economic studies department of economics school of business, economics and law university of ...

167 Pages·2017·4.97 MB·English

ECONOMIC STUDIES
DEPARTMENT OF ECONOMICS
SCHOOL OF BUSINESS, ECONOMICS AND LAW
UNIVERSITY OF GOTHENBURG
237
________________________
Primary Health Care Interventions and Social Ties in Kenya
Josephine Gakii Gatua
ISBN 978-91-88199-34-8 (printed)
ISBN 978-91-88199-35-5 (pdf)
ISSN 1651-4289 (printed)
ISSN 1651-4297 (online)

Printed in Sweden,
Gothenburg University 2018
To my Mum, Dad and Sisters

Acknowledgements
First and foremost, I would like to thank the almighty God for his suf-
ficient grace, love and mercy throughout my PhD journey. Without you
Lord, it was humanly impossible to see a happy conclusion. I chose to
put my faith, hope and trust in you in all I did; and for sure, you have
been my protector and defender. Thank you Lord.
My deepest gratitude goes to my supervisors Jessica Coria, Elina Lampi
and M˚ans S¨oderbom.
Jessica,youtookaninterestinmyideaswhenIwasanoviceinresearch.
Youbelievedinme,encouragedmetokeepworkingandthefruitsofthat
are this thesis. Your unconditional support, insightful guidance through
constructive comments and useful suggestions for my papers is much
appreciated. Ever smiling but always on point. It has been a pleasure
being your student and co-author. Asante sana.
Elina, thank you for your supervision, guidance, numerous comments
and suggestions throughout my research. Your inputs have been very
valuable in designing my survey. Additionally, thank you for organizing
one of my seminars with an excellent audience in record time. Your
commitment to the cause has been phenomenal.
M˚ans, you gladly shared your knowledge in econometrics as both a
teacher and supervisor. In the period of time you have supervised me,
I have learnt a lot from you, including but not limited to how to think
through when writing an empirical paper, numerous econometric tech-
niques and Stata syntax, preciseness, prudence and perseverance that
one should know in research. Your patience, solid advice in academic
and non-academic issues has been very rewarding to me. As a leader,
you are a perfect example to emulate and I hope to do you justice.
Without your support, it would have been impossible for me to reach
the finish line. My heartfelt thanks. It has been a privilege and fantastic
experience working with you and I am indebted.
My sincere gratitude to Gustav Kjellsson, Andreea Mitrut and Joseph
Vecci, for the excellent comments and suggestions you gave as discus-
sants in my final seminars. They have helped improve my papers and
shape up my thesis.
My completion of this PhD would not have been possible without the
supportofmyclassmates.Ithankyouallfortheexperiences,knowledge
shared and gained, wonderful moments and the difficulties endured to-
getherduringourPhDstudies.Youalldeserveatriptothebestplaceon
earth.Iwillmissyouall.Martin,weclickedfromthefirsttothelastday
of my PhD. You were with me in all my high and low moments. Thank
youforthewonderfulandpreciousmomentstogether.Iwillneverforget
that. Caroline, thanks for your great friendship and for allowing me to
be an aunt to Henry and Ingrid. Lisa, you have been a super and loyal
friend. Thank you. Yashu, thanks for the many good moments and look-
ing forward to many more. Andy, thanks for being a good and caring
friend. And to my seniors Simon Wagura, Remidius and Seid Hassan,
thank you for the support, encouragement and the good times we had
at Gothenburg.
To Dr. Mduma and Dr. Razack, thank you for encouraging me and
writing recommendations for me to enroll for the PhD program. It was
worth it. I would like to acknowledge and express appreciation for the
financial support from the Swedish International Development Agency
(SIDA) through the Environmental Economics Unit, at the University
ofGothenburg,throughoutmyPhDprogram.Someofmyresearchwork
benefitedfromadditionalfundingfromFormasthroughtheCOMMONS
program, which I also gratefully acknowledge.
I also wish to thank all academic staff for sharing their knowledge
throughout. Thank you to the administrative staff and IT department
for their extraordinary support up to the very end. Special thanks to
Elizabeth F¨oldi who welcomed me to Gothenburg and has been very
helpful throughout my stay. Thank Selma, thanks for the excellent help
and advice regarding various accounting procedures.
VeryspecialthankstoKatarinaNordblomforbeingadearfriend.Kata-
rina your constant encouragement and warm smile has been a great
source of inspiration. Your genuine and honest concern in my academic
and personal life has been truly amazing and I am forever grateful.
Thank you for always being there to discuss my papers and for always
making me smile.
I am particularly indebted to Mutua Kakinyi of KNBS for helping in
everything involving my fieldwork as well as data sets and handling my
many queries involving the DHS. Without you, this thesis would be a
dream. Much appreciated. To my excellent group of enumerators, thank
you.
My time at Gothenburg has been made enjoyable in large part due to
the many friends that became a part of my life. Notably Eyoual and
Teddy. Through you, I have learnt that a brother does not have to
be a blood relative. We have shared the good, the bad and the ugly;
and still going strong. I will forever cherish the bond we have made
and excited of the many more good years ahead. Betam amasegenalehu
konjos. Samson, there was never a dull moment around you. You have
been a great friend and I look forward to many more years of friendship.
Thank you for pushing me to get out of my comfort zone by introducing
me to LATEX. You have been a great teacher. I will miss you all.
Manypeoplehavesupportedmethroughthisjourney.TomycrewDoris,
Collo, Kaju, Ivy; thank you very much for the love, encouragement,
prayers and support you offered to me. Mary Karumba, Priscilla, Kim,
Ruth, Annika and Daniel; thank for your friendship and constant en-
couragement. Fr. Peter, thank you for the nourishing spiritual guidance.
Lastly, to my girls, Makandi, Flora and Rita: your love, patience and
understanding has been great. My long periods of silence did not deter
you from continued communication, but instead made you more caring
and supportive. Makandi, thanks for visiting. I love you all.
Finally, thank you to my family for your countless sacrifices, uncondi-
tional love, support, and prayers. Thank you for your words of wisdom
andforalwayskeepingmelearning,laughing,andmostimportantly,ap-
preciatingallthatmakeslifeworthwhile.Mum,thankyouverymuchfor
yourprayers,love,supportandadvice.Itworkedmama.Dad,thanksfor
always reminding me that “As one is in the image and likeness of God,
unfathomable powers and possibilities exist in one. Under such convic-
tion, no matter how strait the encounter, one enjoys it”. True Dad. To
mylovelysistersKC,B,DustyandNas,youarefabulous.Youwerewith
me every step of the way. From helping in my fieldwork to visiting me in
Gothenburg, to listening to my highs and lows and providing comfort. I
love you all.
My experiences at the University of Gothenburg have been challenging
but ultimately the most rewarding I have ever had. I am so thankful
that you have all helped mold me through the process. You have pushed
me to reflect on every one of my experiences, and I hope that as a result
I have become a better member of the society.
Josephine G. Gatua
G¨oteborg, February 2018
Contents
Introduction 1
Summary of chapters . . . . . . . . . . . . . . . . . . . . . 4
I: Decentralization, Social Connections and Primary Health Care:
Evidence from Kenya
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Community Health Worker Policy . . . . . . . . . . . . . 5
Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Empirical Strategy . . . . . . . . . . . . . . . . . . . . . . 14
Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Robustness Tests . . . . . . . . . . . . . . . . . . . . . . . 25
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
II: Community Health Workers, Child Health and Health Care Uti-
lization in Kenya
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Community Health Worker Policy . . . . . . . . . . . . . 5
Data and Empirical Strategy . . . . . . . . . . . . . . . . 9
Summary Statistics . . . . . . . . . . . . . . . . . . . . . . 20
Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Discussion and Conclusion . . . . . . . . . . . . . . . . . . 33
Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
III:Information and Cooperation in Preventive Health Behavior: A
Case Study of Bed Net Use
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Experiment and Hypotheses . . . . . . . . . . . . . . . . . 6
Setting and Descriptive Statistics . . . . . . . . . . . . . . 12
Empirical Strategy and Results . . . . . . . . . . . . . . . 19
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . 37