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Management of Health Care Facilities and Patient Attendance During Major Disruptions: Evidence from Kenya
This paper measures and analyzes management practices in the Kenyan health care sector, drawingon a nationally representative survey and linked administrative data. The paper adapts the WorldManagement Survey to measure management quality in primary health care facilities and hospitals,surveying 429 primary health care facilities and 73 hospitals. Primary health care facilities are theprimary point of contact for most patients, providing treatment for common infectious diseases andchronic conditions, as well as services related to maternal and child health. Management quality islow on average, and the distribution is highly compressed. The analysis uses administrative data totest the association between the management quality and performance of primary health carefacilities, measured by outpatient attendance, during a period of disruption that included theCOVID-19 pandemic and a public health workers’ strike. Overall attendance fell during this period.Private facilities experienced a smaller decline than public facilities, consistent with substitutionduring the strike. Within the private sector, better-managed facilities showed greater resilience,driven primarily by operations management. These results underscore the role of managementquality in strengthening facility-level resilience and the complementarity of public and privatesectors in absorbing healthcare shocks.
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