What does access to health care among the urban poor mean Factors associated with use of appropriate

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What does access to health care among the urban
poor mean?Factors associated with use of
appropriate maternal health services in the
slum settlements of Nairobi, Kenya

• By Jean-Christophe Fotso, Alex Ezeh, Nyovani
  Madise,
• Abdhalah Ziraba and Reuben Ogollah
• INDEPTH Network AGM
• Nairobi, September 3-7, 2007

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Background Maternal Deaths and Mortality
Ratio(Deaths per 100,000 live births)
1,200
247,000 deaths
11,000 deaths
1,000
800
Maternal Mortality Ratio (per 100,000)
600
529,000 deaths
527,000 deaths
400
200
0
World
Developing
Sub-Saharan
Kenya
countries
Africa
Source WHO/UNICEF/UNFPA, 2004
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Background (Ctd)

• Kenya resolved to reduce MMR by 3/4 by 2015.
• Kenya NRHSDS (1997-2010)
• Safe motherhood and child survival
• Key pillars include clean and safe delivery.
• Urbanization, poverty and health inequities in
  SSA
• More than 50 of SSA population will be living in
  urban areas by 2030.
• About 7 out 10 inhabitants of Nairobi live in
  slums.
• Growing inequities between the poor and the
  non-poor.
• MDG-5 Attention to the growing urban poor
  populations in SSA.

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Background (Ctd)

• In the slums co-exist
• Private, sub-standard and often unlicensed
  clinics, with
• Well equipped public, religious or large NGO
  facilities, generally in the outskirts of the
  slums.

• Preferable to deliver at home or at TBAs?
• Misleading not to treat the two categories of HFs
  separately.

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Objectives

• Improve understanding of maternity health seeking
  behaviors in resource-deprived urban settings
• Identify the factors which influence the choice
  of place of delivery among the urban poor
• Distinction between sub-standard and
  appropriate health facilities
• Formulate recommendations aimed at improving
  maternal health.

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Data and Methods

• Data from a DSS-nested MHP
• 1,927 who had pregnancy outcomes in 2004-2005
• 25 HFs providing obstetric care
• Dependent variable Place of delivery
• Public/religious/large NGO HF coded 2
• Private, sub-standard HF coded 1
• Not HF (home, TBA ) coded 0
• Covariates
• Socioeconomic variables
• Biodemographic and health-related covariates
• Slum residence (Korogocho, Viwandani)
• Methods
• Descriptive analysis
• Ordered logistic - Partial proportional odds
  models

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Health facility deliveries in Kenya
90
78
80
70
70
60
48
50
Percentage of women ()
40
33
30
20
10
0
Nairobi slums (1)
Nairobi slums (2)
Nairobi
Rural Kenya
(1) All types of HFs (2) Appropriate HFs
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Multivariate results Socioeconomic Residence
plt0.10 plt0.05 plt0.01
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Multivariate results Biodemo and health-related
plt0.10 plt0.05 plt0.01
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Multivariate results Interactions
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Recommendations

• Provision of health services to the urban poor
• Registration of private facilities and clinics
  minimum criteria
• Provision of public health services in/near the
  slums
• Improvement of the quality of care (delays,
  attitude of staff) in public HFs
• Health education campaigns
• Antenatal care attendance
• Advice/counseling on delivery and postnatal care,
  and other pregnancy-related issues
• Target groups
• Poorest, not educated, not working women
• Higher parity women
• Access to FP and RH services

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• Acknowledgements
• The World Bank
• The Wellcome Trust
• Thank you