Safe motherhood strategies in the informal settlement of Kibera, Nairobi city county
This was a cross sectional, descriptive study exploring safe motherhood strategies in the informal settlement of Kibera in Nairobi City County. Specifically, the study examined the strategies adopted by the health facilities and their effectiveness in addressing the constraints faced in ensuring safe motherhood. The study was guided by Intervention and Solution focused theory and data collected through key informant interviews, in depth interviews, and observations. The sample population was drawn from public, private, Faith-based, NGO supported health facilities as well as a Beyond Zero Clinic within Kibera informal settlements. Purposive sampling was used to identify the health facilities in Kibera. The study purposively included facilities run by government (Public) as well as private facilities run by health/medical entrepreneurs and not for profit facilities run by the church or faith based organizations as well as those run by non-governmental organizations. In situations where community run facilities existed, they were included as well as the Beyond Zero Clinic providing maternity services to Kibera residents. The data was analyzed through constant comparative approach which is consistent with the grounded theory and presented according to themes informed by the study objectives. The study has revealed that the informal settlement facilities have adopted specific strategies in the delivery of maternal health care services. Among the strategies adopted include: partnerships with other organizations on provision of a range of services including family planning, ante-natal care, safe and clean delivery, skilled birth attendants, post-natal care, “delivery pack” to incentivize the mothers to have facility deliveries and maternal mortality audit meetings. Further, there is a user fees exemption for maternity services. The strategies, however, are faced by a number of constraints including: insufficient human and material resources; ineffectiveness of the referral systems, physical inaccessibility of the facilities and insecurity. The study concludes that there is an urgent need to address the burden of shortage of staff, stock-outs of drugs, supplies and commodities and an ineffective referral system. The study recommends that referral pathways in the informal settlements needs to be improved and this should be complimented by constant and adequate supply of essential medicines and equipment and monetary resources.