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This study aims at evaluating the technical efficiency (TE) of healthcare systems in the Arab region and exploring the key factors that affect the efficiency performance.

The study applies a two-stage Data Envelopment Analysis (DEA) approach to a sample of 20 Arab countries. In the first stage, a DEA model is used to calculate the TE scores of the examined healthcare systems in 2019 and 2010, following both the output and input orientations of efficiency. In the second stage, a censored Tobit model is estimated to investigate the determinants of healthcare efficiency.

DEA results of 2019 indicate that achievable efficiency gains of the Arab countries range from 0.4% to 16% under the output and input orientations, respectively. Six countries are efficient under both orientations. Although the average efficiency scores of the Arab countries have deteriorated between 2010 and 2019, Djibouti and Sudan had the greatest efficiency improvements between the two years. Bahrain, Mauritania, Morocco and Qatar proved to be efficient in 2010 and 2019 under the two orientations of efficiency and according to the two DEA specifications followed. The Tobit model reveals that corruption and government health expenditure tend to have an adverse impact on healthcare efficiency.

The author evaluates healthcare efficiency and healthcare's efficiency determinants in the Arab countries. Regardless Arab countries' diversity, these countries are facing common health challenges, including diminishing role of governments in healthcare financing; increased out-of-pocket healthcare spending; poor healthcare outputs and prevalence of health inequities resulting from weak governance institutions. Comparing the efficiency of healthcare systems between 2010 and 2019 gives insights on the potential impact of the Arab spring uprisings on healthcare efficiency. Moreover, examining the determinants of healthcare efficiency allows for better understanding of how to improve the efficiency of healthcare systems in the region.

This paper aims to fill a gap in the existing literature by shedding the light on four main issues. First, the relationship between child-at-risk protection and sustainable development and the key factors contributing to the failure or success of child-at-risk protection systems. Second, the main characteristics and limitations of the current institutional arrangements of the child-at-risk protection system in Egypt. Third, the budget allocations to child protection-relevant entities in Egypt. Fourth, the way forward to enhance the effectiveness of the child-at-risk protection system in Egypt.

The methodology used in this paper is of a qualitative nature. The authors relied on desk review of the international and national reports (including the un-published ones) and the relevant literature on the topic. Additionally, the authors reviewed the relevant laws and regulations and analyzed the fiscal data extracted from Egypt’s State budget. Also, semi-structured interviews were conducted with some officials from the different governmental entities covered by the study.

From the institutional perspective, the authors find that the current child-at-risk protection system in Egypt needs effective institutional arrangements, as it is attributed with the limited activation of the child protection committees, lack of coordination mechanisms and overlapping mandates with regards to case management. Hence, the authors propose two institutional approaches that could help in enhancing the performance of the current system. While the first approach has decentralized nature, the other is centralized. From the fiscal perspective, the authors analyze the trend and composition of the budget allocations to the child protection-relevant entities in Egypt. They show that such allocations are relatively small especially when items not related to child protection are excluded.

The paper analyzes the main characteristics and limitations of the current institutional arrangements of the child-at-risk protection system in Egypt. Moreover, it proposes two alternative institutional approaches to deal with such limitations and enhance the effectiveness of the current system. The paper also provides an analysis of the budget allocations to the child protection-relevant entities in Egypt. These issues have not been addressed sufficiently in the Egyptian context.