Disentangling the efficiency drivers in country-level global health programs: An empirical study

Motivated by the cost reductions and outcome improvements generated by benchmarking in many industries, we focus on in-country global health programs to identify and quantify opportunities for process improvement. We empirically study the major efficiency drivers of reproductive health (RH) country programs in Sub-Saharan Africa sponsored by international funding organizations. To ensure a level playing field for comparison across countries, we quantify the impact of cross-country heterogeneity and random shocks on the efficiency of RH programs. To analyze these relationships and isolate the effects attributable to managerial inefficiency, we use a three-stage Data Envelopment Analysis (DEA)/Stochastic Frontier Analysis (SFA) model. We show the impact of environmental factors on program efficiency, linking policy making decisions with operational and health outcome performance. We also show that donor fragmentation negatively impacts managerial efficiency, and we suggest actions to mitigate this effect. We then provide a way to improve performance through benchmarking efforts within groups of countries and present an initial prototype of such efforts.