District hospitals in Ghana are pivotal healthcare providers serving rural and underserved populations. However, their operational efficiency varies significantly across different districts. A multilevel regression model was employed to analyse data from 10 randomly selected districts, accounting for both individual hospital-level and district-level effects. The specific equation used is y₈₉ = eta₀ + eta₁ DistrictIndexᵢ + eta₂ HospitalIndexⱼ + uᵢ + v₈₉, where uᵢ represents the fixed effect of each district, v₈₉ the random effect within hospitals in a given district, and y₈₉ the efficiency score for hospital i in district j. The analysis revealed that district-level factors significantly impact hospital efficiency. For example, districts with higher levels of government support saw an average improvement of 15% in service delivery quality compared to those without such support. Our findings suggest that targeted interventions focused on improving governance and resource allocation within specific districts could lead to substantial improvements in healthcare services. Policy makers should prioritise the development of district-specific strategies based on our results, emphasising areas requiring additional investment and support. District hospitals, Ghana, Multilevel regression, Efficiency gains
Agyeman et al. (2005) studied this question.