Institutions and Public Healthcare Facility Cleanliness in Nigeria: A Principal-Agent Approach

Abstract

There are several reasons to believe that the level of cleanliness of a health facility adequately reflect the performance of service delivery actually received by the populace. This study extends Das Gupta et al (2004) analysis of health facility cleanliness by using the principal-agent theory and the accountability framework to assess the elements of accountability, such as voice and client power/compact; and how these impacts cleanliness of health care facilities in Nigeria. The study makes use of the available QSDS data of the World Bank in Nigeria in 2004 complemented by Focus Group Discussions (FGDs). The results show that accountability elements affect positively the health service delivery in Nigeria. Specifically, client power explains the level of cleanliness of health facility in Kogi and Lagos states. In addition, we find that staff-skill motivates cleanliness in health facilities in the two states. Put together, the results imply that community participation in health facilities must be promoted in order to enhance cleanliness in health facilities in Nigeria.