Determinants of the technical efficiency of health systems in the ECOWAS region: A DEA-Tobit approach using Panel Data (2010-2024)

This study examines the determinants of technical efficiency of health systems in the fifteen member countries of the Economic Community of West Africans States over the period 2010-2024, using panel data from the World Bank and Worldwide Governance Indicators. The starting point is a simple concern: countries can devote considerable resources to health without necessarily obtaining health outcomes commensurate with those resources. To measure efficiency, the study first applies an output-oriented Data Envelopment Analysis. The resulting efficiency scores are then examined using a censored panel Tobit model in order to identify factors associated with differences in efficiency. The DEA results show clear differences across countries and over time. While some countries repeatedly lie on the efficiency frontier, others remain well below it. The Tobit estimates show positive associations between efficiency and primary-school completion, current health expenditure, survival rate, and political stability. Public education expenditure and life expectancy, in contrast, have negative coefficients. Overall, the findings suggest that improving health-system efficiency in ECOWAS is not simply a matter of increasing financial resources. How those resources are allocated and managed, together with human capital and institutional stability, also matters for the ability of health systems to turns available inputs into better health outcomes.