Decentralization, social connections and primary health care: Evidence from Kenya

This research estimates the role of social connections in primary health care provision and their impact on health-related behavior. The study employs novel survey data from Kenya, combining information on households and community health workers (CHWs). The results show that social connections strongly influence the provision of health care: Being a relative or close friend to a CHW increases the probability that a household will receive a health-related visit by about 100 percent (compared to the sample mean). Furthermore, socially connected households exhibit improved health-related behavior, largely attributable to the information they acquire during visits from CHWs. This evidence suggests the existence of nepotism in primary healthcare provision, and further demonstrates how beneficiaries of nepotism may experience improved health outcomes. At the same time, the study underscores that CHWs can deliver essential healthcare services, with the potential to enhance overall community health. In resource-constrained settings like Kenya, and many African countries, targeting CHWs to those most in need may offer a promising avenue for achieving better health outcomes at a lower cost. However, such targeting will need to account for social connections.