Kenya’s Healthcare Crisis Reveals Why Strong Management Matters in Emergencies

A major international study found that poor management practices have weakened Kenya’s healthcare system, leaving many clinics vulnerable during the COVID-19 pandemic and health workers’ strikes. However, better-managed private healthcare facilities proved more resilient, maintaining higher patient attendance and adapting faster during the crisis.

A major international study has found that weak management practices are quietly undermining Kenya's healthcare system, leaving clinics and hospitals vulnerable during crises such as the COVID-19 pandemic and nationwide health workers' strikes. The research, conducted by experts from the National Bureau of Economic Research (NBER), the World Bank, the International Finance Corporation (IFC), the London School of Economics, Johns Hopkins University, and IZA, examined how healthcare facilities across Kenya performed during one of the most difficult periods in recent history.

The study surveyed 429 primary healthcare facilities and 73 hospitals, making it one of the largest investigations ever conducted into healthcare management in Kenya. Researchers wanted to understand whether the way clinics and hospitals are managed affects their ability to continue serving patients during emergencies.

Poor Management Found Across Most Facilities

The findings revealed that management standards in Kenyan healthcare facilities are extremely low compared to international benchmarks. Researchers used a global scoring system ranging from one to five to measure management quality. Kenyan facilities averaged just 1.6, placing them near the bottom among countries included in the comparison.

The study assessed areas such as patient flow organization, medicine and supply management, staff supervision, recordkeeping, performance monitoring, and handling patient complaints. Many facilities lacked clear systems for tracking performance, rewarding strong staff, or improving weak services.

Researchers also found that poor management was widespread rather than limited to a few struggling clinics. Most facilities scored similarly low, suggesting the problem is deeply rooted across the health sector.

Public and private facilities showed only small differences overall. Public clinics performed slightly better in operational systems, while private facilities were marginally stronger in staff management. Still, both sectors showed major weaknesses.

COVID-19 and Strikes Exposed Deep Weaknesses

The pandemic and the nationwide public health workers' strike between late 2020 and early 2021 placed enormous pressure on Kenya's healthcare system. During this period, outpatient attendance dropped sharply as patients struggled to access services or avoided clinics due to fear of infection.

Public facilities were hit especially hard during the strike. Many experienced severe disruptions as healthcare workers walked off the job, reducing access to essential services, including maternal and child healthcare.

Private facilities also saw attendance fall during the pandemic, but many recovered more quickly during the strike period. Researchers believe some patients shifted from public facilities to private providers when government-run services became unreliable or unavailable.

The study highlights how crises can quickly expose weaknesses in healthcare systems, particularly where management structures are already fragile.

Better-Managed Private Clinics Recovered Faster

One of the study's most important findings was that better-managed private healthcare facilities proved more resilient during the disruptions. Clinics with stronger operational systems were able to maintain higher patient attendance levels throughout the pandemic and strike period.

Researchers found that facilities with better management scores recorded outpatient attendance levels about 6.5 percentage points higher than poorly managed clinics during the crisis. The strongest factor was operational management, including organized patient flow, reliable supply systems, proper monitoring, and standardized procedures.

According to the researchers, better-managed facilities were likely more flexible and able to respond quickly when disruptions occurred. They may have reorganized services faster, managed shortages more effectively, and adapted operations to changing conditions.

Interestingly, the same pattern was not found in public facilities. The study suggests that public-sector managers may face stricter bureaucratic controls and have less freedom to make rapid operational decisions during emergencies.

Why the Findings Matter

The researchers say the study carries an important lesson for developing countries: improving healthcare systems is not only about building hospitals or buying equipment. Strong management also matters.

In many low-income countries, healthcare debates focus on funding shortages, staffing gaps, and infrastructure problems. But the Kenyan experience suggests that management quality can determine whether facilities continue functioning during crises.

The findings also highlight the important role private healthcare providers can play when public services are disrupted. While public facilities remain essential for millions of Kenyans, private clinics may help absorb pressure during emergencies, especially when they are well managed.

The researchers conclude that strengthening management practices could improve healthcare resilience, service delivery, and patient outcomes across Kenya and other developing countries facing similar challenges.