Organizational and Regional Determinants of Health Care Organizations' Efficiency: The Case of Infant Mortality and Community Health Centres in Indonesia

The number of studies on determinants of organizational efficiency have increased recently, but insights in the efficiency of health centre organizations and its determinants are relatively scarce, also in Indonesia. The Indonesian government has invested substantially in the national health care system as a way to improve health outcomes, such as reduced infant mortality rates. Especially Community Health Centres are pivotal in this process, since they are the first layer of health care services in Indonesia: they provide the first contact point for patients. The Indonesian government has granted CHCs autonomy to plan their own budgets and activities, based on local health care needs. Moreover, the government has more than doubled the budget for the CHCs in the past year. However, these investments have only marginally contributed to reduced infant mortality rates. This leads to the question how efficient CHCs are in converting their input (in terms of money and staff) into output (in terms of for example infant vaccination, prenatal care and hygiene promotion) that is assumed to contribute to improved health outcomes. Recognizing that reduced infant mortality rates are also related to well-known individual and househould factors such as education and income, this paper focuses specifically on the efficiency of CHCs in Indonesia by comparing CHCs in various local governments. In addition, we explore both regional and organizational explanations of differences in efficiency in these CHCs. We first estimate the technical efficiency of 600 CHCs in Indonesia by using data envelopment analysis (DEA) and then examine the correlation of these CHCs technical efficiency to (1) regional characteristics (urban versus rural; Java versus non Java) and to 2) organizational characteristics (organizational size, professional staff intensity, and the functioning of the laboratory unit).