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Water access and service delivery in Kenya : inequalities, health outcomes and governance
Thesis (PhD)--Stellenbosch University, 2025.
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Stellenbosch : Stellenbosch University
2026
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| _version_ | 1867614077911564288 |
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| access_status_str | Open Access |
| author | Njoroge, Cecilia Wambui |
| author2 | Smith, Anja |
| author_browse | Njoroge, Cecilia Wambui Smith, Anja |
| author_facet | Smith, Anja Njoroge, Cecilia Wambui |
| author_sort | Njoroge, Cecilia Wambui |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (PhD)--Stellenbosch University, 2025. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/134738 |
| institution | Stellenbosch University (South Africa) |
| last_indexed | 2026-06-10T12:46:18.613Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2026 |
| publishDateRange | 2026 |
| publishDateSort | 2026 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/134738 Water access and service delivery in Kenya : inequalities, health outcomes and governance Njoroge, Cecilia Wambui Smith, Anja Von Fintel, Marisa Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Economics. Waterborne infection -- Kenya Water resources development -- Kenya Water supply -- Economic aspects -- Kenya Water utilities -- Kenya Public administration -- Kenya UCTD Thesis (PhD)--Stellenbosch University, 2025. Njoroge, C. W. 2025. Water access and service delivery in Kenya: Inequalities, health outcomes and governance. Unpublished doctoral dissertation. Stellenbosch: Stellenbosch University [online]. Available: https://scholar.sun.ac.za/items/d238d1fb-06b4-4f01-8354-fff9c99bdd1b ENGLISH SUMMARY: Access to water is fundamental for human health and economic development. However, countries worldwide face the dual challenges of water insecurity and gaps in water access. Understanding the extent and depth of water insecurity and identifying vulnerable populations, are critical steps toward achieving universal water access. In this dissertation, I examine three inter-related aspects of water access and service delivery that could support the reduction of water access inequalities. I use data from various microsurveys and on public expenditures in Kenya. Chapter 2 considers who is water insecure by exploring the multidimensional nature of water deprivation at the household level. I propose that water insecurity at the household level is distinct from aggregate regional or sub-regional estimates. Using an approach analogous to the Alkire and Foster (2011) framework for measuring multidimensional poverty, the results indicate that 63% of households are multidimensionally water insecure. Water affordability and sufficiency dimensions are the largest contributors to household water deprivation. The findings show that inequalities in water insecurity exist; rural and economically disadvantaged households are more water insecure. A comparison of the Alkire-Foster estimates with the best existing alternative water deprivation metric highlights a mismatch in water insecurity levels in six counties. Households could simultaneously experience multiple deprivations in aspects of water access, which regional or sub-regional estimates fail to convey. Chapter 3 demonstrates why addressing water insecurity is essential by examining the impact of an unreliable water supply from communally-managed handpumps on the incidence of diarrhoea among children under five. Rural households lacking alternative safe water sources may turn to unsafe sources when handpumps break. Using exogenous variation in groundwater depth and quality in a two-stage least squares method, the study finds that unreliable water supply significantly increases the incidence of child diarrhoea. Households relying on unreliable handpumps report approximately a one-third higher incidence of diarrhoea among children compared to those using reliable handpumps. These findings underscore the health costs of water deprivation for households. Chapter 4 explores how water access gaps could be addressed by asking whether decentralisation improves water service delivery and promotes a more equitable resource allocation. I hypothesise that devolving power from the national to sub-national governments could plausibly reduce ethnic favouritism. Using a difference-in-differences approach, I construct a quasi-control group based on the proportion of counties’ population that shares the same ethnicity as the president. The results show improved perceptions of water access and service delivery in counties ethnically aligned to the president following decentralisation. There is tentative evidence of reduced budgetary allocations to the water sector in counties ethnically aligned to the president after decentralisation. The evidence from perception data supports the hypothesis that decentralisation enhances public service delivery. The dissertation emphasises the importance of addressing inequalities in water access by reaching the underserved population subgroups. It also highlights the need to create sustainable water supply systems. Achieving universal water access will require policies that tackle institutional and governance challenges while ensuring a balanced approach to recurrent and capital funding. AFRIKAANSE OPSOMMING: Toegang tot water is noodsaaklik vir menslike gesondheid en ekonomiese ontwikkeling. Lande wereldwyd staar egter die dubbele uitdagings van wateronsekerheid en toegangsgapings tot water in die gesig. Om die omvang en diepte van wateronsekerheid te verstaan en kwesbare bevolkings te identifiseer, is kritieke stappe in die verkryging van universele toegang tot water. In hierdie proefskrif ondersoek ek drie onderling verwante aspekte van watertoegang en dienslewering wat kan bydra tot die vermindering van ongelykhede in watertoegang. Ek gebruik data uit verskeie huishoudingvlak opnames en oor openbare uitgawes in Kenia. Hoofstuk 2 fokus op wie wateronseker is deur die multidimensionele aard van watertekorte op huishoudelike vlak te verken. Ek stel voor dat wateronsekerheid op huishoudelike vlak onderskei moet word van streeks- of substreekse ramings. Deur ’n benadering te gebruik wat soortgelyk is aan die Alkire en Foster (2011)-raamwerk vir die meting van multidimensionele armoede, dui die resultate aan dat 63% van huishoudings multidimensioneel wateronseker is. Die dimensies van waterbekostigbaarheid en -toereikendheid (“sufficiency”) dra die meeste by tot huishoudelike watertekorte. Die bevindings toon dat daar ongelykhede in wateronsekerheid bestaan; landelike en ekonomies benadeelde huishoudings is meer geneig tot wateronsekerheid. ’n Vergelyking van die Alkire-Foster-skattinge met die beste bestaande alternatiewe beraming vir watertekorte toon ’n wanverhouding in wateronsekerheidsvlakke in ses distrikte. Huishoudings kan gelyktydig tekortkominge in verskeie aspekte van watertoegang ervaar, wat nie voldoende deur streeks- of substreekse ramings weerspieel word nie. Hoofstuk 3 toon waarom dit noodsaaklik is om wateronsekerheid aan te spreek deur die impak van ’n onbetroubare watervoorsiening vanaf gemeenskapsbestuurde handpompe op die voorkoms van diarree onder kinders jonger as vyf te ondersoek. Landelike huishoudings sonder alternatiewe veilige waterbronne mag onveilige bronne gebruik wanneer handpompe buite werking is. Deur eksogene variasie in grondwaterdiepte en -kwaliteit deur middel van ’n “two-stage least squeares” metode te gebruik, dui die studie aan dat ’n onbetroubare watervoorsiening die voorkoms van kinderdiarree aansienlik verhoog. Huishoudings wat op onbetroubare handpompe staatmaak, rapporteer ongeveer ‘n een-derde hoer voorkoms van diarree onder kinders in vergelyking met die wat betroubare handpompe gebruik. Hierdie bevindings beklemtoon die gesondheidskoste van watertekorte vir huishoudings. Hoofstuk 4 ondersoek hoe toegangsgapings tot water aangespreek kan word deur te vra of regeringsdesentralisasie waterdienslewering verbeter en ’n billiker hulpbrontoekenning bevorder. Ek stel die hipotese dat die delegering van mag van die nasionale regering na subnasionale regerings moontlik etniese begunstiging kan verminder. Deur ’n “difference-in-differences”metode te gebruik, konstrueer ek ’n kwasi-beheergroep gebaseer op die proporsie van distrikte se bevolking wat dieselfde etnisiteit as die president deel. Die resultate toon verbeterde persepsies van watertoegang en dienslewering in distrikte wat etnies met die van die president geallieer is na desentralisasie. Verder vind ek voorlopige bewyse van verminderde begrotingstoekennings aan die watersektor in distrikte wat etnies met die president geallieer is na desentralisasie. Die bewyse uit persepsiedata ondersteun die hipotese dat desentralisasie openbare dienslewering verbeter. Hierdie proefskrif beklemtoon die belangrikheid daarvan om ongelykhede in watertoegang aan te spreek deur bevolkingsubgroepe wat tans onderbedien is, te bereik. Dit wys ook op die behoefte om volhoubare watervoorsieningstelsels te skep. Om universele watertoegang te bereik, sal beleidsmaatreels nodig wees wat institusionele en bestuursuitdagings aanspreek, tesame met ’n gebalanseerde benadering tot herhalende en kapitaalfinansiering. Doctoral 2026-01-06T07:35:32Z 2026-01-06T07:35:32Z 2025-12 Thesis https://scholar.sun.ac.za/handle/10019.1/134738 Stellenbosch University xvi, 174 pages : illustrations, maps, includes annexures application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Waterborne infection -- Kenya Water resources development -- Kenya Water supply -- Economic aspects -- Kenya Water utilities -- Kenya Public administration -- Kenya UCTD Njoroge, Cecilia Wambui Water access and service delivery in Kenya : inequalities, health outcomes and governance |
| title | Water access and service delivery in Kenya : inequalities, health outcomes and governance |
| title_full | Water access and service delivery in Kenya : inequalities, health outcomes and governance |
| title_fullStr | Water access and service delivery in Kenya : inequalities, health outcomes and governance |
| title_full_unstemmed | Water access and service delivery in Kenya : inequalities, health outcomes and governance |
| title_short | Water access and service delivery in Kenya : inequalities, health outcomes and governance |
| title_sort | water access and service delivery in kenya inequalities health outcomes and governance |
| topic | Waterborne infection -- Kenya Water resources development -- Kenya Water supply -- Economic aspects -- Kenya Water utilities -- Kenya Public administration -- Kenya UCTD |
| url | https://scholar.sun.ac.za/handle/10019.1/134738 |
| work_keys_str_mv | AT njorogececiliawambui wateraccessandservicedeliveryinkenyainequalitieshealthoutcomesandgovernance |