Examining the level and variation in the efficiency of county health systems in Kenya, and how it can be improved
Medical Research Council
KEMRI Wellcome Trust Research Programme
This research aims to measure the level of efficiency of the 47 county health systems in Kenya, and to examine its determinants. It also aims to examine the potential for efficiency gains and how this can in turn result in increased fiscal space for the Kenyan health sector. Further, the research aims to test the application, and explore methodological refinements of current efficiency measurement methods to LMIC settings, and at sub-national levels of the system (such as counties/districts) rather than health facility level (such as hospitals). We will use two frontier methods to measure the technical efficiency (and its determinants) of county health systems. First, we will use the double bootstrap Data Envelopment Analysis technique. Data envelopment analysis (DEA) is a non-parametric mathematical linear programming technique that has been widely used in low and middle income countries (LMICs) due to its flexible nature. Stochastic frontier analysis (SFA) is a parametric econometric approach that uses regression analysis to estimate a production or cost function, that accounts for error, but can be computationally complex. Bootstrap DEA will generate bias corrected efficiency scores, which will then be subjected to truncated regression analysis to examine the determinants of efficiency. To further explore the determinants of efficiency, we will select 2 counties that are found to be efficient and 2 inefficient counties that are lower than the 75th percentile in efficiency rank, and carry out in-depth qualitative inquiry through in-depth interviews and document reviews. This component of the study answer questions about how identified factors interact with and influence health system efficiency, and how these might be leveraged on to improve health system efficiency. Lastly, we will examine the potential for efficiency gains using DEA, and excel based models
8.1 Organisation and delivery of services / Research Grant