Allocative Efficiency of Public Health Spending in Bangladesh: A Mixed-Methods Study.

Bangladesh's public health care system faces persistent fiscal constraints amid rising demands, with limited opportunities to expand fiscal space. Therefore, this study aims to find ways to increase the efficiency of present resource allocation so that Bangladesh's health system performance can be improved with limited available resources. Initially, an input-oriented, variable returns to scale three-stage data envelopment analysis was used to assess the efficiency using district-level panel data. This was followed by qualitative analysis of data from key informant interviews and focus group discussions, which were thematically analyzed to identify strategies for improving allocative efficiency. The average efficiency score was 0.6, suggesting that the same level of health services delivery could have been achieved with approximately 40% fewer resources if inputs had been distributed more optimally. The qualitative findings indicate that enhancing allocative efficiency depends on integrated reforms in governance, workforce planning, and accountability, rather than budgetary adjustments alone.