Technical efficiency of primary health units in Kailahun and Kenema districts of Sierra Leone

This study applies the data envelopment analysis (DEA) approach to analyse technical efficiency of random samples of 36 MCHPs, 22 CHCs and 21 CHPs using input and output data for 2008.The findings indicate that 77.8% of the MCHPs, 59.1% of the CHCs and 66.7% of the CHPs were variable returns to scale technically inefficient. The average variable returns to scale technical efficiency was 68.2% (SD = 27.2) among the MCHPs, 69.2% (SD = 33.2) among the CHCs and 59% (SD = 34.7) among the CHPs.This study reveals significant technical inefficiencies in the use of health system resources among peripheral health units in Kailahun and Kenema districts of Sierra Leone. There is need to strengthen national and district health information systems to routinely track the quantities and prices of resources injected into the health care systems and health service outcomes (indicators of coverage, quality and health status) to facilitate regular efficiency analyses.The vision of Sierra Leone is to have a functional national health system delivering efficient, high quality health services that are accessible, equitable and affordable for everyone [1]. The general objective of the National Health Sector Strategic Plan (NHSSP) is to strengthen the functions of the national health system so as to improve access to health services (i.e. their availability, utilization and timeliness), quality of health services (i.e. their safety, efficacy and integration), equity in health services (particularly their access by disadvantaged groups), efficiency of service delivery (i.e. value for resources) and inclusiveness (partnerships) [2] in their delivery.The first principle stated in the NHSSP [[2]:p.11] calls for "Accountable central governance and provision of effective and efficient local health services composed of a comprehensive range of primary and secondary health services across the nation". One of strategic objectives of the country's health care delivery is to increase attendance at hea