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

Management of Health Care Facilitiesand Patient Attendance during Major Disruptions Evidence from Kenya Kathryn AndrewsFabiano Dal-RiRoberta GattiRenata LemosMario MacisLydia Nakhone People Vertical &Middle East, North Africa, Afghanistan,and Pakistan RegionMay 2026 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 primarypoint of contact for most patients, providing treatmentfor common infectious diseases and chronic conditions, aswell as services related to maternal and child health. Man-agement quality is low on average, and the distribution ishighly compressed. The analysis uses administrative datato test the association between the management quality 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 facilitiesshowed greater resilience, driven primarily by operationsmanagement. These results underscore the role of man-agement quality in strengthening facility-level resilienceand the complementarity of public and private sectors inabsorbing healthcare shocks. 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 isavailable athttp://reproducibility.worldbank.org, clickherefor direct access. 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 thoseof the authors. They do not necessarily represent the views of the International Bank for Reconstruction and Development/World Bank andits affiliated organizations, or those of the Executive Directors of the World Bank or the governments they represent. ManagementofHealthCareFacilitiesandPatientAttendanceduringMajorDisruptions:EvidencefromKenya KathrynAndrews,FabianoDal-Ri,RobertaGatti,RenataLemos,MarioMacis,LydiaNakhone∗ Keywords:management practices;primary health care;outpatient attendance;shocks. 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,andforthepartnershipoftheKenyaMinistryofHealth,CouncilofGovernors,andNationalCouncilforPopulationandDevelopment. 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 healthsystems 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 indicatesthat many aspects of health care quality are influenced by management practices (McConnellet al. 2013, Bloom et al. 2015, Goetz et al. 2015, Dunsch et al. 2017, Macarayan et al. 2019,Bloom et al. 2020, Angelis et al. 2021, Mu˜noz and Otero 2025). Yet, data linking managementto health care quality in low- and lower-middle-income countries, where quality tends to