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Cited by 32Healthcare Systems and ReformsPublic Health and Social InequalitiesUrban and Rural Development Challenges

Demand and supply-side barriers and opportunities to enhance access to healthcare for urban poor populations in Kenya: a qualitative study

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Bakibinga, Pauline, Kisia, Lyagamula, Atela, Martin, Kibe, Peter M., Kabaria, Caroline, Kisiangani, Isaac, Kyobutungi, Catherine·2022·BMJ Open
DOI 10.1136/bmjopen-2021-057484PMC PMC9083429
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Abstract

Objective: To explore the barriers to and options for improving access to quality healthcare for the urban poor in Nairobi, Kenya. Design and participants: This was a qualitative approach. In-depth interviews (n=12), focus group discussions with community members (n=12) and key informant interviews with health providers and policymakers (n=25) were conducted between August 2019 and September 2020. Four feedback and validation workshops were held in December 2019 and April–June 2021. Setting: Korogocho and Viwandani urban slums in Nairobi, Kenya. Results: The socioe-conomic status of individuals and their families, such as poverty and lack of health insurance, interact with community-level factors like poor infrastructure, limited availability of health facilities and insecurity; and health system factors such as limited facility opening hours, health providers’ attitudes and skills and limited public health resources to limit healthcare access and perpetuate health inequities. Limited involvement in decision-making processes by service providers and other key stakeholders was identified as a major challenge with significant implications on how limited health system resources are managed. Conclusion: Despite many targeted interventions to improve the health and well-being of the urban poor, slum residents are still unable to obtain quality healthcare because of persistent and new barriers due to the COVID-19 pandemic. In a devolved health system, paying attention to health services managers’ abilities to assess and respond to population health needs is vital. The limited use of existing accountability mechanisms requires attention to ensure that the mechanisms enhance, rather than limit, access to health services for the urban slum residents. The uniqueness of poor urban settings also requires in-depth and focused attention to social determinants of health within these contexts. To address individual, community and system-level barriers to quality healthcare in this and related settings and expand access to health services for all, multisectoral strategies tailored to each population group are needed.

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  • External results from studies conducted in similar research contexts cite high visit costs as a primary deterrent from seeking medical care.

    “External results from studies conducted in similar research contexts cite high visit costs as a primary deterrent from seeking medical care [30, 33, 34].”

    From Community and facility-level barriers to achieving UHC in Kono District, Sierra Leone and Maryland County, Liberia (2023) · cites this paper as [33]

    The Results (Enabling factors; page unavailable) identify relatively high care costs and limited financial resources as challenges to accessing healthcare in the two Kenyan urban slums studied. The paper describes multiple barriers but does not establish visit costs as a primary deterrent relative to the others. (LLM, conf=0.83)

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  1. [1]Jacobs B, Ir P, Bigdeli M, et al. Addressing access barriers to health services: an analytical framework for selecting appropriate interventions in low-income Asian countries. Health Policy Plan 2012; 27: 288– 300. 10.1093/heapol/czr038 21565939 · DOI
  2. [2]Santalahti M, Sumit K, Perkiö M. Barriers to accessing health care services: a qualitative study of migrant construction workers in a southwestern Indian City. BMC Health Serv Res 2020; 20: 619. 10.1186/s12913-020-05482-1 32631320 PMC7339387 · DOI · Paper page
  3. [3]Bakeera SK, Wamala SP, Galea S, et al. Community perceptions and factors influencing utilization of health services in Uganda. Int J Equity Health 2009; 8: 25. 10.1186/1475-9276-8-25 19602244 PMC2717964 · DOI
  4. [5]Kumar J, Kumar P. COVID-19 pandemic and health-care disruptions: count the most vulnerable. Lancet Glob Health 2021; 9: e722– 3. 10.1016/S2214-109X(21)00098-X 33811826 PMC8012027 · DOI
  5. [11]Muraguri L. Kenyan government initiatives in slum upgrading. Eastafrica 2011; 44: 119– 27. 10.4000/eastafrica.534 · DOI
  6. [13]Amendah DD, Mutua MK, Kyobutungi C, et al. Reproductive health voucher program and facility based delivery in informal settlements in Nairobi: a longitudinal analysis. PLoS One 2013; 8: e80582-e. 10.1371/journal.pone.0080582 24260426 PMC3832453 · DOI
  7. [14]Njuki R, Abuya T, Kimani J, et al. Does a voucher program improve reproductive health service delivery and access in Kenya? BMC Health Serv Res 2015; 15: 206. 10.1186/s12913-015-0860-x 26002611 PMC4443655 · DOI
  8. [15]Lang'at E, Mwanri L, Temmerman M. Effects of implementing free maternity service policy in Kenya: an interrupted time series analysis. BMC Health Serv Res 2019; 19: 645. 10.1186/s12913-019-4462-x 31492134 PMC6729061 · DOI
  9. [16]Masaba BB, Mmusi-Phetoe RM. Free maternal health care policy in Kenya; level of utilization and barriers. International Journal of Africa Nursing Sciences 2020; 13: 100234. 10.1016/j.ijans.2020.100234 · DOI
  10. [17]Njuki R, Obare F, Warren C, et al. Community experiences and perceptions of reproductive health vouchers in Kenya. BMC Public Health 2013; 13: 660. 10.1186/1471-2458-13-660 23866044 PMC3721984 · DOI
  11. [18]Wamalwa EW. Implementation challenges of free maternity services policy in Kenya: the health workers’ perspective. Pan African Medical Journal 2015; 22. 10.11604/pamj.2015.22.375.6708 PMC4796785 27047616 · DOI
  12. [19]Otieno PO, Wambiya EOA, Mohamed SM, et al. Access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya. BMC Public Health 2020; 20: 981. 10.1186/s12889-020-09106-5 32571277 PMC7310125 · DOI
  13. [20]Fotso JC, Mukiira C. 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? Health Policy Plan 2012; 27: 505– 15. 10.1093/heapol/czr074 22080515 · DOI
  14. [21]Jacobs B, Ir P, Bigdeli M, et al. Addressing access barriers to health services: an analytical framework for selecting appropriate interventions in low-income Asian countries. Health Policy Plan 2012; 27: 288– 300. 10.1093/heapol/czr038 21565939 · DOI
  15. [22]Bakibinga P, Kabaria C, Kyobutungi C, et al. A protocol for a multi-site, spatially-referenced household survey in slum settings: methods for access, sampling frame construction, sampling, and field data collection. BMC Med Res Methodol 2019; 19: 109. 10.1186/s12874-019-0732-x 31146676 PMC6543601 · DOI
  16. [23]Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 1995; 36: 1– 10. 10.2307/2137284 7738325 · DOI · Paper page
  17. [24]Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. Milbank Q 2005; 83: Online-only. 10.1111/j.1468-0009.2005.00428.x 4198894 · DOI
  18. [25]Wamukoya M, Kadengye DT, Iddi S, et al. The Nairobi urban health and demographic surveillance of slum dwellers, 2002–2019: value, processes, and challenges. Global Epidemiology 2020; 2: 100024. 10.1016/j.gloepi.2020.100024 · DOI
  19. [26]Kyobutungi C, Ziraba AK, Ezeh A, et al. The burden of disease profile of residents of Nairobi's slums: results from a demographic surveillance system. Popul Health Metr 2008; 6: 1. 10.1186/1478-7954-6-1 18331630 PMC2292687 · DOI
  20. [27]Zulu EM, Beguy D, Ezeh AC, et al. Overview of migration, poverty and health dynamics in Nairobi City's slum settlements. J Urban Health 2011; 88 Suppl 2: S185– 99. 10.1007/s11524-011-9595-0 21713552 PMC3132239 · DOI
  21. [28]Mudege NN, Zulu EM. Discourses of illegality and exclusion: when water access matters. Glob Public Health 2011; 6: 221– 33. 10.1080/17441692.2010.487494 20628930 · DOI
  22. [29]editor. AC E, Chepngeno. G, Kasiira. AZ. The Situation of Older People in Poor Urban Settings: The Case of Nairobi, Kenya. In: Cohen B, Menken J, eds. Aging in sub-Saharan Africa: recommendation for Furthering research. 6. Washington (DC): National Academies Press (US), 2006. 20669443
  23. [30]Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004; 24: 105– 12. 10.1016/j.nedt.2003.10.001 14769454 · DOI · Paper page
  24. [31]Graneheim UH, Lindgren B-M, Lundman B. Methodological challenges in qualitative content analysis: a discussion paper. Nurse Educ Today 2017; 56: 29– 34. 10.1016/j.nedt.2017.06.002 28651100 · DOI
  25. [32]Kibe PM, Kisia L, Bakibinga P. COVID-19 and community healthcare: perspectives from Nairobi's informal settlements. Pan Afr Med J 2020; 35: 106. 10.11604/pamj.supp.2020.35.2.24532 PMC7687469 33282061 · DOI
  26. [33]Bakibinga P, Ettarh R, Ziraba AK, et al. The effect of enhanced public-private partnerships on maternal, newborn and child health services and outcomes in Nairobi-Kenya: the PAMANECH quasi-experimental research protocol. BMJ Open 2014; 4: e006608. 10.1136/bmjopen-2014-006608 PMC4208053 25341452 · DOI
  27. [34]Oti SO, van de Vijver SJM, Agyemang C, et al. The magnitude of diabetes and its association with obesity in the slums of Nairobi, Kenya: results from a cross-sectional survey. Trop Med Int Health 2013; 18: 1520– 30. 10.1111/tmi.12200 24118454 · DOI
  28. [35]Werner ME, van de Vijver S, Adhiambo M, et al. Results of a hypertension and diabetes treatment program in the slums of Nairobi: a retrospective cohort study. BMC Health Serv Res 2015; 15: 512. 10.1186/s12913-015-1167-7 26577953 PMC4650397 · DOI
  29. [37]Kimathi L. Challenges of the devolved health sector in Kenya teething problems or systemic contradictions? Africa Development / Afrique et Développement 2017; 42: 55– 77.
  30. [38]Masaba BB, Moturi JK, Taiswa J, et al. Devolution of healthcare system in Kenya: progress and challenges. Public Health 2020; 189: 135– 40. 10.1016/j.puhe.2020.10.001 33227596 · DOI

Cited by

Sorted by citations

Authors
Bakibinga, P., Kisia, L., Atela, M., Kibe, P. M., Kabaria, C., Kisiangani, I., & Kyobutungi, C.
Affiliations
  • African Population and Health Research Center (KE)
  • University of Cambridge (GB)
Corresponding author
Kisia, Lyagamula
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2022-05
Volume
12
Issue
5
Pages
e057484
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2021-057484
PMC
PMC9083429
OpenAlex
W4229063048
Cited by
32
References
1
Citations by year
2026: 2 · 2025: 9 · 2024: 14 · 2023: 6 · 2022: 1
FWCI
5.50
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Apollo (University of Cambridge) (submittedVersion, cc-by-nc)
  • Apollo
Funders
NIHR Global Health Research Unit on Improving Health in Slums (R.MRPT.0067)
Topics
  • Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
  • Social Sciences › Health › Public Health and Social Inequalities
  • Social Sciences › Urban Studies › Urban and Rural Development Challenges
Keywords
health care access, urban poor, urban slums, health disparities, barriers to care, health system factors, social determinants of health, health insurance, COVID-19 pandemic impact on healthcare, stakeholder decision-making, Nairobi
MeSH terms
COVID-19, Health Facilities, Health Services Accessibility, Humans, Kenya, Qualitative Research, Population Groups, Pandemics

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