Child survival, poverty and policy options from DHS surveys in Kenya: 1993-2003

Will Kenya achieve the Millennium Development Goals (MDGs) on child survival by 2015? While child and infant mortality rates declined massively following Kenyan independence, progress since 1990 has slowed down – particularly on infant mortality - making it seem increasingly unlikely. This is the conclusion of new report brought out by the Poverty and Economic Policy Network (PEP). Using Demographic and Health Survey (DHS) data, it examines the poverty and inequality determinants of child survival from 1978 to 2003. Based on these results, it then simulates the impact of various policy variables on child mortality.

The report looks at three rounds of DHS data from 1993 to 2003 to which it adds women’s birth histories from 15 years prior to the surveys to create a time series of data for child mortality from 1978 to 2003. In the absence of income data in the DHS, an asset index which takes into account households’ income endowments is included as an indirect measure of household income and resource investments on health. This information is complemented with secondary macroeconomic data on GNP per capita, health expenditure and the regional distribution of health facilities for each year of a child’s birth from 1978 and merged with the generated time series data by year of birth.

Its principal findings include the fact that:

• children with the lowest probability of survival are from households with the lowest level of assets
• households’ asset-status is a more important determinant of mortality in rural than in urban areas
• boys in rural areas have a lower rate of mortality than girls
• the probability of child survival varies by region
• periods of GNP growth and increased health expenditures do not necessarily result in lower mortality
  

Policy simulation exercises reveal that while there is room for improvement, persistently high poverty and inequality make it unlikely that the child and infant mortality targets set by Kenya will be achieved. Having discovered that micro-level household and community characteristics wield a significant influence on child mortality, however, the report advises Kenya’s policy makers to nevertheless concentrate on: 

• ensuring girls’ universal enrollment in primary education while also improving their access to secondary and post-secondary education
• improving health care provision in regions and districts with low coverage, with a particular focus on increasing access to immunization, birthing assistance and contraception services
• addressing socio-cultural factors that hamper child survival
• improving people’s access to information on child survival issues