Perceived quality of and access to care among poor urban women in Kenya and their utilization of delivery care: harnessing the potential of private clinics?

Abstract

This paper uses data from a maternal health study carried out in 2006 in two slums of Nairobi, Kenya, to: describe perceptions of access to and quality of care among women living in informal settlements of Nairobi, Kenya; quantify the effects of women's perceived quality of, and access to, care on the utilization of delivery services; and draw policy implications regarding the delivery of maternal health services to the urban poor. Based on the results of the facility survey, all health facilities were classified as 'appropriate' or 'inappropriate'. The research was based on the premise that despite the poor quality of these maternal health facilities, their responsiveness to the socio-cultural and economic sensitivities of women would result in good perceptions and higher utilization by women. Our results show a pattern of women's good perceptions in terms of access to, and quality of, health care provided by the privately owned, sub-standard and often unlicensed clinics and maternity homes located within their communities. In the multivariate model, the association between women's perceptions of access to and quality of care, and delivery at these 'inappropriate' facilities remained strong, graded and in the expected direction. Women from the study area are seldom able to reach not-for-profit private providers of maternal health care services like missionary and non-governmental organization (NGO) clinics and hospitals. Against the backdrop of challenges faced by the public sector in health care provision, we recommend that the government should harness the potential of private clinics operating in urban, resource-deprived settings. First, the government should regulate private health facilities operating in urban slum settlements to ensure that the services they offer meet the acceptable minimum standards of obstetric care. Second, 'good' facilities should be given technical support and supplied with drugs and equipment.

Do active patients seek higher quality prenatal care?: A panel data analysis from Nairobi, Kenya

“…friendliness and respectfulness of staff, facility amenities, etc.). This is consistent with other research from the Nairobi slums, which demonstrates that women perceive the quality of care to be highest at the small, private (often unlicensed) maternity facilities, which are often unequipped technically to provide safe deliveries but which offer kinder, more respectful care and more comfortable amenities (Fotso and Mukiira, 2012). …”

“…A large number of public, private and mission facilities offer antenatal care (ANC) and delivery services in Nairobi, with wide variation in the quality of services (National Coordinating Agency for Population and Development, Fotso and Mukiira, 2012, Ziraba et al, 2009). We define “active” ANC patients as women who switch providers over the course of their pregnancy and analyze the characteristics and health seeking behavior of these patients, exploring whether active patients appear to be seeking and receiving a different level of quality than “non-active” patients (i.e.…”

Perceived Quality of Care of Community Health Worker and Facility-Based Health Worker Management of Pneumonia in Children Under 5 Years in Western Kenya: A Cross-Sectional Multidimensional Study

“…Previous studies have shown that a high perceived quality of care is associated with an increased utilization of services and therefore acceptability. 31 The PCAS measures caregivers' perceptions of the quality of primary care through 10 different domains, including detailed measurement of the providerpatient relationship (communication quality, patient trust, provider knowledge of patient, interpersonal treatment, and relationship duration). For this study, we have grouped these 10 domains into three general categories of accessibility, clinical care, and patient relationships ( Table 1).…”

Why Urban Citizens in Developing Countries Use Traditional Medicines: The Case of Suriname

“…However, an increasing number of people in developing countries now live in urban areas. Few of these large cities are able to provide their rapidly growing populations with the appropriate health care, which often results in increased levels of urban poverty and ill health [15]. While we are gaining insight in the use of CAM in developed countries, the use of herbal medicine or other forms of TM among urban populations in developing countries is poorly documented [12].…”