The special problem of tertiary care facilities

The management of tertiary-level health facilities (meaning mostly major urban hospitals) merits special attention. Improving efficiency at such facilities without increasing their budget allocations in real, or even nominal, terms would be highly desirable. Management audits can lead to the establishment of specific targets for efficiency gains. At the Kenyatta National Hospital in Nairobi, for example, the performance targets include reducing the average length of an inpatient's period of hospitalization from 8.6 days in 1989-90 to 7.1 days in 1995-96, a reduction in staff from 5.4 to 4.0 per 1,000 patient days, and an increase in the ratio of maintenance to total recurrent expenditures from 2.2 percent to 6.0 percent. Malawi has prepared five-year efficiency plans for its three major hospitals that include reductions in funding for transport and utility systems, other items, and improved accounting and expenditure control.