# 5. Discussion

Overall, while this study does not present causal inferences, it does document the evidence of existing correlations between different infrastructure variables and the quality of health services provided in Kenya after controlling for a wide set of other characteristics. These results are supported with and complement other existing literature to study possible channels and/or corroborate findings.

In determining the quality of health services, many factors come into play. We acknowledge that health care quality and infrastructure have several dimensions that cannot be covered by the available data or the scope of this work, which might have influenced the variability or quality of the variables explained by our model. Nonetheless, with the existent information we have relevant evidence to positively associate infrastructure access to our analyzed dimensions of health quality. For the case of Kenya, this study finds suggestive evidence that infrastructure matters, and that investments in infrastructure and technology may play an important role in improving the quality of health service provision, including the services for early childhood and maternal health. These results contribute to the understanding of quality in the health services from a supply side, by exploring dimensions of infrastructure to which it might be related and providing evidence on the relevance of the relationship. More work is needed to explore the quality of health services from a demand side perspective and, for both sides, more frequent and up to date data is needed to perform relevant and timely evaluations of the service and its components.

In terms of policy recommendations, in order to ensure that everyone, especially households in poorer and more isolated areas, has access to high-quality basic health services, it is important to prioritize electrifying the facilities that do not have access to electricity. While most facilities have access to electricity (89%), half do not have stable access, which is crucial for delivering health services, even in a broader scope than those analyzed here. In addition to the shown relationship between access to electricity and provider’s knowledge, the availability of drugs, vaccines and medical inputs, a stable electricity connection is also key to perform tests (e.g., laboratory test), treat patients (e.g., use ventilators), be able to perform medical procedures from the simplest to surgeries, among others. Therefore, providing the health facilities with a nationwide access to stable electricity access remains a priority to be addressed in Kenya. Needless to say, this would be an investment that would benefit many other sectors and households directly.

Likewise, it is equally important to invest in and improve the accessibility to roads and enhance their quality. Our findings suggest that more and better roads might help facilities eliminate access barriers that allow health facilities to access inputs, patients, and providers with more ease. Making facilities more accessible, however, may not contribute to addressing these issues if other complementary measures are not put into place. For instance, the 2018 SDI data suggests that urban-based health care workers had similar levels of diagnostic accuracy scores as their rural counterparts. Therefore, just increasing access will not necessarily translate into better providers if the pool of qualified providers is not large enough.

Moreover, the evidence presented suggests that ICT may be a valuable ally for improving the efficiency of supply chains and distribution of inputs to their end users. Enabling facilities to access and use ICT may positively impact the availability of medicines and inputs and also save time and resources. There is a substantial potential to increase the use of ICT for supply chain management in Kenya since only 15% of the facilities reported using it for this purpose.

Overall, these results show that investments in infrastructure might have significant positive effects for the quality of health service delivery and might be a relevant factor for improving health (and possibly many other) outcomes in the population as a whole.

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