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Open Access Efficiency of TB service provision in the public and private health sectors in Ethiopia

BACKGROUND: The Ethiopian Government has identified efficiency of TB services as a key priority in planning and budgeting. Understanding the magnitude and sources of inefficiencies is key to ensuring value for money and improved service provision, and a requirement from donors to justify resource needs. This study identifies the cost of providing a wide range of TB services in public and private facilities in Ethiopia.

METHODS: Financial and economic unit costs were estimated from a health provider´s perspective, and collected retrospectively in 26 health facilities using both top-down (TD) and bottom-up (BU) costing approaches for each TB service output. Capacity inefficiency was assessed by investigating the variation between TD and BU unit costs where the factor was 2.0 or more.

RESULTS: Overall, TD unit costs were two times higher than BU unit costs. There was some variation across facility ownership and level of care. Unit costs in urban facilities were on average 3.8 times higher than in rural facilities.

CONCLUSION: We identified some substantial inefficiencies in staff, consumable and capital inputs. Addressing these inefficiencies and rearranging the TB service delivery modality would be important in ensuring the achievement of the country´s End TB strategy.

Keywords: Ethiopia; efficiency; tuberculosis; unit costs

Document Type: Research Article

Affiliations: 1: Armauer Hansen Research Institute, Addis Ababa, Ethiopia 2: National Tuberculosis and Leprosy Control Programme, Ethiopia Federal Ministry of Health, Addis Ababa, Ethiopia 3: Health Economics Unit and Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa 4: Global TB Programme, World Health Organization, Geneva, Switzerland 5: Global Health Economics Centre, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK

Publication date: December 1, 2022

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