Technical efficiency at public health dispensaries in Kenya: a case study of the Imenti-south sub-county

Abstract

The Imenti sub-County in Meru County inherited a large health system infrastructure from the Central Government but the performance of this system remains unknown. Meru is a rapidly growing county in terms of population, which is projected to reach 1.6 million in 2016. The demand for medical services is also growing. This study had the following objectives: to determine the level of technical efficiency in public health dispensaries in Imenti sub-county; to estimate the input reductions and output increases needed to make any inefficient public dispensaries efficient; to determine the factors influencing the level of efficiency of dispensaries in the study area; and to make recommendations to the County Government.The two stage Data Envelopment Analysis (DEA) method was used to estimate efficiency levels and the OLS and Tobit methods were used to explain variation in the efficiencies. The data on output variables were obtained from the County health records, while the information on inputs was collected from the universe of the sub-county dispensaries. Forty-one percent of the dispensaries were found to be inefficient, with the average for variable returns to scale efficiency being 70 percent. The means for constant and scale efficiencies were 55% and 80%, respectively. The factors influencing variation in efficiencies include gender of the head nurse, education of the head of the management board, and size of the dispensary. The study concludes that the county health policy makers together with dispensary management boards can increase the volume of health service delivered by dispensaries by up to 38 percent by implementing efficiency improving measures without increasing staff or health infrastructure.