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

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 Countrys Economy Development.

Introduction cont
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

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?.

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.

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 countrys 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

Table1:
Year

Growth in Healthcare Facilities (1967-2000)

No. of beds & Cots na 27691 30986 33086 47214 57416 No. of personnel na 19307 27850 33918 43264 55732

Health centres 1967 199 162 1980 216 241 1985 243 267 1990 268 299 1995 356 531 2000 481 601 Source; Economic survey various issues

Hospital

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

Infant and the Under-5 Mortality Rates in Kenya

Deaths per 1000 live births

250 200 150 100 50 0

Infant Mortality Under five mortality 1960 1979 119 202 104 112 1990 1991 1992 74 110 52 75 51 74 1993 1995 1998 63 96 68 90 74 112 2003 77 115

Years

Infant Mortality Under five mortality

Health indicators cont

the remarkable performance of the countrys 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

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

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.

Variables
Infant Mortality is the dependent variable while independent variable are GDP per capita, public health expenditure, doctors 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)

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

Tests statistics
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 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.

Study finding Cont

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

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 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 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

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

recommendations cont
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 clean environment etc

Thank you