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Assessing the Impact of Maternal and Infant Mortality on Healthcare System Efficiency in Sub-Saharan Africa Using Data Envelopment Analysis

Omobolaji odunowo
University of North Texas, College of Information, information science., USA
tajiir 2025
VOL. 7 / NO. 10 OCTOBER
VOLUME 7
ISSUE 10
YEAR 2025
PAGES 31-42

Abstract

Objective: This study evaluates the impact of maternal and infant mortality on healthcare system efficiency in Sub-Saharan Africa (SSA) using a directional Data Envelopment Analysis (DEA) model.

Method: The analysis incorporates desirable outputs, such as healthcare coverage, and undesirable outputs, specifically maternal and infant mortality rates, to assess the relative efficiency of 36 SSA countries over 12 years (2006–2017).

Findings: Findings reveal that healthcare expenditure significantly influences efficiency, accounting for over 50% of the variation in performance scores, followed by the availability of nurses and midwives. Countries with lower maternal and infant mortality rates consistently ranked higher in efficiency, highlighting the dual role of mortality as both an outcome and a determinant of health system performance. Sensitivity analysis further confirmed that strategic investments in workforce and financing yield substantial efficiency gains.

Conclusion: The study offers empirical evidence supporting the integration of mortality indicators into performance assessments and presents a robust methodological framework for evaluating health systems in resource-constrained settings. It contributes to the literature by addressing methodological gaps and providing actionable insights for policymakers. The results underscore the urgency of prioritizing maternal and child health in healthcare reform agendas to achieve equity and efficiency across SSA.

Keywords

Maternal Mortality Infant Mortality Healthcare Efficiency Data Envelopment Analysis Sub-Saharan Africa

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References

  1. Abdulraheem, I. S., Olapipo, A. R., & Amodu, M. O. (2017). National health insurance scheme: A catalyst for maternal and child healthcare delivery in Nigeria? Journal of Public Health in Africa, 8(2), 722. https://doi.org/10.4081/jphia.2017.722
  2. Abimbola, S., Negin, J., Martiniuk, A. L., Jan, S., & Owoaje, E. (2015). Is a free health care policy pro-poor? Findings from a household survey in Nigeria. BMC Health Services Research, 15, 58. https://doi.org/10.1186/s12913-015-0713-y
  3. Akazili, J., Garshong, B., Aikins, M., Gyapong, J., McIntyre, D., & Mtei, G. (2018). Progressivity of health care financing and incidence of service benefits in Ghana. Health Policy and Planning, 33(7), 879–889. https://doi.org/10.1093/heapol/czy054
  4. Aparicio, J., Pastor, J. T., & Zofío, J. L. (2015). On the inconsistency of the Malmquist–Luenberger index: A directional distance function approach. European Journal of Operational Research, 244(3), 925–939. https://doi.org/10.1016/j.ejor.2015.02.039
  5. Arah, O. A., Klazinga, N. S., Delnoij, D. M. J., Asbroek, A. H. A. T., & Custers, T. (2003). Conceptual frameworks for health systems performance: A quest for effectiveness, quality, and improvement. International Journal for Quality in Health Care, 15(5), 377–398. https://doi.org/10.1093/intqhc/mzg049
  6. Chambers, R. G., Chung, Y., & Färe, R. (1996). Benefit and distance functions. Journal of Economic Theory, 70(2), 407–419. https://doi.org/10.1006/jeth.1996.0096
  7. Cooper, W. W., Seiford, L. M., & Zhu, J. (2007). Data envelopment analysis: History, models, and interpretations. Springer.
  8. Deaton, A., & Tortora, R. (2016). People in Sub-Saharan Africa rate their health and health care among the lowest in the world. Health Affairs, 34(3), 519–527. https://doi.org/10.1377/hlthaff.2014.0798
  9. Ekundayo, O. J., & Adejumo, P. O. (2020). Impact of national health insurance scheme on maternal health in Nigeria. Journal of Health Research and Reviews, 7(4), 210–215. https://doi.org/10.4103/jhrr.jhrr_2_20
  10. Folayan, M. O., Fatusi, O. A., & Soyemi, K. (2016). Assessing the impact of national health insurance scheme on out-of-pocket healthcare services utilization and household catastrophic health spending in Nigeria. PLOS ONE, 11(11), e0166121. https://doi.org/10.1371/journal.pone.0166121
  11. Iloh, G. U., Amadi, A. N., & Nwankwo, B. O. (2019). Universal health coverage in Nigeria: An analysis of the national health act and the 2014 national health policy. Nigerian Medical Journal, 60(4), 163–170. https://doi.org/10.4103/nmj.NMJ_102_19
  12. Mekonnen, Y., Taddesse, N., Negash, L., & Desalegn, D. (2020). Universal health coverage and its implication on maternal and child health: A qualitative study from Ethiopia. PLOS ONE, 15(9), e0238992. https://doi.org/10.1371/journal.pone.0238992
  13. National Population Commission (NPC) [Nigeria] and ICF. (2019). Nigeria demographic and health survey 2018. NPC and ICF.
  14. Olaniyan, O., & Inyiama, L. E. (2020). Impact of health insurance on maternal healthcare utilization in Nigeria: Evidence from the national living standard survey. Heliyon, 6(4), e03743. https://doi.org/10.1016/j.heliyon.2020.e03743
  15. Orisaremi, T. C., & Alubo, O. (2012). Gender and the reproductive health of Tarok women in central Nigeria. African Journal of Reproductive Health, 16(1), 83–96.
  16. Oyekale, A. S. (2020). Does national health insurance scheme enrolment reduce catastrophic health expenditure in Nigeria? Evidence from a cross-sectional study. BMC Health Services Research, 20(1), 1090. https://doi.org/10.1186/s12913-020-05995-1
  17. Oyekale, A. S., & Oyekale, T. O. (2020). Socio-economic determinants of maternal and child health in Nigeria: Insights from the 2018 Nigeria Demographic and Health Survey. PLOS ONE, 15(9), e0238827. https://doi.org/10.1371/journal.pone.0238827
  18. Rusa, L., Ngirabega, J. D., Janssen, W., Van Bastelaere, S., Porignon, D., & Vandenbulcke, W. (2019). Performance-based financing for better quality of maternal and child health care in Rwanda. The Belgian Journal of Medicine, 1(1), 1–8.
  19. Teleayo, A. (2023). Assessing the impact of universal healthcare coverage on maternal and child health outcomes in Nigeria. Journal of Community Health Provision, 3(1), 1–7. https://doi.org/10.55885/jchp.v3i1.219
  20. Uche, C. A., & Udeh, I. H. (2022). Measuring healthcare productivity in Sub-Saharan Africa: A Malmquist index approach. African Development Review, 34(1), 100–112. https://doi.org/10.1111/1467-8268.12559
  21. Umeano-Enemuoh, J. C., & Onwujekwe, O. E. (2019). Impact of community-based health insurance programme on maternal and child health outcomes in Nigeria: A propensity score matching analysis. PLOS ONE, 14(11), e0225507. https://doi.org/10.1371/journal.pone.0225507
  22. Valdmanis, V. G., Rosko, M. D., & Mutter, R. L. (2016). Hospital efficiency and quality: A literature review. European Journal of Health Economics, 18(1), 1–19. https://doi.org/10.1007/s10198-016-0781-3
  23. World Bank. (2020). Nigeria overview. https://www.worldbank.org/en/country/nigeria/overview
  24. World Health Organization. (2021). Universal health coverage. https://www.who.int/health-topics/universal-health-coverage#tab=tab_1
  25. Zheng, H., Deng, W., & Wu, J. (2019). Efficiency evaluation of healthcare systems in developing countries: A DEA analysis. Health Policy and Planning, 34(7), 513–524. https://doi.org/10.1093/heapol/czz050