Infrastructure Matters : Complementarities with the Quality of Health Service Delivery in Kenya

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