Résumé
Introduction Burkina Faso faces many challenges in the health domain, with no real opportunity for an increase in public health expenditures. In Burkina Faso, as in all low-income countries, health spending efficiency is crucial. The objective of this paper is to assess the efficiency of Advanced Medical Centers (AMCs)-which correspond to district hospitals-in Burkina Faso over the 2017-2020 period and identify the factors that promote-or, on the contrary, limit-the efficiency of these health structures.</p></div> <div>Method<p>We first assessed the efficiency level of the 45 AMCs running in the country between 2017 and 2020 using a bootstrap Data Envelopment Analysis (DEA) methodology. Inputs include the number of doctors, nurses, other medical staff, non-medical staff, and beds, while output variables correspond to the number of inpatients, surgeries, outpatients, and inpatient days. In a second step, determinants of AMC's efficiency levels were explored using a double-bootstrap procedure. The roles of AMCs' internal and environmental factors were both considered.</p></div> <div>Results<p>We found a mean efficiency score of 0.51 over the study period, indicating that AMCs could have almost doubled their healthcare production without needing additional resources. The size, education level, and health status of the covered population and the density of the healthcare supply in the district appeared to be the driving factors of AMCs' efficiency.</p></div> <div>Conclusion<p>Our results indicate that improving the efficiency of AMCs should be a high-level priority for the Burkinabe health policy. Resources could be reallocated across AMCs to increase the overall efficiency of the health system. Key messages -The efficiency of health spending is of crucial importance in Sub-Saharan Africa, given the important health needs and financial constraints those countries face.</p><p>-No recent study has investigated the efficiency of Advanced Medical Centers (AMCs), which correspond to district hospitals, in Burkina Faso, although they play a pivotal role in the health system.</p><p>-The healthcare production of AMCs could have almost doubled over the 2017-2020 period without any increase in the resources used.</p><p>-Resource reallocation across AMCs based on population size and health needs could be performed to increase the overall efficiency of the health system.</p></div>