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This paper presents a review of maternal and child health services in Nairobi, Kenya.
Key supply-side barriers identified included inadequate health service infrastructure serving informal settlements and inconsistent quality resulting in “erratic” utilisation of available facilities; relaxed opening hours in some facilities and concentrated periods during which services are offered in most facilities, with only a few facilities adhering to stipulated operating hours; long and multiple queues, a lack of triage, as well as short registration periods resulting in long waiting times and caretakers being sent away (or giving up); as well as inconsistent supply of nutrition human resources and commodities.
On the demand side, caretaker competing priorities were largely work-related, whether this was through casual, self-employment or formal employment arrangements. In most instances, time taken to attend the maternal and child health (MCH) clinic, is done at the expense of an income for that day or the needs of the household, including other children. Caretakers also highlighted the lack of voice to effectively “negotiate” complex health service arrangements. The review confirmed that it is often the system itself which serves to limit an individual’s capacity to engage with it.