Introduction Kenya adopted a decentralized health system as part of the efforts to improve access, eliminate inequalities and make progress towards universal health coverage (UHC). With significant investments, county governments are charged with the responsibility of delivering healthcare to their population. However, questions remain about the efficiency of resource utilization to meet the health goals.

Methods We assembled a dataset comprising health sector inputs, outputs, and contextual factors to measure the efficiency of Kenya’s health system across 47 counties in 2022. We estimated overall technical efficiency (OTE), pure technical efficiency (PTE) and scale efficiency (SE) employing Simar and Wilson’s single-step data envelopment analysis (DEA) approach. We assessed the impact of contextual factors on efficiency levels using a truncated regression model.

Results Considering child survival as a health system output, the national average for OTE was 0.74 (95% CI:0.70-0.78), while PTE was 0.85 (95%CI:0.82-0.88) and SE was 0.87 (95%CI:0.85-0.89). Meanwhile, for childhood immunization coverage, average OTE was 0.83 (95%CI:0.81-0.87), while PTE was consistently high across the counties. For maternal survival, OTE was low at 0.51 (95%CI:0.48-0.55), and PTE was 0.61 (95%CI:0.57-0.69), with SE averaging 0.82 (95%CI:0.79-0.84). Taking healthy adjusted life expectancy (HALE) as the health system output, average OTE was 0.83 (95%CI:0.81-0.85). There was a high correlation between OTE scores that considered child survival, childhood immunization coverage and HALE as health system outputs. Efficiency scores showed a heterogenous picture across the country both at the provincial and county levels.

Conclusion In 2022 the Kenyan health system was inefficient. Decision makers in Kenya have an opportunity to improve health outcomes without the injection of additional resources particularly through better managerial practices as pointed by low attainment in PTE. Additionally, reorganizing the scale of health programs to operate at the optimal level would yield improved efficiency.

The authors have declared no competing interest.

This study did not receive any funding

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Permission to conduct the study was granted by the Ministry of Health in Kenya and the respective national institutions that provided the data used on the analysis. Since our study used only deidentified publicly available secondary data at the county level, it was exempt from the full institutional board review.

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The main data sets supporting the conclusions of this article are available on request and with written permission from the Kenya National Bureau of Statistics. The data from IHME are publicly available and can be accessed through this publication: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30472-8/fulltext