The Influence of Institutional Factors in Access to Healthcare in Kenya: A case of Nairobi County, Kenya

A case of Nairobi County, Kenya

  • Davies N. Chelogoi University of Nairobi  
  • University of Nairobi University of Nairobi
  • Dr. Henry Amadi University of Nairobi
Keywords: Access, Inequality, Health Inequality and Socio-Economic Inequality


This study examines the influence of institutional factors on access to public healthcare in Kenya, a case for Nairobi County. It addresses the influences of health policies, leadership and governance, health infrastructure, health facilities, health workers, health finances and health insurance. The objective of the study is to evaluate the influence of institutional variables in access of public healthcare.
The study used data from a sample of 1066 households purposively selected from Nairobi County. All households were aged 15 years and above. The households were subjected to interviews that covered a wide range of topics. Descriptive design was chosen for the study. The study adopted multiple sampling methods for the study. These included purposive sampling,
systematic sampling, snowball sampling and multi stage cluster sampling frame. The data was collected using various techniques or instruments which included observation, key informant interviews, questionnaires, in-depth interviews, and focus-group discussions. The data was processed using descriptive statistics. Correlation and regression analyses were used to correlate and interpret the data of the study.
The findings show access to healthcare is inadequate and unevenly distributed among the households in Nairobi County. The factors attributed to these inequalities were inadequate and poorly implemented health policies, inadequate health facilities, and inadequate health workers, shortage of essential drugs, low level funding and poorly managed health insurance. This study argues that these institutional factors should be made adequate, accessible and quality improved. The focus should be on the lower social classes, who are deprived, and denied capabilities to access healthcare. This is despite the interventions made to access healthcare to the entire population in the County


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Author Biographies

Davies N. Chelogoi, University of Nairobi  

Ph.D Candidate, Department of Political Science and Public Administration, University of Nairobi  

University of Nairobi, University of Nairobi

Associate Professor, Department of Political Science and Public Administration, University of Nairobi

Dr. Henry Amadi, University of Nairobi

Lecturer, Department of Political Science and Public Administration, University of Nairobi


Aday L. A. (1993), Equity, Accessibility, and Ethical Issues: is the US health care reform debate asking the right questions? 36: 724-740

African Union, (2001), Abuja Declaration on HIV/AIDS, tuberculosis and other related infectious diseases. Addis Ababa

Agabin N. et al. (2015), Undocumented and Uninsured: After Effects of the Patient Protection and Affordable Care Act. J Med Project Management; 30(5):345–58

Andersen RM, et al. (2001), Improving Access to Care in America: Individual and Contextual Indicators, Jossey-Bass; 3–30

Almeida LM et al. (2013), Migration and Maternal Health: Experiences of Brazilian Women in Portugal. Rev Bras Saude Matern Infant; 13(4):309–16

Athanasakis K. et al. (2009), The Economic and Social extensions of Alzheimer. Neurologia, 18: 220-227

Avila RM. et al. (2013), Language and Immigrant Status Effects on Disparities in Hispanic

Children’s Health Status and Access to Health Care. Maternal Child Health J; 17(3):415–23

Aye M (2002), Economic Role of Solidarity and Social Capital in Accessing Modern

Health Care Services in the Ivory Coast. Social Science Medical; 55:1929–46

Bartley M. (2004), Health inequality - An Introduction to Theories, Concepts and Methods. Malden (U.S.): Polity Press

Braveman P. et al. (2002), Social Inequalities in Health within Countries: not only an issue for affluent nations, Soc Sci Med, 54, pp.1621-35

Braven P. et al. (2003), “Defining Equity in Health”, Journal of Epidemiology and Community Health, 57; 254-258

Brawley M. (2000), The Client perspective: what is quality healthcare service? A literature Review, Kampala, Uganda

Bourdieu P. (1984), Distinction, A social Critique of the Judgment of Taste, Trans, Richard Nice, Cambridge, M.A. Harvard University Press Carmona R, et al. (2014), Use of health services for immigrants and native population: a

systematic review. Rev Esp Salud Publica; 88(1):135–55

Carroll KM, (2005), Behavioral Therapies for Drug abuse. Am J Psychiatry; 162(8):1452–

Constitution of Kenya. (2010), Fourth Schedule. Nairobi, Kenya: Government of Kenya

Cutler, D. et. al. (2002), “The Economic Impacts of the Tobacco Settlement,” Journal of Policy

Analysis and management, 21:1-9

Donabedian A. (1990), The Seven Villas of quality; 1115-1118

David M. (2002),“Health Care and the Public Sector.” Handbook of Public Economics

Davidson PL, Andersen RM, Wyn R, Brown ER. (2004). A framework for evaluating safety-net

and other community-level factors on access for low-income populations. Inquiry; 41(1):21–38

Deci E. et al. (1999), A meta-analytic review of experiments examining the effects of extrinsic

rewards on intrinsic motivation. Psychol Bull; 125(6):627–668

Deineger K. et al. (1996), “Anew Data Set Measuring Income Inequality,” World Bank

Economic Review 10: 565-591.

Elgar FJ. Et. al. (2015), Socioeconomic inequalities in adolescent health 2002-2010: a timeseries analysis of 34 countries participating in the health Behavior in School-aged Children

study, Lancet

Fields G. (2004), Department for Labour Economics Discussion Paper UK: Cornell University;

'Regression-based decomposition: A new tool for managerial decision-making Fraenkel J. et al. (2000), How to design and evaluate research in Education, New York NY: Mc

Grawhill companies Inc

Government of Kenya. (2002), Economic Survey, Government Printers, Nairobi

-------------------------------(1999), National Poverty Eradication Plan 1999-2015, Department of

Development Co-ordination, Office of the President, Government Printer, Nairobi

-------------------------------.(1996), National Report and Plan of Action on Shelter and Human

Settlements to Habitat 11 Conference, Ministry of Public Works and Housing, Nairobi

---------------------------------(2001), 1999 Population and Housing Census Volume I Central

Bureau of Statistics Nairobi

-------------------------------- (2015), Comparative Health Expenditure, Nairobi, Kenya

----------------------------------- (2013), Devolution of Health services in Kenya, KPMG;.7

----------------------------------- (2016), Master Facility List, Nairobi 32

---------------------------------------(1996), Welfare Monitoring Survey 1994, Basic Report, Nairobi:

Central Bureau Statistics

------------------------------------------(1998a), Kenya Demographic and Health Survey. Nairobi:

Government Printer

------------------- (2012), Vision 2030, Second Medium Term Plan, 2013-2017, Transforming

Kenya, Pathway to devolution, socio-economic development, equity and national unity,

Government Printer, Nairobi

Gulliford M. (2002), What does 'access to health care' mean? J Health Serv Res Policy; 7(3):186-

Gummesson, E. (1991), Qualitative Methods in Management Research (Revised Edition)

Hall P, (2009), In: Successful Societies: How Institutions and Culture affect Health. Hall P,

Lamont M. (editor). Cambridge: Cambridge University Press. Health, social relations and public

policy; pp. 82–103

Head J, et al. (2007) The Potential Impact on Health and Sickness Absence of Management

Standards for Work-Related Stress. Research Report to Health and Safety Executive. Health and

Safety Executive

House, WJ. (1978), “Nairobi’s Informal Sector A Reservoir of Dynamic Entrepreneurs of a

Residual Pool of Surplus Labour?” University of Nairobi Working Paper No 347, Institute of

Development Studies, Nairobi Jonyo F. (2014), Mitigating African Conflicts through Securitization of Development, DBA

Africa Management Review, No 3

Jonyo F. (2015), Gender in Socio-Economic Development in Kenya, DBA Management Review

No. 4

Republic of Kenya (1998), Integrated Labour Force Survey 1998/99. Nairobi. Central Bureau of


Republic of Kenya (1998b), National Poverty Eradication Plan. Nairobi: Government Printer

Institute of Medicine. (2001), Crossing the Quality Chasm: A New Health System for the 21st


Gwatkin D. R. et al. (20040, Making health systems more equitable; 1273-1287

Jong-wook L. (2003), Global health improvement and WHO: shaping the future. Lancet, 20;


Karanikolos M, (2013),Financial crisis, austerity, and health in Europe. Lancet, 381: 1323-

Kawachi, I. et al. (2002), A glossary for health inequalities: J Epidemiol Community Health, 56,


Kawachi I, et al. (2003), Neighborhoods and Health, New York, NY: Oxford University Press.

Kelly S, et al. (1997), Searching for the biological pathways between stress and health. Annual

Review of Public Health; 18:437–462

Kerlinger, F.N. (1986), Foundations of Behavioral Research (3rded). New York: Holt,

Rinehart and Winston

Keruly JC, Conviser R, Moore RD. (2002), Association of medical insurance and other factors

with receipt of anti-retroviral therapy. Am J Public Health; 92:852–857

Koblinsky MA, (1999), Organizing delivery care: what works for safe motherhood? Bull

World Health Organization; 77(5): 399–406

Krasnik A. (1996), The concept of equity in health services research, Scand J Soc Med: 24:2-7

Krieger N. (2001), Theories for social epidemiology in the 21st century: an ecosocial

perspective. International Journal of Epidemiology; 30:668–677

Leedy and Ormrod. (2005), Practical research: Planning and design (8th ed.). Upper Saddle

River, NJ: Prentice Hall

Lin N. (2001), Social capital: a theory of social structure and action. New York: Cambridge

University Press

Lynch JW et al. (2000). Income inequality and mortality: importance to health of individual

income, psychosocial environment, or material conditions. BMJ; 320:1200–1204

Mahler H. (1987), The safe motherhood initiative: a call to action. Lancet; 1 (8534):668–670

Mackenbach J. et al. (1997), “Measuring the magnitude of Socio-Economic Inequalities in

Health: An Overview of Available Measures Illustrated With Two Example From Europe”,

Social Science and Medicine; 44: 757-771

Marmot M. (2010), Marmot Review, Fair Society, Healthy Lives, Strategic Review of Health

Inequalities in England, University college London

Marmot M, (1997), Social inequalities in health: next questions and converging evidence.

Social Sciences & Medicine; 44:901–910

Mbogua, JP. (2000), “Problems of Shelter and Planning Constraints in the City of Nairobi”

Paper presented to the Annual National Convention of the Architectural Association of Kenya

held at Safari Park Hotel, Nairobi

McCormick et al. (2000), Annual report on access to and utilization of health care for children

and youth in the United States. Ambulance Pediatrics; 1:3–15

Miller WR et al. (2002), Motivational Interviewing: Preparing People for Change 2nd ed. New

York, NY: Guildford Press

Minas M et al. (2010), Prevalence of chronic diseases and morbidity in primary health care in

central Greece: an epidemiological study. BMC Health Serv Res, 28: 252

Ministry of Health, (2014), Health Sector Human Resource Strategy 2014-18

Ministry of Health. (2017), Health Sector Report, 2017/18

Morgan G. et al. (2003), what does 'access to health care' mean? J Health Serv Res Policy:


Mortimer D. et al. (2006), Economic evaluation of interventions for problem drinking and

alcohol dependence: do within-family external effects make a difference? Alcohol ; 41(1):92–98

Moyer C. et al. (2013), “Drivers and deterrents of facility delivery in sub-Saharan Africa: A

systematic review,” Reproductive Health, Vol. 10:40

Mugenda G. (2008), Social research theory and principles, Kijabe Printing Press

Murray CJ. et al. (1999), Critical Reflection-health inequalities and social group differences:

what should we measure? Bull World Health Organization, 77:537-44

Obudho, RA and Aduwo. (1992),“The Nature of the Urbanization Process and Urbanism in the

City of Nairobi, Kenya African Urban Quarterly Vol7 No 1 & 2

Obudho and Aduwo, (1988), “The Role of Nairobi in Spatial Planning in Kenya, Towards a

Planning Alternative,” First International Conference on Urban Growth and Spatial Planning of

Nairobi, Nairobi

Olima et al. (2001), “The Dynamics and Implications of Sustaining Urban Spatial Segregation in

Kenya – Experiences from Nairobi Metropolis” A Paper Presented at the International Seminar

on Segregation in the City Held at Lincoln Institute of Land Policy in Cambridge, USA

Penchansky, Ret et al. (1981), The concept of access: definition and relationship to consumer

satisfaction. Med. Care2: 127–140

Pogge T. (2002). Can the capability approach be justified? Philos Top; 30(2):167–228

Ronsmans C et al. (2006), Maternal mortality: who, when, where, and why. Lancet:


Royal College of Psychiatrists. (2010), No Health without Public Mental Health: The Case for

Action (Position Statement PS4/2010), Royal College of Psychiatrists

Ruger JP, (2009), Measuring the costs of outreach motivational interviewing for smokingcessation and relapse-prevention among low-income pregnant women

Sen AK. (1999), Development as Freedom, Oxford: Oxford University Press

-------------- (1992), Inequality Re-examined, Oxford: Clarendon Press

-----------------(1994), ‘Capability and Well-being’ in Martha C. Nussbaum and Amartya K. Sen.

(eds), The quality of life, Oxford: Clarendon Press: 30-53

----------------------(1994), ‘Well-Being, Capability and Public Policy’, Giornale Degi Economist

e Annali di Economiia, 53, 333-47

------------------------------(1997), ‘Editorial: Human Capital and Human Capability’, World

Development, 25 (12), 1959-61

-------------------------------(2005), ‘Human Rights and Capabilities’, Journal of Human

Development, 6(2), 151-66

Schellenberg JA, et al. (2003), Inequities among the very poor: health care for children in rural

southern Tanzania. Lancet; 361:561–566

Schneider EC et al. (2002), Racial disparities in the quality of care for enrollees in Medicare

managed care. JAMA; 287:1288–1294

Siegrist J. (1998), Reciprocity in basic social exchange and health: can we reconcile personbased with population-based psychosomatic research? Journal of Psychosomatic Research;

:99– 105

Simkhada B, (2008), Factors affecting the utilization of antenatal care in developing

countries: systematic review of the literature. J Adv Nurs; 61(3):244–260

Situma, (1992), “The Environmental Problems in the City of Nairobi” African Urban Quarterly,

Vol 7 Nos 1 and 2:167

Smith, E. R. (1996), What do connectionism and social psychology offer each other? Journal of

Personality and Social Psychology, 70, 893-912

Smith, Adam 91776), reprinted in Edwin Cannon (eds.), (1976), The Wealth of the Nations,

Chicago: University of Chicago Press

Smith KB et al. (2008), disadvantage of health Aust J Rural Health: 16:56-66

Stevens RD. (2000), Safe motherhood: an insight into maternal mortality in the developing

world. Health Millions; 26(3):34–37

Turin, D.R. (2010), HealthCare Utilization in the Kenyan Health System: Challenges and

Opportunities." Student Pulse, 2(09)

UNDP. (2005), Human Development Data, New York

USAID. (2013), “Kenya HIV/AIDS Fact Sheet”, Kenya

Van D. et al. (2004), Explaining the differences in income-related health inequalities across

European countries. Health Economics; 13:609–628.

Veugelers PJ et al. (2003), services use Chronic Dis Can 24:116-123

Wamala SP. (2007), Perceived discrimination, socioeconomic disadvantage and refraining from

seeking medical treatment in Sweden. J Epidemiol Community Health; 61:409–415

Whitehead M. (1992), The concepts and principles of equity and health. Int J Health Serv; --


-----------------------(2006), Leveling up (part 1): a discussion paper on concepts and principles of

tackling social inequalities in health. Studies on social and economic determinants of population

health, Copenhagen, WHO Regional Office for Europe

World Health Organization, (2005), Guiding Principles for Feeding Non breastfed Children 6 to

Months of Age. Geneva, Switzerland

World Health Organization, (2011), MDG 5: improve maternal health

World Health Organization, (2007), Achieving Health Equity, from root causes to fair outcomes,


World Bank, (1997), World Development Report 1997, Investing in Health, New York: Oxford

University Press

Xu K, et al. (2006), Understanding the impact of eliminating user fees: Utilization and

catastrophic health expenditures in Uganda. Soc Sci Med; 62:866–876

Yin, R. (1984), Case study research: design and methods. Sage publications

How to Cite
Davies N. Chelogoi, University of Nairobi, & Dr. Henry Amadi. (2019). The Influence of Institutional Factors in Access to Healthcare in Kenya: A case of Nairobi County, Kenya. EPH - International Journal of Humanities and Social Science (ISSN: 2208-2174), 5(7), 16-44. Retrieved from