Background: Health houses are the most important providers of primary health care to the rural communities of Iran, mainly based on Behvarz workers. The aim of present study was estimate the technical efficiency of Health houses and ascertain factors that affect this efficiency.
Methods: This is a Longitudinal study of rural primary health care centers in Hamadan province (2002-2016). Data Envelopment Analysis was employed to estimate technical efficiency of sampled health facilities while Panel Tobit Analysis was applied to predict factors associated with efficiency levels. The outputs were child mortality rate under one year of age and child mortality rate under five years of age. The input was Behvarzes (rural health workers).
Results: The results of efficiency analysis showed that the average efficiency scores of the centers had a fluctuating trend during the period of the study, but the average performance scores generally decreased in 2016, as compared with 2002. The highest and lowest average performance scores were observed in 2003 (0.78) and 2013 (0.56), respectively. Number of physicians and rural primary healthcare centers per population had a positive statistically significant and the number of midwives and the total fertility per population had a negative statistically significant effect on efficiency.
Conclusions: The findings suggest some level of wastage of health resources in primary health centers. The policy maker and relevant stakeholders should undertake more effective need analysis, optimizing human resource utilization and reducing fertility in rural areas to promote efficiency.