results Among the 25 AAMs included in the study, six (24%) were identified as relatively efficient, while the remaining centres demonstrated varying degrees of inefficiency. The mean TE score among the low-performing AAMs was 0.66 (SD: 0.16), indicating that these centres could potentially increase their outputs by 34% using the existing level of inputs. Most AAMs had adequate staffing availability; however, deficiencies in medicine availability, training coverage, and achievement of service delivery targets were observed. Tobit regression analysis showed that the age of the Community Health Officer (CHO), total population served by the AAM, and duration since the CHO had been posted at the centre were significantly associated with the TE scores. Conclusion The study demonstrates the feasibility of assessing the TE of AAMs using DEA and highlights substantial variations in performance across centres. Identifying factors associated with efficiency can support targeted interventions and resource optimization strategies to strengthen primary healthcare delivery at the block and district levels.