Correlates of Technical Efficiency of Healthcare Delivery in Kenya

Healthcare systems in low- and middle-income countries face persistent pressure to achieve more from constrained budgets. This study investigates the factors that explain variation in technical efficiency across Kenya's health facilities by ownership type and service level. Using data from the 2018 Kenya Health Service Delivery Indicators Survey, which covers 3,094 facilities across all 47 counties, a two-stage analytical framework is applied. In the first stage, Data Envelopment Analysis generates facility-level technical efficiency scores. In the second stage, truncated regression with bootstrapping identifies the determinants of efficiency variation. Results indicate that staff absenteeism is the most consistent predictor of inefficiency across dispensaries, health centres, and hospitals, with effects most pronounced at hospital level. Private for-profit facilities exhibit higher inefficiency than public counterparts across service levels, whereas private not-for profit dispensaries demonstrate lower inefficiency. Urban location and extended operating hours both depict lower inefficiency. Private for-profit health centres achieve the highest mean efficiency score (0.82), while public dispensaries record the lowest (0.41). The findings yield actionable implications for absenteeism management, ownership policy, and operational strategy in Kenya's devolved health system.