Poor Management Weakens Kenya’s Healthcare Response During Major Crises

A major study finds that weak management across Kenya’s health facilities limits their ability to handle crises, with most clinics performing poorly on basic operational practices. Better-managed private facilities proved more resilient during COVID-19 and strikes, highlighting management as a key driver of healthcare stability.

In Kenya's healthcare system, a new study suggests that what happens behind the scenes inside clinics can determine whether patients get treated during a crisis. Research by the World Bank, the International Finance Corporation, Johns Hopkins University and the London School of Economics highlights a simple but powerful idea: management matters.

The study looks at how health facilities performed during two major disruptions, the COVID-19 pandemic and a nationwide health workers' strike. It finds that the way facilities are managed can make the difference between continuing to serve patients and seeing services collapse.

Weak Management Across the System

Researchers surveyed more than 400 primary health care facilities and over 70 hospitals across Kenya. Their findings reveal a worrying trend: management quality is low across the board.

Most facilities scored poorly on key practices such as organizing patient flow, tracking performance and managing supplies. Even more concerning, nearly all facilities performed at similarly low levels. There are very few well-managed outliers, suggesting that weak management is a system-wide issue rather than a problem limited to a few clinics.

Why Primary Care Matters So Much

Primary health care facilities are the backbone of Kenya's health system. These are the clinics people rely on for everyday treatment, maternal care, vaccinations and chronic disease management.

Because they serve such a large portion of the population, especially poorer communities, any disruption in their functioning has serious consequences. When these clinics struggle, access to basic healthcare quickly declines, affecting women and children the most.

Crisis Reveals a Public-Private Divide

The real test came during the pandemic and the health workers' strike. Patient visits dropped sharply across the country when COVID-19 hit. But the strike created an even bigger shock.

Public health facilities saw a steep fall in patient numbers as services were disrupted. Private clinics, however, showed much more stability. Many patients shifted to private providers when public options became unavailable.

This shift exposed a clear divide in how the two sectors handled the crisis.

Better Management, Better Resilience

The study finds that management quality played a key role in how private clinics performed. Facilities with better management practices were able to maintain higher patient attendance during disruptions.

The most important factor was operations management. Clinics that managed supplies well, organized patient flow efficiently and tracked performance closely were better able to keep running under pressure. These practical, day-to-day systems helped them adapt quickly when conditions changed.

Interestingly, staff management practices such as hiring or evaluations were less important during crises. What mattered most was how well the facility handled its operations in real time.

Why Public Facilities Struggled

In public facilities, the story was different. Management quality did not seem to improve performance during the crisis.

This is likely because public clinics often operate under strict rules and limited flexibility. Managers may not have the authority to make quick decisions about staffing, supplies or workflows. As a result, even well-managed public facilities struggle to respond effectively in emergencies.

Private clinics, on the other hand, can adapt more quickly. This flexibility allows good management to make a real difference.

Lessons for the Future

The findings point to an important lesson for policymakers. Improving healthcare is not just about building more facilities or hiring more staff. It is also about improving how those facilities are managed.

Better management, especially in operations, can help clinics stay functional during crises. But for this to work in the public sector, managers need more flexibility and decision-making power.

The study also shows the importance of having both public and private providers. During disruptions, private clinics can help absorb demand and keep services available. However, this also raises concerns about access, since not everyone can afford private care.

As countries prepare for future health shocks, the message is clear. Strong systems are not built only on resources. They are built on how effectively those resources are managed every day.