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 first stage, we derived the bootstrapped DEA scores using an output orientation. We 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. We assessed the level and determinants of technical efficiency of the 47 county health systems in Kenya. In 2013, Kenya transitioned into a devolved system of government granting county governments autonomy over budgets and priorities. Improving health system efficiency is a key strategy to increase health system performance and accelerate progress towards Universal Health Coverage.
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