ISSN: 2056-3736 (Online Version) | 2056-3728 (Print Version)

Impact of HIV and Covid-19 pandemics on ivorian health system efficiency

Tito Nestor TIEHI

Correspondence: Tito Nestor TIEHI,

University of Cocody-Abidjan, Côte d’Ivoire

pdf (289.57 Kb) | doi:


The purpose of this study is to estimate the impact of HIV and Covid19 on the efficiency of the public health system in Côte d'Ivoire. To this end, we use non-parametric data envelopment analysis (DEA) and double bootstrap procedures to analyze the data. The analyze reveals that district hospitals are not technically efficient. These estimates show that in 2019, TB-HIV co-infection and geographic accessibility increases technical efficiency, while respiratory diseases reduce it. In contrast, in 2020, the advent of the Covid-19 pandemic blunted the positive impact of TB-HIV co-infection and geographical accessibility on the technical efficiency of the Ivorian health system observed in 2019. This result, due to the reorientation of resources allocated to the health sector to deal with the Covid-19 pandemic, is similar to the crowding out of the HIV pandemic by that of Covid-19.


  Double Bootstrap, Tuberculosis/HIV, Covid-19.


Aldieri, L., Brahmi, M., Chen, X. and Vinci, C.P. (2021). “Knowledge spillovers and technical efficiency for cleaner production: An economic analysis from agriculture innovation”, Journal of Cleaner Production,, B. T., Alhassan, H., and Danso-Abbeam, G. (2020). “Technology adoption and technical  efficiency of smallholder farmers in Tolon district of Ghana: double bootstrap DEA approach”, Agricultural Economics and Policy., G. and Corra, G. (-1977). “Estimation of a production frontier model with application to the pastoral zone of Eastern Australia” Aust. J. Agric. Resour. Econ. 21, 167–179Blank, J.L.T. and Valdmanis, V.G. (2010). “Environmental factors and productivity on Dutch hospitals: a semi-parametric approach” Health Care Management Science 13, 27-34.Chilingerian, J. A. (1995). “Evaluating physician efficiency of decision-making units” European Journal of Operational Research 80, 548-574.Coelli, T. (1998). “A multi-stage methodology for the solution of orientated DEA models” Operations Research Letters 23, 3-5 143-149.Farrell, M. J. (1957). “The Measurement of Productive Efficiency” Journal of the Royal Statistical Society, A 120, 253-290.Halkos, G. E. and Tzeremes, N. G. (2011).“A conditional nonparametric analysis for measuring the efficiency of regional public healthcare delivery: An application to Greek prefectures”. Health policy, 103(1), 73-82.Kirjavaïnen, T. and Loikkanen, H. A. (1998). “Efficiency differences of Finnish senior secondary schools: an application of DEA and Tobit analysis” Economics of Education Review. 17,4, 377-394.Leleu, H. and Derveaux, B. (1997). “Comparaison des différentes mesures d’efficacité technique: application aux centres hospitaliers français” Economie et Prévision, 129-130, 3/4.Romley, J.A. and Goldman, D.P. (2011). “How Costly is Hospital Quality? A Revealed‐Preference Approach” The Journal of Industrial Economics 59, 4, 578-608.Scheraga, D. J. (2004). Operational efficiency versus financial mobility in the global airline industry: A Data Envelopment and Tobit analysis. Transportation Research. part A. 38, 383-404.Simar, L. and Wilson, P.W. (2007). “Estimation and Inference in Two-Stage. Semi-Parametric Models of Production Processes” Journal of Econometrics,136, 31-64.Steinmann, L. Zweifel (2003). “On the Inefficiency of Swiss hospital”, Applied Economics vol 35, n°3, pp 361-370.Tiehi, T.N. (2020). “Technical Inefficiency of District Hospitals in Côte d'Ivoire: Measurement, Causes  and Consequences, International” Journal of Economics and Finance, 12,9, 35-45.UNAIDS (2020). “2020 Global AIDS Update -Seizing the moment-Tackling entrenched inequalities to end epidemics”, UNAIDS report on the global AIDS epidemic, retrieved  from:, V., Kumanarayake, L. and Lertiendumrong, J. (2004). “Capacity in Thai Public Hospitals and the Production of Care for Poor and Nonpoor Patients”, Health Service Research Volume39, Issue6p2 Pages 2117-2134.Ventura, J., Gonzalez, E. and Carcaba, A. (2004). Efficiency and program-contract bargaining in Spanish public hospital, Annals of public and cooperatives Economics, vol 75, n°4, pp 549-573.WHO (‎2021)‎. “World health statistics 2021: monitoring health for the SDGs, sustainable development goals”. World Health Organization. Licence: CC BY-NC-SA 3.0 IGO