Health System Productivity In Sub-Saharan Africa: Tuberculosis Control In High Burden Countries

Abstract Background: 21 of the 30 countries with a high tuberculosis (TB) burden are in Sub-Saharan Africa (SSA). SSA is also home to 74% of all HIV-positive TB patients reported worldwide in 2014. This paper analyses the productivity changes of TB programs and decompose this productivity down into technological change and technical efficiency. Method: this study was carried out in 16 SSA countries where TB is highly endemic and covers the period 2009-2016. The data is taken from the annual reports of global TB Program. We used the Hicks-Moorsteen index to compute and decompose total factor productivity (TFP), and the β-convergence and σ-convergence tests to check for convergence patterns among SSA countries. Results: The largest increase in the TFP (35.7%) in 2016 with respect to the base year corresponds to the cutbacks in inputs (9.1%) and a positive change in outputs (0.9%). We found that technological change has been the main driver of the TFP growth, and that increasing technical efficiency may be the first objective in efforts to improve the TFP of TB programs. Our findings support the hypothesis of convergence among SSA countries in the fight against TB. Moreover, corruption was considered as one of the most important determinants of tuberculosis control in SSA countries.Conclusion: the findings suggest that improving the technical efficiency of TB programs mainly calls for better resource allocation, capacity building in governance and management of programs, improved training of the health providers and stronger prevention policies. An efficient use of funds will arguably reduce the number of tuberculosis cases and TB burden. The Global Fund must closely monitor all the grants in its portfolio and respond decisively and urgently to any instances of corruption.