Monitoring and Accountability for Public Service Delivery: A Study of Electricity Reliability to Health Services Providers in Rural Kenya

As COVID-19 spreads in lower-income countries, the continued delivery of health services will depend critically on reliable access to electricity, which health facilities use for functions such as lighting, data management, refrigeration, sterilisation, and provision of running water. While grid connections in sub-Saharan Africa have grown rapidly in recent years, power reliability varies and remains a critical issue that causes substantial losses in firm productivity. In the healthcare sector, a 2013 systematic review finds that in eight countries with data in sub-Saharan Africa (including Kenya), only 34 percent of hospitals had reliable electricity in the week prior to the survey. In this project, Eric Hsu and Anne W. Wambugu will document electricity reliability in rural areas in Kenya and its impacts on healthcare providers. They will further examine experimentally whether increased public awareness can be a source of accountability for service provision by the state-controlled utility company.

The project will use a randomised controlled trial to identify the effects of greater public awareness on electricity reliability. Three rounds of phone surveys will be conducted to monitor electricity reliability over time. After conducting the first round of surveys, the researchers will begin publicising treated facilities that experience frequent outages. To do this, they will partner with the leadership of a recent grassroots advocacy campaign to influence Kenya Power to address issues with opaque billing and unreliable service. Randomly selected sites with frequent outages will be highlighted in a social media campaign that will leverage existing #SwitchOffKPLC social media networks that have been active in the past year to engage with poor service delivery by Kenya Power. This will give us a unique opportunity to evaluate whether public awareness can play a role in improving electricity service.

Electricity reliability is important to the functioning of public institutions and firms of all sizes. During the on-going pandemic, it is particularly important for the continued delivery of health services including testing, treating patients, and administering vaccines. This project has the potential to shape policy by rapidly generating data on electricity reliability at health facilities in rural areas, which tend to have less reliable power and disproportionately service particularly vulnerable low-income communities. This project will unlock existing data from health facilities, which will be shared with policymakers in and outside of Kenya. With COVID-19 threatening to overrun the capacity of healthcare systems in Africa, these data will allow policymakers to rapidly identify where limited resources can be prioritised.


Eric Hsu

University of California, Berkeley

Anne W. Wambugu

Strathmore Energy Research Centre