# 3. Data and Methodology

This section describes the data used in the paper and the construction of the main variables of interest. It then provides summary statistics and discusses some data limitations.

## 3.1. Data Sources

We combined high-quality georeferenced facility survey data with geospatial data on infrastructure and location-specific characteristics for this analysis, including: Service Delivery Indicators Data The Service Delivery Indicators (SDI) initiative gathers comparable international information on service delivery for education and health around the world. These data help to identify gaps, track changes over time, benchmark progress, stimulate evidence-based debate, and ultimately, influence how countries design policies and interventions to accelerate progress in human capital outcomes. Even when service coverage has been shown to have increased in many countries, the quality remains uneven, and the investments in expansion and access have not been matched with human development outcomes (World Bank, 2021). The SDI surveys develop a set of critical indicators that benchmark service delivery performance to provide valuable inputs for direction and policy making, increase public accountability, track progress over time and improve quality and human capital accumulation across countries (World Bank, 2018). Launched by the World Bank in partnership with the African Economic Research Consortium and the African Development Bank in 2010, the SDIs for health and education were piloted in 2010 in Senegal and Tanzania, implemented in Kenya in 2012. Since then, they have been scaled up to cover more than 15 African countries and adapted outside Africa, like in Iraq, Indonesia, Bhutan, and Moldova, where work is ongoing (Gatti R., et al., 2021).

The SDIs are nationally representative surveys that involve three dimensions of health care service provision: (i) providers’ knowledge, (ii) providers’ effort, and (iii) providers’ inputs to work. SDI surveys allow for assessing how these elements come together to produce quality health services in the same facility. Data collection is undertaken by enumerators visiting selected medical facilities in announced and unannounced visits and observing providers’ performance, the availability of inputs, and the infrastructure in place.

For this analysis, we rely on the SDI health survey implemented in Kenya in 2018, the largest to date, for which 3,094 facilities, of which 1,718 public and 1,313 private facilities, were visited between March and July 2018. The survey is representative of each of the 47 counties, the location of facilities (i.e., urban or rural), facility ownership (i.e., public or private), and facility level (i.e., hospital, health center, or dispensary and clinic).

Data on service delivery performance, including the availability of inputs and medical providers’ knowledge, are aggregated at the facility level. We focus on questions related to the availability of resources, such as medicines and vaccines, and providers’ knowledge, focusing on early childhood and maternal health. For the former, enumerators verify firsthand the availability of non-expired medicines and vaccines from a list of essential pharmaceuticals and maternal and reproductive products. For the latter, Patient Case Simulations (PSC, also called vignettes) are performed to assess the providers’ diagnostic and treatment accuracy for specific illnesses of wide prevalence in the country. A random sample of staff is selected in each facility<sup>5</sup> with one of the enumerators presenting different cases of a sick patient to each health provider while the other acts as an observer. Section 3.2 describes the variables built based on SDI questions.

> 5 Up to ten medical personnel from those who regularly treated patients.

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