DETERMINANTS OF HEALTH STATUS IN KENYA

1. 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 OF ECONOMICS MARCH 2003

2. Introduction • Health “as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” WHO (1978) • “the health of the people is fundamental to the attainment of peace and security and is dependent upon the fullest co-operation of individuals and the state”. WHO (1978) • Human health has a major role to play in a Country’s Economy Development.

3. Introduction con’t • There is a direct relationship between the health status of a population and its productivity as demonstrated by industrialized countries, which are now benefiting from years of investment in health services • The provision of good health satisfies one of the basic human needs and contributes significantly towards maintaining and enhancing the productivity of the people

4. Research Problem • The health sector is at crossroads. Health statistics shows 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 government spending may not necessarily lead to improvement in 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 factors in addition to public spending in determination of health status of a country?.

5. Objective of the study • is to analyse the factors determining health status in Kenya. • Outline policy options necessary for reversing declining health status in Kenya.

6. Overview of the Health sector in Kenya • Kenya entered the 1970s with a strong economy exemplifying the excellent macroeconomic performance of the 1960s. This was reflected in high growth of the overall and sectoral gross domestic product (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 health status of the Kenyans as well as social economic development of the country

7. Table1:Growth in Healthcare Facilities (1967-2000) Year Hospital Health No. of beds No. of centres & Cots personnel 1967 199 162 na na 1980 216 241 27691 19307 1985 243 267 30986 27850 1990 268 299 33086 33918 1995 356 531 47214 43264 2000 481 601 57416 55732 Source; Economic survey various issues

8. Health status indicators • As the health facilities increased, “indicators” of health status improved tremendously. • Infant mortality rate declined from 120 to 62 per 1000 live births while the Under 5 mortality rate dropped from about 200 to 97 per 1000 between 1963 and 1991. • Life expectancy increased from 40 years in 1965 to 60 years by 1990

9. Infant and the Under-5 Mortality Rates in Kenya

10. Health indicators con’t • the remarkable performance of the country’s health sector 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 from 112 in 1998 to 115 in 2003. • Life expectancy at birth for females declined to 48 years and 47 for males

11. Causes of poor performance • the factors associated with the decline in the health status include under-funding of the health sector which has led to lack of drugs, inappropriate staffing and staff shortages, poor maintenance of equipment and facilities resulting to poor and/or unavailability of the services(inappropriate policy responses ). • In addition, there are causes outside the health sector, which include increased levels of poverty

12. Methodology • The study utilizes a combination of utility maximization approach as developed by Grossman 1972 and Guilkey et al (1987) model on relationship of health status and other social economic factors. • The utility maximization model assumes that individuals maximize utility over their lifetime from a flow of services of health stock achieved as a result of good health status.

13. Variables • Infant Mortality is the dependent variable while independent variable areGDP per capita, public health expenditure, doctor’s access by household, female literacy level, immunization coverage, and access to clean water and sanitation. The functional model was specified as • Hs = f ( pci, g , da, fl, imm, rw, uw, e)-------------- (I)

14. variable specification 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

15. Tests statistics • Two tests were carried out • stationarity (unit root) and • co integration tests. Data type and sources. The studyutilized time series data collected from government publications in the Ministry of Finance and Planning, Central Bureau of Statistics (CBS) and the Ministry of Health.

16. Study findings • income per capita and female literacy were found to be highly significant in determination of health status. The result indicated that a 0.37% increase in income per capita led to a 1% reduction in infant mortality. • Similarly 1.6% increase in female literacy level led to a 1% reduction in infant mortality • government health expenditure, was also significant in determining health status of the households. However, it was also found that government health expenditure also influences health status with a lag. This implies that the current and past government (investment and spending) spending in the health sector have significant effect on the health of the population.

17. Study finding Con’t • Other notable factors that influence health status include 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 in determining the health status of the population. The results showed that a 0.05% increase in HIV/AIDs prevalence led to a 1% increase in infant mortality

18. Study limitations • The study utilized only the central government health expenditures to explain health status of the population. In reality there are other health related expenditures especially by the local government and religious organisation that were not taken into consideration. • Possibility of measurement errors in the variables. For instance, though infant mortality is considered as one of the best measure of health status, it has its own logistical problems in measurement egcases of unregistered births and deaths especially in the rural areas

19. conclusion • Several factors have been identified as being significant in determination of health status in Kenya. These include income per capita, female literacy 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 the factors influencing the health status of the population revolve around government spending the involvement of other sectors especially the private sector is necessary for achievement of good health

20. Policy Recommendations • the government policy framework should be geared towards improving the income per capita of the economy • 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 so the girl child education

21. recommendations con’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 necessaryeg Provision of clean water and sanitation, ensuring clean environment etc

22. Thank you