Difference-in- differences analysis among level 5 hospitals  showed that Nyeri County recorded an increase in eight indicators. Out of these, four indicators recorded significant increase. Three indicators recorded non-significant decline. In terms of absolute numbers, outpatient attendance for the above 5 years cohort had the highest increase. Difference-in-differences analysis showed that outpatient attendance for the over 5 years cohort increased significantly among level 4 hospitals in Nyeri County while that of the under 5 years cohort also increased though insignificantly. The reverse was observed for level-3 facilities. Outpatient attendance for under 5 increased significantly while that of over 5 increased though insignificantly