Health Service Availability and Mapping in Urban Slums: A Descriptive Analysis of Health Facility Data in Two Kenyan Communities

Purpose Limited available evidence suggests urban slum inhabitants are at a disadvantage for accessing health services compared to other urban residents. Given the growing needs of marginalized urban populations in developing... [ view full abstract ]

Purpose
Limited available evidence suggests urban slum inhabitants are at a disadvantage for accessing health services compared to other urban residents. Given the growing needs of marginalized urban populations in developing countries who tend to seek care via private formal or informal service providers, measurement of health service availability within slum communities using context-appropriate, adapted tools that include the informal sector is crucial. This study’s aims are to describe the formal and informal health services available in two urban slums in Kenya. Results from this health facility assessment are further compared to the population-based Service Provision Assessment (which does not take into account informal providers) to better understand how service availability in slums compares to availability at the national and regional levels.


Methods
We analyzed 2011 health facility census data from formal and informal providers in two Kenyan slums: 11 facilities in Nyalenda slum of Kisumu, and 35 facilities in Langas slum of Eldoret. A version of the World Health Organization’s Service Availability and Readiness Assessment that was adapted to include informal providers was administered. We descriptively analyzed general characteristics of facilities including human resource capacity, interventions provided, and general equipment available. We further mapped findings using spatial data for all facilities to illustrate the distribution of services. Similar secondary data from the 2010 Service Provision Assessment were analyzed and compared to this study’s results.


Conclusions
This study provides a detailed picture of health services availability within two urban slums in Kenya. Standard population-based assessments fail to include informal providers and this results in an incomplete sample of facilities. Notably, our method captured that 36% of facilities in Nyalenda and 43% in Langas were private retailers or informal providers. These findings should be incorporated into slum health interventions, monitoring and evaluation of health systems strengthening, and urban health policy development.