The accessibility to highest achievable standards of health is identified as a basic human right (WHO, 1978). Over the years there has been global, regional and local focus to improve accessibility to health care. The sustainable development goal (SDG) 3 aims to safeguard the lives of individuals of all ages and ensure their wellbeing.(United Nations, 2022). Locally, President Uhuru Kenyatta declared in 2017 the commitment of the government to improve the lives of Kenyans through the Big Four action plan. Amongst the plan was to attain universal health coverage through scale up of NHIF uptake. As various policies are formulated to increase demand for health care and subsequently improvement health status then it becomes necessary to have a critical look at the health system arises. Amongst Kenya’s counties is Kiambu county which manages 108 health facilities. In the year 2018/2019, Kiambu county approved budget for the health department was over Ksh. 5.92 billion against a total county budget of Ksh. 17.89 billion which translates 33.4% of the total budget of Kiambu county. Despite this high allocation, the county grapples with inadequate health resources resulting in a challenge in health service provision (County Government of Kiambu, 2018). The main purpose of this research was to evaluate technical efficiency of county managed level 4 and level 5 hospitals in Kiambu County for the year 2019. The specific objectives were to determine the relative technical efficiency of the county government managed hospitals in Kiambu County. Additionally, the factors that have an effect on the technical efficiency of the county government hospitals in Kiambu County were to be determined. The findings of these objectives were to be used provide policy options. The study used a two-part model of output- ix oriented Data Envelopment Analysis and subsequently Ordinary Least Squares regression analysis which was employed to establish the factors influencing technical efficiency of these hospitals. The study revealed that only 2 (15%) hospitals of the assessed facilities showed a CRS technical efficiency score of 1 and 6 (46.2%) had VRS technical efficiency score of 1. Of the assessed hospitals, 8 (61.5%) exhibited decreasing returns to scale and 23.1% of the assessed hospitals exhibited increasing returns to scale. Moreover, the research study showed no zero correlation between technical efficiency and size of hospital, catchment population, type of hospital and location of hospital. The research proposes improvement of technical efficiency of Kiambu county public hospitals through by emulating best practices of the technically efficient hospitals. Additionally, the redistribution of excess resources is also proposed. An investigation into the health care services utilization of the population is recommended.

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