background public district hospitals (pdhs) in tunisia are not operating at full plant capacity and underutilize their operating budget. methods individual pdhs capacity utilization (cu) is measured for 2000 and 2010 using dual data envelopment analysis (dea) approach with shadow prices input and output restrictions. the cu is estimated for 101 of 105 pdh in 2000 and 94 of 105 pdh in 2010. ...