Governance for Health: Infrastructural Power and Healthcare Service Delivery and Utilization in Africa

• In Event: 366 - Open Refereed Roundtable Session II
  In Refereed Roundtable: B. Table 26. Sociology of Health

Abstract

Infrastructure provisioning is predominantly studied by institutional economists who measure it in terms of physical and capital stocks or public spending flows. They do not view infrastructure provisioning as directly related to a form of state power which sociologist Michael Mann calls infrastructural power. Failing to relate infrastructure provisioning with the broader aspects of governance, most economistic analyses do not enhance our understanding of the fact that even though there is sufficient infrastructure provisioning, the state might not deliver related services efficiently, and intended beneficiaries, especially the poor, might not have easy access to those services. Countries vary in terms of their infrastructural power, but large regional discrepancies also exist in the expansion and penetration of physical infrastructure within a country, such as between urban and rural areas. This is most ready evident in Africa where geographic disadvantage is compounded by its poor infrastructure performance. Using both 2013 Afrobarometer survey data of 34 African countries and Worldwide Governance Indicators, this study finds evidence that sufficient infrastructure provisioning, especially in urban areas, is not significantly associated with people’s better healthcare service utilization and that the bureaucratic quality of service delivery matters most in both urban and rural area types.

Author

• Amm Quamruzzaman, McGill University