Title: What does access to health care among the urban poor mean Factors associated with use of appropriate
1What 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
2Background 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
3Background (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.
4Background (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.
5Objectives
- 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.
6Data 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
7Health 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
8Multivariate results Socioeconomic Residence
plt0.10 plt0.05 plt0.01
9Multivariate results Biodemo and health-related
plt0.10 plt0.05 plt0.01
10Multivariate results Interactions
11Recommendations
- 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
12- Acknowledgements
- The World Bank
- The Wellcome Trust
- Thank you