roads in fair condition (Iimi, et al., 2016). Finally, mobile subscriptions had a penetration close to 100% in 2018, but only 23% of the population in Kenya had access to internet services in 2019 (World Bank, 2021). Given these gaps, improving the access and quality of infrastructure has a potentially important role for improving health service provision in Kenya.

This paper focuses on specific dimensions of infrastructure with data availability and for which we found prior suggestive evidence on their link to the quality of health service delivery. In particular, we study access to and quality of electricity (using stability of the connection as a proxy for quality), road quality and accessibility, cellphone, and internet connectivity (2G and 3G), and use of ICT. Likewise, in this paper we are restricted to study only certain aspects related to the quality of health services for which we have data. While we understand that quality of health service delivery is multi-dimensional and complex to measure, we use level of health services’ readiness (i.e., availability of key medicines, vaccines for children, and ANC tests) and health providers’ medical knowledge to treat certain conditions (i.e., diagnostic accuracy) as proxies of quality of health service delivery. For this analysis, we combine geo-referenced survey data collected at the health facility level with geospatial data on infrastructure and location characteristics in order to document some of the cross-sectoral drivers of the quality of health.

We first find that access to electricity and quality of roads are associated with more accurate provider diagnostics for general illnesses and for those affecting primarily the early development of children and threatening the life of pregnant women. We also find that access to electricity is associated with (i) higher availability of vaccines for children, mostly by making it possible to have a working fridge, which is essential to store most vaccines; and (ii) higher availability of essential and priority medicines for children and pregnant women, partially through the use of ICT for supply chain management. Finally, access to electricity and ICT use for supply management are positively related to the availability of antenatal care (ANC) tests for pregnant women. Test availability also decreases when facilities are further away from fair or good quality roads. Overall, our results suggest that investments in infrastructure and technology may play an important role in improving the quality of health service delivery, including early childhood and maternal health.

Our contributions to the literature are three. First, we focus on the potential impact of access to infrastructure (i.e., electricity, road quality, cellphone and internet coverage, and use of ICT) on the quality of health service provision in a lower-middle-income setting. This is different from the current literature in that (a) we focus on the supply side while most papers focus on the demand side; (b) we use novel data by merging geospatial data with high-quality health service delivery indicators survey data from different sectors; and (c) while our data does not allow to identify causal impacts, we document the initial gaps in access to infrastructure and control for a wide set of characteristics in our correlational analysis to quantify the potential effect of infrastructure on health service provision. Furthermore, we provide insights for the provision of general health services, as well as for early childhood care and pregnant women. Second, we take advantage of the rich set of questions in the health service delivery indicators survey to provide suggestive evidence of the possible channels through which infrastructure affects the quality of health service delivery. Third, we lay the groundwork for future cross-sectoral studies by reviewing the literature and proposing a simple analytical framework on the channels through which infrastructure affects the quality of health service delivery.

The rest of the paper continues as follows. Section 2 summarizes some of the main findings from the literature around a simple framework. Section 3 describes the sources of data used, the construction of the indicators analyzed, and the methodology for the proposed analysis. Section 4 presents the results and policy implications of our findings.

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