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, drawing on a nationally representative survey and linked administrative data. The paper adapts the World Management 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 the primary point of contact for most patients, providing treatment for common infectious diseases and chronic conditions, as well as services related to maternal and child health. Management quality is low on average, and the distribution is highly compressed. The analysis uses administrative data to test the association between the management quality and performance of primary health care facilities, measured by outpatient attendance, during a period of disruption that included the COVID-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 substitution during the strike. Within the private sector, better-managed facilities showed greater resilience, driven primarily by operations management. These results underscore the role of management quality in strengthening facility-level resilience and the complementarity of public and private sectors in absorbing healthcare shocks.