Developing healthcare systems in Botswana

Evaluation Paper 3-Assessment of productivity of hospitals in Botswana: a DEA application

Michelle Marumo
Professor Matt Murrie
English Academic Writing
29 March 2014
Evaluation: “Assessment of Productivity of Hospitals in Botswana” “Assessment of productivity of hospitals in Botswana” by Naomi Tlotlego is a journal article published PubMed United states National online library of Medicine about a study conducted on the productivity of hospitals in Botswana. Tlotlego thoroughly and effectively assesses how productive hospitals are by quantifying the technical and scale efficiency of twenty one hospitals indifferent regions of Botswana using advanced DEAP software over a period of three years. Tlotlego’s objective was to find out if hospitals in Botswana are maximizing the available resources and possibly stimulate ideas to contribute towards accelerated progress for millennium development goals. Tlotlego effectively explains the origins of the idea to conduct a study on the efficiency of hospitals in Botswana by giving some background information on the current status of development of health systems in Botswana. This included Botswana national health policy that states that the Ministry of Health is responsible for reviewing and revising how healthcare systems such as hospitals are operated or managed in order to maintain a high level of efficiency in the provision of healthcare. However it has been noted by Tlotlego et al that individuals in positions of leadership in the health sector have not taken it upon themselves to measure the technical efficiency of Hospitals. Moreover the article is clearly written with sub headings to guide the reader to explore the article in a more systematic manner .By explaining the origins of the idea the author not only gives a better understanding of what the article is about but also draws the reader in.
The author shows how important it is to clearly define what are health institutions as well as further explains the function of each in order to be thorough and more effective in helping the reader understand the purpose of the journal article. Tlotlego defines health systems as being all organizations, whose “primary purpose is to promote, restore or maintain people’s health, both length of life and health-related quality of life”. Tlotlego states that a hospital is meant to combine “limited health system inputs” such as workforce and supplies “to produce preventive, curative and rehabilitative services”. It is stated that if a hospital does not effectively operate in this manner then it is not efficient. To support the definition of an efficient hospital, the DEA software is also defined as a “linear programming method designed to measure the relative efficiencies of hospitals”. By defining complex terminologies throughout the article Tlotlego makes it easier for the reader to fathom the basis of the study being explored in the article.
Tlotlego’s article well explores, whether hospitals in Botswana which consumes majority of the health sector resources are operating at an optimal scale. Prior to the study secondary research was done making a comparison of GDP per capita ,availability of resources is made with other African countries such as Ghana,Benin,Zambia and South Africa to give a basis of the assessment. Percentages of the efficiency values according to the DEA scale for first world countries such as Portugal (productivity change of 51 hospitals in Portugal) .Focus was then made on Botswana’s available resources and how productive it is expected to be based on these resources.Tlotlego illustrates obtained secondary information for the number of times patients visited the hospitals and the number of days patients stayed in the hospitals for both rural and urban regions within the country: 3 referral hospitals , 7 district hospitals a, 2 mission district hospitals (fully funded by government), 3 mine hospitals, 2 private hospitals 17 primary hospitals and an selection of private general practitioners. This information was then further analyzed on the basis that the more patients visited the more trusting the patients were of that particular hospital .Moreover the shorter the time stayed in the hospital the more effective healthcare workers are at treating the patients. Tlotlego step by step analysis helps the reader have a clearer understanding of how the optimal scale at which these 21 hospitals operate was found.
The journal article accurately shows how the productivity of the 21 hospital was quantified. Using information from the first section of the study, a demonstration of how for each region using the number of patient visits and the duration of stay percentages were calculated to find out how many out of the 21 hospitals are productive. Tlotlego states that out of the 21 hospitals 16 which 76.2% of the hospitals are. , are run inefficiently. However only 4.2% are run efficiently according to the DEAP software a In the journal article the author uses quantified information in order to support the quantitative information in the first section of the study in order to help the reader further understand the study. Although the numerous calculations and scales mentioned seem to be of high complexity the author still supports the quantitative information.
Lastly the article is effective is showing the trends of hospital productivity and the attributions that can be made to technical efficiency change over the years. To create a better understanding of the study the author makes attributions of the quantitative and qualitative information observed in the first two sections of the article. Furthermore Tlotlego goes as far as to give possible solutions for inefficient hospitals. Inefficiency was attributed to an insufficient distribution of staff across clinics in various regions across the country as well as lack of sufficient space for patients to stay in hospitals. A possible solution to this problem, Tlotlego says, these hospitals “needed to increase the number of outpatient visits by 117627 (18 percent) and inpatient days by 49415 (13 percent) in order to reach full efficiency” As a solution to the lack of space the author advises the government to transfer excess number of staff and equipment to places in communities where staff is needed the most(small clinics or health posts) to allow not necessarily a more equal but a more productive distribution of staff members in hospitals. On the other hand Tlotlego also gives attributions for the hospitals that are being run efficiently. Although the 5 hospitals that were being run efficiently in they are a small percentage, Tlotlego states the reasons why these particular health systems are successful. The success 4.2 % efficiency of hospitals in Botswana was attributed to the locations of the hospitals, specifically the capital city Gaborone. Development of facilities is focused on areas of the country considered important by government. In conclusion Tlotlego effectively and thoroughly explores in detail the study that was conducted in order accurately measure the efficiency or productivity of hospitals in Botswana. The systematic way the journal article was laid out makes it easier for the reader to understand clearly the dynamics of the study conducted. Quantitative (statistics) information is presented to emphasize or support the qualitative information provided. In fact according to the DEAP application 76.2% of the hospitals are run efficiently the article also makes a comparison of health systems efficiency to other African countries as a way of giving background information and to make a clear distinction between Botswana and other similar countries. Possible reasons and solutions for inefficiency are also given by the author after presenting Tlotlego implies that it the objective of the article was to stimulate a different train of thought and makes Batswana question why hospitals are being run ineffectively as well as question what the government is doing about it .