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?

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Study Justification:
– The study aims to understand the perceptions of access to and quality of care among poor urban women in Kenya.
– It also quantifies the effects of these perceptions on the utilization of delivery services.
– The study draws policy implications regarding the delivery of maternal health services to the urban poor.
Study Highlights:
– The study found that women living in informal settlements of Nairobi, Kenya have good perceptions of access to and quality of care provided by privately owned, sub-standard, and often unlicensed clinics and maternity homes.
– Despite the poor quality of these facilities, women still utilize them for delivery services.
– Women from the study area have limited access to not-for-profit private providers of maternal health care services.
– The study recommends harnessing the potential of private clinics operating in urban, resource-deprived settings.
Recommendations for Lay Reader and Policy Maker:
1. Regulate private health facilities operating in urban slum settlements to ensure they meet acceptable minimum standards of obstetric care.
2. Provide technical support and supply drugs and equipment to ‘good’ facilities.
3. Improve access to not-for-profit private providers of maternal health care services for women in the study area.
Key Role Players:
1. Government regulatory bodies responsible for overseeing health facilities.
2. Private clinic owners and operators.
3. Non-governmental organizations (NGOs) involved in maternal health care provision.
4. Missionary clinics and hospitals.
5. Community leaders and organizations advocating for improved maternal health care.
Cost Items for Planning Recommendations:
1. Regulatory inspections and monitoring of private health facilities.
2. Training and capacity building for private clinic staff.
3. Procurement and supply of drugs and equipment to ‘good’ facilities.
4. Outreach programs and awareness campaigns to improve access to not-for-profit private providers.
5. Collaboration and coordination efforts between government agencies, NGOs, and private providers.

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. © The Author 2011; all rights reserved.

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The study recommends two key actions to improve access to maternal health in urban, resource-deprived settings:

1. Regulation of private health facilities: The government should establish regulations and guidelines to ensure that private health facilities operating in urban slum settlements meet the acceptable minimum standards of obstetric care. This would involve setting and enforcing standards for the services provided by private clinics to ensure they are safe and of high quality.

2. Support for “good” facilities: Facilities that meet the acceptable minimum standards of obstetric care should be identified as “good” facilities. These facilities should receive technical support and be supplied with necessary drugs and equipment to enhance their capacity to provide quality maternal health services.

By implementing these recommendations, private clinics can play a significant role in improving access to maternal health for women living in urban slum settlements, where accessing not-for-profit private providers of maternal health care services is challenging.
AI Innovations Description
The recommendation proposed in the study is to harness the potential of private clinics operating in urban, resource-deprived settings to improve access to maternal health. The recommendation includes two key actions:

1. Regulation of private health facilities: 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. This would involve setting and enforcing regulations and guidelines for private clinics to ensure they provide safe and quality maternal health services.

2. Support for “good” facilities: Facilities that meet the acceptable minimum standards of obstetric care should be identified as “good” facilities. These facilities should be given technical support and supplied with drugs and equipment to enhance their capacity to provide quality maternal health services.

By implementing these recommendations, it is expected that private clinics can play a significant role in improving access to maternal health for women living in urban slum settlements, where accessing not-for-profit private providers of maternal health care services is challenging.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be used:

1. Selection of study population: Identify a representative sample of women living in urban slum settlements who are in need of maternal health services. This can be done through a random sampling technique, ensuring that the sample is diverse and includes women from different socioeconomic backgrounds.

2. Baseline data collection: Collect data on the current state of access to maternal health services in the study population. This can include information on the distance to the nearest health facility, availability of services, affordability, and quality of care. This data will serve as a baseline against which the impact of the recommendations can be measured.

3. Intervention implementation: Implement the two main recommendations proposed in the study. This involves regulating private health facilities operating in urban slum settlements to ensure they meet minimum standards of obstetric care, and providing technical support and necessary supplies to identified “good” facilities.

4. Post-intervention data collection: After the recommendations have been implemented, collect data on the changes in access to maternal health services. This can include measuring the distance to the nearest health facility, assessing the availability and affordability of services, and evaluating the perceived quality of care.

5. Data analysis: Analyze the collected data to determine the impact of the recommendations on improving access to maternal health services. Compare the post-intervention data with the baseline data to identify any significant changes. Statistical methods such as regression analysis can be used to assess the association between the implementation of the recommendations and the improvements in access to maternal health services.

6. Policy implications: Based on the findings of the analysis, draw policy implications regarding the delivery of maternal health services to the urban poor. This can include recommendations for scaling up the implementation of the proposed recommendations or making adjustments based on the observed impact.

By following this methodology, researchers can assess the impact of the recommendations proposed in the study on improving access to maternal health services in urban slum settlements. The findings can inform policy decisions and interventions aimed at addressing the maternal health needs of women in resource-deprived settings.

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