HEALTH CARE SYSTEM EFFICIENCY: A SUB-STATE LEVEL ANALYSIS FOR ORISSA (INDIA)

In recent years, there has been renewed emphasis on efficiency in resource utilization in the healthcare sector. Most studies in the Indian context have focused on state level analysis. This paper explores sub-state level health system efficiency in Orissa, a low-income state in India. Our analysis estimates the efficiency of the healthcare system at sub-state level using 2012 district level data. We explore the reasons for relative performance of different districts using a frontier estimation technique. There is a substantial difference in performance between the most efficient district of Jharsuguda and the least efficient district of Balangir, resulting from inadequate utilization of available health care resources. Our study also identifies complementarity of private health care resources and the role of other factors, such as sanitation facilities, village electrification, and rural population growth. Our results suggest a need for better utilization of budgetary resources, both under the state department of health and the National Rural Health Mission, to increase health manpower and improve quality through training and better management resources in order to improve district health systems in Orissa.