Responding to Crisis: Patterns of Health Care Utilization in Central Kenya Amid Economic Decline

Abstract

Abstract: African states have become increasingly unable to provide adequate health care to their citizens due to debt, structural adjustment, poverty, and mismanagement. The health crisis is worsening in many areas and driving up mortality rates after decades of decline. This article investigates how African communities and their citizens respond in light of state inability to deliver health-related services. Drawing on a survey of more than five hundred rural Kenyans, our analysis shows that people are dissatisfied with government facilities and are turning to mission clinics and hospitals as well as to private clinics. A number of factors determine choice of health-care facility, including cost, level of education, socioeconomic background, the time taken to reach a facility, the type of disease requiring treatment, and agro-ecological zones. These findings have profound theoretical implications for health and development models, which normally are biased in favor of developed Western countries. Resume: A cause de la dette, de l'ajustement structurel, de la pauvrete et d'une mauvaise gestion, les etats africains sont devenus de plus en plus incapables d'offrir une couverture medicale adequate a leurs citoyens. La crise de la sante s'aggrave dans de nombreuses regions et fait grimper les taux de mortalite apres des annees de regression. Cet article examine comment les communautes africaines et leurs citoyens reagissent au vu de l'incapacite de l'etat a leur offrir des services lies a la sante. En s'inspirant d'une enquete effectuee sur plus de cinq cent Kenyans ruraux, notre analyse montre que la population n'est pas satisfaite des structures offertes par le gouvernement et qu'elle se tourne vers les cliniques et hopitaux de mission ainsi que vers les cliniques privees. Un nombre de facteurs determine le choix de ces structures medicales, comme par exemple le cout, le niveau d'instruction, le milieu socio-economique, le temps necessaire pour atteindre une structure, le type de maladie a traiter, et les zones agro-ecologiques. Ces resultats ont de profondes implications theoriques sur les modeles de sante et de developpement qui d'habitude sont influences en faveur des pays occidentaux developpes. Introduction It is an unfortunate reality that the world region most in need of health care is least able to provide it. African states-burdened by debt, structural adjustment, poverty, and poor governance-are increasingly unable to allocate resources to combat the leading killers across the continent: pneumonia, diarrheal diseases, measles, malaria, and now HIV/AIDS. The health crisis is worsening in many areas and driving up mortality rates after decades of decline. This leads to a simple but important question: How do African communities and their citizens respond when states have less capacity to deliver health services? Several responses are possible. People may rely on home treatment, they may seek out nongovernment facilities, they may turn to traditional healers, or they may opt for private clinics. These options are influenced by a wide variety of individual arid community characteristics such as income, seriousness of the disease, cost of treatment, and some additional factors that are unique to developing societies. In fact, few studies have examined the sociological determinants of changing patterns of health care utilization amid economic decline. This limits our knowledge and encourages the use of inappropriate theoretical models. In response, this paper addresses these issues by reporting the results of a comprehensive and representative survey of over five hundred rural Kenyans from the central part of the country in 1995. The survey is important for a number of reasons. It ascertains the illnesses and diseases that afflict people, determines how they respond to sickness, and measures how satisfied (or dissatisfied) they are with several health-care alternatives. Moreover, it reports various economic, social, community, and cultural factors that help condition individual decision-making in health care. …