Resource use efficiency in rural healthcare in India - Some insights from data envelopment analysis

There are widespread differences across the Indian states when it comes to rural health outcomes. On the one hand are states like Kerala, Tamil Nadu and Himachal Pradesh where health outcomes are at par with developed countries, despite their average economic indicators. The (Infant Mortality Rate) IMR in these states is 5, 23 and 35 respectively, the (Child Mortality Rate) CMR in these states is 6, 31 and 39 respectively and the life expectancy at birth is 74.9, 70.6 and 71.6 respectively. On the other extreme of this scale are states like Madhya Pradesh, Bihar and Uttar Pradesh where both the economic and health indicators are low by any standard measure. The IMR in these States is 54, 49 and 67 respectively, the CMR in these states is 69, 60 and 82 respectively and the life expectancy at birth is 64.2, 68.1 and 64.1 respectively. The main reasons explaining these inter regional differences are differences in the status of health infrastructure and outcomes at a certain base period, variation in the health outcome facilitating variables like per capita income, female literacy, level of urbanisation, availability of safe drinking water and sanitation facilities across different regions and variations in the resource use efficiency. The present study focuses on evaluating the resource use efficiency of rural health sector across the Indian states. This would help to identify the factors responsible for low efficiency of the inefficient states. In 2005, the mean technical efficiency score in rural health sector of India was 0.81 and in 2015 the mean technical efficiency was 0.78.