Infrastructure Matters : Complementarities with the Quality of Health ServiceDelivery in Kenya

In many low- and middle-income countries, the lack of access to essential infrastructuresuch as roads, electricity, and information and communications technology may hinder the provision of manycritical services such as health care. For instance, scarce and deficient roads might limit the patients’ access tohealth facilities, restrict the supply of qualified staff, and constrict access to key inputs such as medicines andvaccines. Likewise, lack of reliable electricity and internet connection may limit the ability of healthfacilities to power essential equipment, have better access to information, potentially serve more patients, and managetheir supply chain efficiently. This paper combines exhaustive health facility surveys with geospatial data tostudy the extent to which better access to infrastructure in Kenya might improve the functioning of health carefacilities and the quality of their services. First, the paper documents the gap in access to infrastructure in thehealth care sector in Kenya and reviews the literature on this topic. Then, using a novel data set, it finds thataccess to electricity and good quality roads is associated with more accurate provider diagnostics for both generalillnesses and those primarily affecting children and pregnant women. Additionally, access to electricity isassociated with (i) higher availability of vaccines for children—mostly by making it possible to have a workingfridge, which is essential to store most vaccines; and (ii) higher availability of essential and priority medicines, byfacilitating the use of information and communications technology for supply chain management. Finally, access togood quality roads, electricity and use of information and communications technology for supply management arepositively related to the availability of antenatal care tests for pregnant women. Overall, the results suggest thatincreased investment in infrastructure and communications technologies may improve health service provision in Kenya.