In Kenya, gaps exist in health service provision to slum residents, especially service availability and access to quality care. There is also little information on the health status of people living in slums other than in Nairobi. The purpose of this paper is to generate evidence for use in designing interventions to improve health services in four mid-sized slums in Embu, Nyeri and Thika, Kenya.A cross-sectional survey of clients receiving services in health facilities was conducted in the targeted slums. Data were collected through face-to-face interviews. Factor scores were generated using the Rasch model; simple and multivariate logistic regression analyses were done using the R statistical software.Overall, 81 per cent of the 203 participants reported being satisfied with health services. Most clients (89 per cent) reported that health facility staff greeted them warmly; 82 per cent said their consultation was private. The facility type, waiting time and client experience with service providers determined their satisfaction (p<0.05).Healthcare managers can improve client satisfaction levels by understanding the client flow in their facilities and addressing causes of client dissatisfaction, such as long waiting times, while at the same time promoting facilitating factors.The authors use latent variable modelling to compute client satisfaction scores, which were dichotomised into two categories and fitted into a logistic regression model to identify factors that influence client satisfaction. Health facility clients in the four slums are satisfied with services and have confidence the providers will serve them in a friendly and professional manner that promotes respect and quality care. The paper recommend healthcare managers in similar settings carry out client flow analysis and institute remedial measures to address long waiting times. Qualitative studies are recommended to determine the reasons behind the high satisfaction levels reported in this study.
Background: Prevention of mother-to-child transmission of HIV (PMCT) was first introduced in Kenya on a pilot basis in 1999 and scaled up from 2001 as an integrated HIV/AIDS prevention program within maternal child health services (MCH).Methodology: An indigenous professional non-governmental organization (NGO) partnered with 12 District Health management teams (DHMTs) to scale-up integration of prevention of PMCT into MCH services to reach 80% of the pregnant women accessing care. DHMTs were empowered to provide standard training, delivery and support of PMCT services while the NGO partner provided technical support for training, security of critical consumables, support-supervision, commodity management and monitoring and evaluation. Results of the scale-up, uptake of HIV counselling and testing (HCT) and anti-retroviral prophylaxis over a one-year period are presented.Results: PMCT services were provided in 341 facilities including 194 newly initiated sites. A total of 89,393 women found out their HIV status, 94% through antenatal testing and 6% maternity testing. Uptake of antenatal HCT was 73% with four-fifths of the women finding out their status at first antenatal visit. Uptake of HCT was significantly higher at District and sub-District hospitals compared to lower level facilities, and in low HIV prevalence Districts compared to high prevalence Districts (p< 0.001). Facilities in high HIV prevalence regions were 18 times more likely to deliver ARV prophylaxis compared to low prevalence Districts. Conclusion: Standardized approaches and partnership with the development partner enhanced PMCT scale-up. Further operational research is required to enhance quality of PMCT services at lower level facilities
Zebedee Mwandi and colleagues discuss Kenya's scale-up of voluntary medical male circumcision services, highlighting government leadership, a clear implementation strategy, and program flexibility and innovation as keys to Kenya's success.
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