The Quality of Health and Education Systems Across Africa
facilities, enabling an examination of differences between management practices and incentive systems by facility ownership. The survey builds off two highly used management tools—the D-WMS and the SafeCare Standards— and was adapted to fit the Kenyan primary health care context.6 Five hundred facility managers will each participate in an hour-long phone survey, in which they will be asked a series of validated questions covering 17 domains of management practices, including leadership vision and goals, standardization of protocols, performance tracking and review, and continuous improvement. This survey not only will allow for benchmarking of management practice outcomes in Kenya against practices in other settings (given that the D-WMS methods are standardized) but also will introduce innovations to measure management practices relating to staff absenteeism and stockouts of equipment, supplies, and medicines. Beyond management, various SDI surveys have also attempted to get a general idea of the revenue composition of both schools and health facilities—that is, whether they finance their operations with their own resources, cost recovery, transfers from the central level, transfers from decentralized levels, donations, or any other means. Although these data have proven to be extremely useful for understanding the potential implications of education and health financing reforms at the country level, their collection and cross-country comparability have been challenging because of country-specific financing and organizational structures, as well as data privacy concerns. Likewise, having a broad understanding of the composition of expenditures (human resources, equipment, and maintenance, among others) would be invaluable for understanding differences in efficiency between facilities and over time. As the SDI program continues to evolve, it will inevitably grapple with the balance between cross-country comparability and country-specific needs, particularly as they relate to financing, structural organization, and expenditures.
Understanding interactions with family background Learning, child development, and health are outcomes of complex processes that are based on access to quality schooling and affordable, quality health care, but also on individual and family choices. A large body of evidence shows that children in poor households experience worse human capital outcomes, and several factors can contribute to these gaps. Lack of financial resources and limited ability to borrow often prevent poor households from accessing health and education services. External shocks may force children in poor households to drop out of school or may otherwise adversely affect their learning outcomes. 98
