DEA ونموذج Tobit قياس كفاءة الإنفاق العام على الصحة في افريقيا وتحليل اثر جائحة كوفيد_19عليها باستخدام منهجية

Abstract

This study aims to analyze the efficiency of public health expenditure in ten African countries during the period 2018–2021 within the context of structural challenges intensified by the COVID-19 pandemic. It is based on the assumption that health system performance depends not only on the volume of allocated resources but also on the efficiency with which these resources are utilized to achieve optimal health outcomes. A two-stage quantitative approach was adopted. In the first stage, Data Envelopment Analysis (DEA) under both Constant Returns to Scale (CRS) and Variable Returns to Scale (VRS) assumptions was used to evaluate relative efficiency scores. In the second stage, the Tobit Model model was employed to investigate the determinants of technical efficiency before and during the pandemic, as well as across the full panel dataset. The findings reveal significant structural disparities across countries and indicate that a substantial share of performance gaps is attributable to scale inefficiency rather than managerial inefficiency. Tobit estimates show that the pre-pandemic VRS model provided the strongest explanatory power, with health expenditure exerting a positive and significant effect on efficiency, while GDP displayed a negative effect. COVID-19-related variables did not exert a statistically significant direct impact, suggesting that pandemic effects operated through deeper structural and institutional channels. The study concludes that improving health system efficiency requires governance and institutional reforms beyond merely increasing health expenditure.