ArticleCost effectiveness and resource allocation : C/E2021
Level and determinants of county health system technical efficiency in Kenya: two stage data envelopment analysis.
Article in Cost effectiveness and resource allocation : C/E, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Analysing the Efficiency of Health Systems: A Systematic Review of the Literature.Applied health economics and health policy · 2023Pooled it
- Beyond Efficiency Scores: Explaining Health System Performance Using Two-Stage Bootstrap DEA and Machine Learning.Healthcare (Basel, Switzerland) · 2026Article
- Technical and scale efficiency in health service production in Kenya: subnational analysis of 47 county governments.Archives of public health = Archives belges de sante publique · 2026Article
- Financial determinants of effective hypertension and diabetes care in rural primary health facilities in Kisumu, Kenya: a mixed-methods study.BMC public health · 2026Article
- Level and determinants of district primary healthcare system technical efficiency in Ghana: two-stage stochastic frontier analysis.BMJ global health · 2026Article
- Three decades in healthcare service efficiency evaluation: a bootstrapping Data Envelopment Analysis (DEA) of Ministry of Health Malaysia.Health economics review · 2025Article
- Antimicrobial stewardship challenges at a referral Hospital in Western Kenya: insights from a Kakamega-Cambridge health partnership.Frontiers in public health · 2025Article
- Efficiency of the healthcare system and the impact of smoking bans: a DEA analysis of the Guangdong-Hong Kong-Macau Greater Bay Area in Asia.Frontiers in public health · 2025Article
- Technical efficiency analysis of advanced medical centers in Burkina Faso.BMC health services research · 2024Article
- Efficiency evaluation and promoter identification of primary health care system in China: an enhanced DEA-Tobit approach.BMC health services research · 2024Article
- Examining the influence of health sector coordination on the efficiency of county health systems in Kenya.BMC health services research · 2023Article
- Examining the influence of budget execution processes on the efficiency of county health systems in Kenya.Health policy and planning · 2023Review
- The costs and financing needs of delivering Kenya's primary health care service package.Frontiers in public health · 2023Article
- Budget monitoring, accountability practices and their influence on the efficiency of county health systems in Kenya.PLOS global public health · 2023Article
- Management of human resources for health: implications for health systems efficiency in Kenya.BMC health services research · 2022Article
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Authors and funding
10 authors.
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Abstract
backgroundImproving health system efficiency is a key strategy to increase health system performance and accelerate progress towards Universal Health Coverage. In 2013, Kenya transitioned into a devolved system of government granting county governments autonomy over budgets and priorities. We assessed the level and determinants of technical efficiency of the 47 county health systems in Kenya.
methodsWe carried out a two-stage data envelopment analysis (DEA) using Simar and Wilson's double bootstrap method using data from all the 47 counties in Kenya. In the first stage, we derived the bootstrapped DEA scores using an output orientation. We used three input variables (Public county health expenditure, Private county health expenditure, number of healthcare facilities), and one outcome variable (Disability Adjusted Life Years) using 2018 data. In the second stage, the bias corrected technical inefficiency scores were regressed against 14 exogenous factors using a bootstrapped truncated regression.
resultsThe mean bias-corrected technical efficiency score of the 47 counties was 69.72% (95% CI 66.41-73.01%), indicating that on average, county health systems could increase their outputs by 30.28% at the same level of inputs. County technical efficiency scores ranged from 42.69% (95% CI 38.11-45.26%) to 91.99% (95% CI 83.78-98.95%). Higher HIV prevalence was associated with greater technical inefficiency of county health systems, while higher population density, county absorption of development budgets, and quality of care provided by healthcare facilities were associated with lower county health system inefficiency.
conclusionsThe findings from this analysis highlight the need for county health departments to consider ways to improve the efficiency of county health systems. Approaches could include prioritizing resources to interventions that will reduce high chronic disease burden, filling structural quality gaps, implementing interventions to improve process quality, identifying the challenges to absorption rates and reforming public finance management systems to enhance their efficiency.
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