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DETERMINANTS OF HEALTH

STATUS IN KENYA

GAKUNJU E. M.

2001/HD06/013K

MASTERS OF ARTS IN ECONOMIC POLICY MANAGEMENT

EPM 651: RESEARCH PAPER

MAKERERE UNIVERSITY INSTITUTE OFECONOMICS

MARCH 2003



Introduction� Health ́ as a state of complete physical, mental and

social well-being and not merely the absence of

disease or infirmityµ WHO (1978)� ´the health of the people is fundamental to the

attainment of peace and security and is dependentupon the fullest co-operation of individuals and the

stateµ. WHO (1978)

� Human health has a major role to play in aCountry·s Economy Development.



Introduction con¶t� There is a direct relationship between the health

status of a population and its productivity as

demonstrated by industrialized countries, which arenow benefiting from years of investment in healthservices

� The provision of good health satisfies one of the

basic human needs and contributes significantly towards maintaining and enhancing the productivity of the people



Research Problem

� The health sector is at crossroads. Health statisticsshows tremendous decline in the performance of the health indicators over the last ten years despite

the increase allocation in health expenditure.� Implies therefore the increasing governmentspending may not necessarily lead to improvementin health status as would be expected. Why is this

the case?� What other factors can explain the health status?

� What is the role of the social and economic factorsin addition to public spending in determination of

health status of a country?.



Objective of the study

� is to analyse the factors determining healthstatus in Kenya.

� Outline policy options necessary for reversing

declining health status in Kenya.



Over vi

ewof th

eH

ealth

sector in K

eny

a

� Kenya entered the 1970s with a strong economy exemplifying the excellent macroeconomic

performance of the 1960s. This was reflected in highgrowth of the overall and sectoral gross domesticproduct (GDP) averaging more than 5% per annum.

� The country·s health sector recorded tremendous

growth especially in its public sub-sector.� This sector growth was attributed to the high

priority accorded to the improvement of the healthstatus of the Kenyans as well as social economicdevelopment of the country



Table1: Growth in Healthcare Facilities

(1967-2000) Y ear Hospital Health No. of beds No. of

centres & Cots personnel1967 199 162 na na

1980 216 241 27691 19307

1985 243 267 30986 278501990 268 299 33086 339181995 356 531 47214 432642000 481 601 57416 55732

Source; Economic survey various issues



Hea

lthst

atu

sindic

ator

s

� As the health facilities increased, ´indicatorsµ

of health status improved tremendously.

� Infant mortality rate declined from 120 to 62 per1000 live births while the Under 5 mortality ratedropped from about 200 to 97 per 1000 between

1963 and 1991.� Life expectancy increased from 40 years in

1965 to 60 years by 1990



Infant and the Under-5 Mortality Rates in Kenya

0

50

100

150

200

250

Years

D

e a t h s p e r 1 0 0 0 l i v e b i r t h s

Infant Mortality

Under five mortality

Infant Mortality 119 104 74 52 51 63 68 74 77

Under f ive mortality 202 112 110 75 74 96 90 112 115

1960 1979 1990 1991 1992 1993 1995 1998 2003



Hea

lth indicator

scon¶t

� the remarkable performance of the country·s healthsector was not sustained after the first two decades

of independence.� By the start of the millennium, health status in

Kenya worsened even further.

� Infant mortality rate increased from 74 in 1998 to 77

in 2003 while the under five-mortality rate rose from112 in 1998 to 115 in 2003.

� Life expectancy at birth for females declined to 48years and 47 for males



Cau

sesof poor p

erfor

manc

e� the factors associated with the decline in the

health status include under-funding of thehealth sector which has led to lack of drugs,

inappropriate staffing and staff shortages,poor maintenance of equipment and facilitiesresulting to poor and/or unavailability of theservices(inappropriate policy responses ).

� In addition, there are causes outside thehealth sector, which include increased levelsof poverty



Methodology

� The study utilizes a combination of utility maximization approach as developed by Grossman

1972 and Guilkey et al (1987) model onrelationship of health status and other socialeconomic factors.

� The utility maximization model assumes that

individuals maximize utility over their lifetime froma flow of services of health stock achieved as a resultof good health status.



Vari

a bl

es

� Infant Mortality is the dependent variable while

independent variable are GDP per capita, public

health expenditure, doctor·s access by household,female literacy level, immunization coverage, andaccess to clean water and sanitation. The functionalmodel was specified as

� Hs = f ( pci, g , da, fl, imm, rw, uw, e)-------------- (I)



vari

a bl

e s p

ecific

ation

structural estimation equation was expressed as

follows:

Lnim= lnpci + lnfl + lnda + lnimm + lnrw +

lnuw + lnlg + dummy + e-----------------(ii)

Dummy was to capture the effect of

HIV/AIDS



Test

s st

ati

stic

s

� Two tests were carried out

� stationarity (unit root) and

� co integration tests.

Data type and sources.

The study utilized time series data collected

from government publications in the Ministry of Finance and Planning, Central Bureau of Statistics

(CBS) and the Ministry of Health.



Study findings

� income per capita and female literacy were found to

be highly significant in determination of healthstatus. The result indicated that a 0.37% increase inincome per capita led to a 1% reduction in infantmortality.

�Similarly 1.6% increase in female literacy level led toa 1% reduction in infant mortality

� government health expenditure, was also significantin determining health status of the households.

However, it was also found that government healthexpenditure also influences health status with a lag. This implies that the current and past government(investment and spending) spending in the healthsector have significant effect on the health of the

population.



Study finding

Con¶t

� Other notable factors that influence health statusinclude the immunization coverage. A 0.11%

increase in immunization coverage led to a 1%reduction in infant mortality.

� HIV/AIDs prevalence, was also to be significant indetermining the health status of the population.

The results showed that a 0.05% increase inHIV/AIDs prevalence led to a 1% increase ininfant mortality



Study li

mit

ation

s

� The study utilized only the central governmenthealth expenditures to explain health status of the

population. In reality there are other health relatedexpenditures especially by the local government andreligious organisation that were not taken intoconsideration.

� Possibility of measurement errors in the variables.For instance, though infant mortality is consideredas one of the best measure of health status, it has itsown logistical problems in measurement eg cases of unregistered births and deaths especially in the rural

areas



conclusion

� Several factors have been identified as being significant in determination of health status inKenya. These include income per capita, femaleliteracy level, government spending in health sector,

immunization coverage, and access to doctors by households as well as the HIV/AIDs prevalence.

� It is important to note that although most of thefactors influencing the health status of the

population revolve around government spending the involvement of other sectors especially theprivate sector is necessary for achievement of goodhealth



Policy Recommendations

� the government policy framework should be gearedtowards improving the income per capita of theeconomy

� Increasing and restructuring the public expenditure

on the health sector is necessary.� There is need for the government to step up the

immunization coverage.

� There is need for increased involvement of the

private sector in provision of health care.� The government should continue with

iimprovement of the education system and more sothe girl child education



r eco

mmend

ation

scon¶t

� Enhancement of the HIV/AIDs campaign

strategies so as to reduce the HIV/AIDS new

infections.

� General improvement in the provision of basic social services is necessary eg Provision

of clean water and sanitation, ensuring cleanenvironment etc



Thank you

gakunju edward m

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