重大中断期间的医疗设施管理和患者护理：来自肯尼亚的证据

Policy Research Working Paper Management of Health Care Facilitiesand Patient Attendance during Major Disruptions Evidence from Kenya Kathryn AndrewsFabiano Dal-RiRoberta GattiRenata LemosMario Macis People Vertical &Middle East, North Africa, Afghanistan,and Pakistan Region A verified reproducibility package for this paper isavailable athttp://reproducibility.worldbank.org,clickherefor direct access. Policy Research Working Paper11369 Abstract This paper measures and analyzes management practicesin the Kenyan health care sector, drawing on a nationallyrepresentative survey and linked administrative data. Thepaper adapts the World Management Survey to measuremanagement quality in primary health care facilities andhospitals, surveying 429 primary health care facilities and73 hospitals. Primary health care facilities are the primary and performance of primary health care facilities, measuredby outpatient attendance, during a period of disruptionthat included the COVID-19 pandemic and a publichealth workers’ strike. Overall attendance fell during thisperiod. Private facilities experienced a smaller decline thanpublic facilities, consistent with substitution during thestrike. Within the private sector, better-managed facilities This paper is a product of the People Vertical and the Office of the Chief Economist, Middle East, North Africa, Afghanistan,and Pakistan Region. It is part of a larger effort by the World Bank to provide open access to its research and make acontribution to development policy discussions around the world. Policy Research Working Papers are also posted onthe Web at http://www.worldbank.org/prwp. The authors may be contacted at kandrews@worldbank.org; fdalri@ifc.org;rlemos@worldbank.org; rgatti@worldbank.org; mmacis@jhu.edu. A verified reproducibility package for this paper is The Policy Research Working Paper Series disseminates the findings of work in progress to encourage the exchange of ideas about developmentissues. An objective of the series is to get the findings out quickly, even if the presentations are less than fully polished. The papers carry thenames of the authors and should be cited accordingly. The findings, interpretations, and conclusions expressed in this paper are entirely those ManagementofHealthCareFacilitiesandPatientAttendanceduringMajorDisruptions:Evidencefrom KathrynAndrews,FabianoDal-Ri,RobertaGatti,RenataLemos,MarioMacis,LydiaNakhone∗ Keywords:management practices;primary health care;outpatient attendance; JEL Codes:I15, L32, M10 Andrews:TheWorldBank.Dal-Ri:InternationalFinanceCorporation.Gatti:TheWorldBank,IZA,andCEPR.Lemos:TheWorldBank,CEP-LSE,andCEPR.Macis:JohnsHopkinsUniversity,IZA,andNBER.ThisstudywasapprovedbytheAmrefAfricaEthicsandReviewCommittee(ESRCP778-2020)andtheJohnsHopkinsHomewoodIRB(HIRB00010949).Weacknowledgefinancials upportf romt heResearchDepartmentattheWorldBank(ResearchSupportBudget).WearegratefultoRaissaEbner,RifatHaider,andJuanMunozforoutstandingresearchassistance,toElizabethNaukusiWangiaforhelpfulcomments, 1Introduction Low- and middle-income countries have made substantial progress in expanding access toessential health services in recent years.However, concerns persist that merely increasingaccess without addressing the quality of health care may not yield the desired improvement inhealth outcomes (Das et al. 2018). For example, estimates indicate that high-quality health systems could prevent 1 million newborn deaths and half of all maternal deaths annually inlow- and middle-income countries (Kruk et al. 2018). A growing body of evidence indicates In this paper, we begin to bridge this knowledge gap by investigating managementpractices in health facilities in a lower-middle-income country, with a focus on essential publichealth services. We developed a survey instrument based on the World Management Survey(WMS) and applied it to a sample of 429 primary healthcare (PHC) facilities in Kenya, a country with important shortcomings in healthcare provision.PHC facilities typically comparable measurements of management practices in this setting.1 We also surveyed maternal and child health-related departments in 73 Kenyan hospitals, which allowed us Our first contribution is descriptive: we analyze the data on management practicesand uncover three main findings. First, we find that management-practice quality scores inKenyan PHC facilities are low on the WMS scale. On a scale between 1 (“worst practices”)and 5 (“best practices”), the mean management score in Kenyan PHC facilities is 1.61, which Our second and main contribution is to combine our survey results with administrativedata from the Kenyan Health Management Information System (HMIS) on quarterlyoutpatient attendance between 2018 and 2021, collected independently of our managementsurvey, to explore the association between management practices and service provision during Prior studies have shown that strikes in public health facilities in Kenya were associated