Maternal and child health care delivery and utilization in low income urban settlements: A Case of Nyalenda and Pandipieri, Kisumu, Kenya
Health care services are among the public services that profoundly affect human well being. The provision of health services therefore need to demonstrate sensitivity to social, economic, cultural, environmental and spatial components which influence the configuration of health care systems and personal health behaviours. The scarcity of health care services in urban areas has been exacerbated by rapid population growth and lack of planning for such rapid increases resulting in high demand for health services, problems of housing, sanitation, pollution and family dislocation. The intra-urban patterns of accessibility to health care have hence shown a general picture whereby the poor people and poor neighbourhoods suffer some disadvantage. This finds expression in the urban structure and its constraining effects on locational decisions. The study sought to examine the factors which affect the delivery and utilization of maternal and child health care services in the low income urban settlements and their implications on planning of health services for the urban poor. It is demonstrated that while the greatest attention of health care should be directed to the poor and those who can not afford to compete effectively in the market place of health care, it is most unfortunate that the urban slums receive the least attention from policy makers and health planners. It then follows that these settlements are often subjected to untold environmental insults, insecurity and poor infrastructural base for the delivery of primary health care. In this situation, the worst hit are the women and children who constitute over 60% of the total urban population. They are in turn subjected to suffer from multiplicity of health problems which are otherwise preventable. The author critically analyses the theoretical formulations in literature which govern the delivery and response to the health care interventions provided. These include issues of public health policy, health education, family planning, the role of hospitals in MCH/FP delivery, community participation in the health care delivery process. Also critically reviewed are the the Health Belief model and Health planning approach which provided the theoretical framework Oil which the study was based. Out of the inadequacies of the two models, the author empirically formulated an alternative model to explain further the interplay of various factors at different levels in affecting the delivery and utilization of health care in low income urban settlements. Both primary data and secondary data was collected. The primary data was obtained from 80 household respondents sampled using the cluster sampling technique and the key informants whose choice was based on non probability sampling technique. Of the techniques used, the use of questionnaires and participant observation proved the most valuable. Various descriptive and inferential statistics were performed including percentages, averages cross tabulations and chi square. The data is graphically presented using bar graphs and pie charts. The main body of the work presents the analysis of the general health determinants in the study area and the factors influencing the delivery and use of MCHlFP services. The author argues that poor health status of the people living in the low income urban settlements of whom the majority are women and children, result from a combination of both structural and situational factors. III the examination of factors, financial resources, formal education, functional efficiency of health facilities and location were found to exert a lot of influence on the provision of MCH/FP services and therapeutic behaviour of users. It is therefore recommended that greater attention should be directed on the adoption of an integrated and comprehensive approach to the planning of health care services including the provision of health education, public health infrastructure such as sanitation, motivation of health workers and the recognition of traditional health systems by the health policy.