Mapping the Community-Defined Health System for HIV/AIDS and Diabetes Services for Korogocho Slum Residents

Purpose Stark inequalities exist with respect to the availability and accessibility of health services for the urban poor. As urbanization rates continue to rise in developing countries, so too will the proportion of people... [ view full abstract ]

Purpose
Stark inequalities exist with respect to the availability and accessibility of health services for the urban poor. As urbanization rates continue to rise in developing countries, so too will the proportion of people living in slums. Slum dwellers are likely to be disproportionately affected by the negative health outcomes that may accompany urbanization. It is imperative to investigate whether urban health systems are adequately equipped with the health care services and human resources to withstand epidemiologic shifts, especially in socioeconomically disadvantaged communities. A key step in the process of ensuring that health care services are available and accessible to slum residents is understanding the health system landscape from community members’ perspectives.

Methods
We conducted participatory research with residents of the Korogocho slum in Nairobi, Kenya, in order to understand their health utilization behavior, particularly in terms of the availability and accessibility of HIV- and diabetes-related health services. Based on the information we acquired from key respondents, we embarked on a mapping exercise using geographic information systems to spatially characterize a community-defined health system for these slum residents.

Results
Korogocho residents use a mix of private and public health facilities and providers from both the formal and informal sectors. Respondents were more inclined to use public rather than private facilities. Their health utilization behavior was influenced by the availability (number and distribution) of human resources for health, equipment, drugs, supplies, and infrastructure at health facilities. Additionally, geographic, economic, societal, and organizational accessibility factored into their use of the resources available to them. Results were also illustrated on maps.

Conclusions
There is substantial room for improvement with regard to enhancing the availability and accessibility of the health care system for the Korogocho community. Policies need to be revised and implemented to facilitate health systems strengthening and health equity for slum populations.