The authors use latent variable modelling to compute client satisfaction scores, which were dichotomised into two categories and fitted into a logistic regression model to identify factors that influence client satisfaction. Health facility clients in the four slums are satisfied with services and have confidence the providers will serve them in a friendly and professional manner that promotes respect and quality care. The paper recommend healthcare managers in similar settings carry out client flow analysis and institute remedial measures to address long waiting times. Qualitative studies are recommended to determine the reasons behind the high satisfaction levels reported in this study.

Background: In Kenya, guidelines have been developed and activities undertaken aimed at improving the quality of health services in health facilities and communities. These efforts could help in contributing to the country’s goal of the highest standards of health for citizens. Current research on the subject is limited to whether the novel idea is understood and its benefits. This study takes a deep emic dive to understand the dynamics of work improvement teams (WITs) in the case of five community units within Kasarani sub-county of Nairobi City County, Kenya. Methods: Focus group discussions and key informant interviews were conducted with members of WIT. Interviews were recorded and transcribed, after which analysis conducted using NVIVO software was based on inductive coding. Results: Participants vividly recollect core WIT training and implementation aspects in particular the power of teamwork, the mentoring role of community health assistants (CHAs), and community innovations. Appreciation of WIT training and implementation finds expression in warmer reception accorded mothers referred by community health volunteers (CHVs); more open sharing of health concerns due to the social nearness of CHVs to community members; community own-resource contributions. Members of work improvement teams share a sense of empowerment post-training and feel triumphant after winning in WIT competitions. Experiences of WIT members include championing roles such as the CHV as the health educator, the CHA as the captain, and the chief personifying Government’s effective presence in the community. Similarly, the experience of disconnections between the community and the formal health systems is evident in respondent narratives, as are gapping (identifying health problems in the community), and discussion steps during work improvement. Enabling factors for quality improvement through community work improvement teams include passion, commitment, and self-motivation as well as team household visits. Nevertheless, hurdles within and external to mother, CHV, and facility levels persist. Conclusion: Respondents present fresh recalls, appreciations, and experiences on WIT training and implementation in Kasarani sub-county. These imply WIT efforts as inflection events propelling performance of community health units. The intervention should be scaled to other community health units and regions, considering enablers and challenges.

Background: In concert with international commitments, the Government of Kenya identified universal health coverage (UHC) as one of its four priority agenda to enable its populations have access to health care without financial duress. Nevertheless, only about 19.5% of the Kenyan population is enrolled in any insurance health cover. Since 2016, Amref Health Africa and PharmAccess Foundation have been implementing the innovative partnership on universal and sustainable healthcare (iPUSH) programme in Navakholo sub-county of Kakamega County. The objective of this study is to examine ownership of health insurance cover among women of reproductive age (WRA) in Navakholo sub-county, Kakamega County. Methods: We analysed data captured during household registration conducted in February 2021. The dataset consisted of a total of 148,957 household members within 32,262 households, 310 villages, and 32 community health units. The data had been collected using mobile phones by trained community health volunteers (CHVs) and transmitted using the Amref electronic data management platform and reposited in a server. After much review of data quality, variables qualifying were analysed through descriptive and causal methods using STATA software. Results: Insurance coverage in Navakholo sub-county stood at 11% among women aged 15-49 years who were either spouses of the head of household or heads of households themselves. This is much lower than the national aggregate reported from sample surveys, but higher than the 7% found in the same survey for the Western region where Navakholo is situated. Social determinant variables – age, perceived condition of the household, and wealth ranking – are highly significant in the relationship with ownership of health insurance cover while measures of reproductive health and health vulnerability are not. Conclusions: In Navakholo sub-county of western Kenya, health insurance coverage is lower than the national aggregate estimated from sample surveys. Age, perception of household condition, and wealth ranking are very significantly related to ownership of a health insurance cover. Frequent household registrations should be conducted to help monitor the trends and impact of health insurance campaigns. Training – upstream and downstream – on community household registration and data processing should be conducted to arrive at better quality data.

Background In concert with international commitments, the Government of Kenya identified Universal Health Coverage (UHC), mainly through the National Health Insurance Fund (NHIF), as one of its four priority agenda to enable its populations access health care without financial duress. Nevertheless, only about 19.5% of the Kenyan population is enrolled in any insurance health cover. Since 2016, Amref Health Africa and PharmAccess Foundation have been implementing the Innovative Partnership for Universal and Sustainable Healthcare (iPUSH) programme in Navakholo sub-county of Kakamega County. The main objective of this study is to examine use of health insurance cover among Women of Reproductive Age (WRA) in Navakholo sub-county, Kakamega County. Methods We analysed data captured during household registration conducted in February 2021 which embraced a question on use of health insurance cover including NHIF. The dataset consisted 148,957 household members within 32,262 households, 310 villages, and 32 community health units. The data had been collected using mobile phones by trained Community Health Volunteers (CHVs) and transmitted using the Amref electronic data management platform and reposited in a server. Data were analysed through frequency distributions and logistic regression (descriptive and causal methods) using STATA software. Results Insurance coverage, all providers included, in Navakholo sub-county stood at 11% among women aged 15–49 years. This is much lower than the national aggregate reported from sample surveys, but higher than the 7% found in the same survey for the region where Navakholo is situated. Social determinant variables – age, perceived condition of the household, and wealth ranking – are highly significant in the relationship with use of health insurance cover while measures of reproductive health and health vulnerability are not. Conclusion In Navakholo sub-county of Western Kenya, all—health-insurance coverage is lower than the national aggregate estimated from sample surveys. Age, perception of household condition, and wealth ranking are very significantly related to use of a health insurance cover. Frequent household registrations should be conducted to help monitor the trends and impact of health insurance campaigns. Training – upstream and downstream – on community household registration and data processing should be conducted to arrive at better quality data.