Comparing health system performance in India and Kenya: A cross-national analysis to understand the achievement of Millennium Development Goals

The ongoing global financial meltdown and the contraction of economies across the world, and prevailing concerns about a possible decline in global, regional and national resources for health and other social sectors, present hard choices to many national and local governments in the developing world: they would have to either improve the efficiency with which they use their existing inputs or risk losing the ground they have achieved so far in terms of better outcomes and coverage of essential services. Since Independence, India and Kenya have been working to achieve better health status and have followed different strategies to improve the wellbeing of their respective populations, which resulted in some localities (in each of these countries) delivering lower outcomes than others, even when they have comparable input levels. This study measures the performance of two countries India and Kenya (facing challenges to meet the Millennium Development Goals (MDGs), following a stochastic production frontier approach. Specifically, we draw on national and sub-national data on health inputs, outputs and outcomes and identify the determinants of health care inefficiencies in two different settings. Our preliminary analysis suggest that gains from investment on health and social services seem to be uneven in the study area, with some localities delivering lower outcomes than others, even when they have comparable input levels.