The Development of Health System Resiliency: How Kenya's Experience with Malaria Impacted Its Reaction to the COVID-19 Pandemic

Public health scholars have recently focused on health system resiliency to explain how previous experiences dealing with public health crises impact the healthcare sector, public behavior, and policy response to novel crises. However, it is unclear how resiliency develops. This study contributes by testing whether a health system’s experience with a health emergency and significant interventions impacts the response to a novel crisis. This research asks, “How has Kenya’s experience with malaria impacted its response to COVID-19?” Using the United States Agency for International Development (USAID) Malaria Indicator Survey (MIS), I develop a malaria adherence score to measure county-level compliance with standard malaria prevention protocols. I use publicly available data from the Kenyan Ministry of Health's (MOH) situation reports and the Bureau of Statistics to create cumulative COVID-19 prevalence and vaccination rates for each county. I test the hypothesis that higher malaria adherence scores are associated with higher COVID-19 vaccination uptake in a given community. Controlling for a host of other factors that could explain COVID-19 outcomes, I find mixed evidence in support of the hypothesis. Counties with higher rates of malaria protocol adherence are associated with higher COVID-19 vaccination rates. However, rates of malaria protocol adherence were also associated with higher COVID-19 rates, which challenges the expectation that previous compliance with interventions leads to more resilient health systems. Issues of reverse causality, ecological inference, and incomplete data limit the scope of the findings and are addressed in the discussion.