Child Health in Kenya: Synergy of Provider and Consumer Quality of Healthcare

Abstract

Besides access to health services, quality of healthcare is recognized as a key element in putting an end to preventable childhood illnesses which in turn contributes to improved population health outcomes. Quality of healthcare and its effects on health is often assessed at the facility level while neglecting the role of consumers of healthcare as co-producers of quality healthcare; they are capable of using their knowledge and resources to enhance their own (and their children’s) health. Moreover, existing theoretical and empirical evidence does not explore the synergistic health effects of provider and consumer quality of healthcare on health outcomes. To address the existing knowledge gap, this thesis addressed three objectives. To begin with, we assessed provider quality of healthcare in Kenya and establishing its determinants. We then developed a measure for consumer quality of healthcare and examined the determinants of household level quality of healthcare. Lastly, we sought to model theoretically and empirically the interaction effect of provider and consumer quality of healthcare on child health. This thesis has its theoretical foundations on microeconomic models of utility maximization, the agency models and health production theories. We utilize two data sets; the 2018 Kenya Health Service Delivery Indicators (SDI) survey data and the 2014 Kenya Demographic Health Survey data. The ordered logit model and Instrumental Variables Approach were employed appropriately for estimation of regression results. The results of the analysis point to the following main conclusions: First, on the supply side, being male, higher education and training level as well as having been trained in Integrated Management of Childhood Illnesses were more likely to result in provision of quality healthcare. Health facility characteristics, mainly, higher facility tier, government ownership and urban location were significant in improving provider quality of healthcare. Secondly, the demand side quality of healthcare was mainly determined by child characteristics such as child’s age and twin status as well as maternal level of education level and a household’s wealth index. Lastly, the effect of the interaction term between provider and consumer quality of healthcare on child health, was positive and significant suggesting that consumer quality of healthcare enhances child health given provider quality of healthcare. Other explanatory variables among them twin birth, birth-order number as well as socioeconomic status as indicated by wealth index and education level were key in influencing child health status. Policies should therefore focus on simultaneously improving both supply and demand side quality of healthcare. While provider side quality of healthcare has been the focus for many governments, the demand side quality of healthcare could be enhanced through enhanced maternal education and creating awareness on the importance of implementing recommended interventions at the family level.