Transcript determinants of health status in kenya gakunju em

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
Country’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 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 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
Table1:
Year
Growth in Healthcare Facilities
(1967-2000)
Hospital
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
No. of beds
& Cots
na
27691
30986
33086
47214
57416
No. of
personnel
na
19307
27850
33918
43264
55732
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
Deaths per 1000 live births
Infant and the Under-5 Mortality Rates in Kenya
250
200
150
100
50
0
1960 1979 1990 1991 1992 1993 1995 1998 2003
Infant Mortality
119
104
74
52
51
63
68
74
77
Under five mortality
202
112
110
75
74
96
90
112
115
Years
Infant Mortality
Under five mortality
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
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, 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)
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 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
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 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 necessary eg Provision
of clean water and sanitation, ensuring clean
environment etc
Thank you