Efficiency of TB service provision in the public and private health sectors in Ethiopia

BACKGROUND: The Ethiopian Government has iden-tified efficiency of TB services as a key priority in planning and budgeting. Understanding the magni-tude and sources of inefficiencies is key to ensuring value for money and improved service provision, and a requirement from donors to justify resource needs. This study identifies the cost of providing a wide range of TB services in public and private facilities in Ethiopia.METHODS: Financial and economic unit costs were estimated from a health provider's perspective, and collected retrospectively in 26 health facilities using both top-down (TD) and bottom-up (BU) costing approaches for each TB service output. Capacity inefficiency was assessed by investigating the variation between TD and BU unit costs where the factor was 2.0 or more.RESULTS: Overall, TD unit costs were two times higher than BU unit costs. There was some variation across facility ownership and level of care. Unit costs in urban facilities were on average 3.8 times higher than in rural facilities.CONCLUSION: We identified some substantial ineffi-ciencies in staff, consumable and capital inputs. Ad-dressing these inefficiencies and rearranging the TB service delivery modality would be important in ensur-ing the achievement of the country's End TB strategy.