Kuboresha Afya Mitaani project (KAM), also known as the Urban Maternal, Newborn and Child Health (MNCH) Project, is using implementation research to better understand and improve MNCH outcomes for almost 60,000 of Nairobi’s most vulnerable women and children living in the informal settlements of Kawangware and Mathare North.
While Sub-Saharan Africa is experiencing rapid urbanization, a growing number of urban residents live in informal settlements, and health systems are poorly prepared to meet their needs due to changing epidemiological and demographic profiles. Nairobi, Kenya’s capital, is one of the prime examples of this trend. Over 60% of Nairobi’s population is estimated to be living in informal settlements with approximately 73% of this population living below the Kenya poverty line (92.4 in Kenya shilling (2015) or US$1.90 (2011 PPP) per day per capita). The challenges faced by informal settlement residents in Nairobi contribute to health outcomes that are substantially worse than that of the broader population, particularly amongst vulnerable populations such as women and children. For example, the maternal mortality ratio in two informal settlements in Nairobi was estimated at 709 per 100,000 live births, which is almost twice the national average (362/100,000 live births).1 The Nairobi Cross-sectional Slums Survey (2012) estimated an under-five mortality rate of 79.8 per 1000 live births, compared with the national rate of 52/1000 live births.2 Morbidity and mortality of children in poor, urban environments may be explained by higher rates of respiratory infections, diarrheal diseases, and malnutrition in informal settlements.2
Led by Jacaranda Health and teams from Population Council, the Nairobi City County, Sanergy, and Berkeley Air Monitoring Group, the Kuboresha Afya Mitaani project (KAM) is using implementation research and a package of MNCH strategies to explore a ‘quality ecosystem’ in two informal settlements of Nairobi, which includes integrating typically siloed actors in the quality of care space (individuals, communities, facilities, providers, health regulators), and actors in the non-health sector. The ‘quality ecosystem’ is intended to incorporate a positive feedback approach between actors and serve as a model for how to sustainably increase demand for and incentivize provision of quality MNCH services within an urban context. The research will improve an understanding of the drivers of poor health, test innovative solutions, and catalyze political interest in leading to better MNCH outcomes for vulnerable populations.
A multi-stakeholder, participatory environment is created where learnings from interventions and implementation research findings and can be embedded into an effective learning cycle
Mothers, households and communities are empowered to demand higher quality care at the right time and place
Health facility and frontline providers have increased capacity to deliver high-quality, life-saving care
Health management has the tools to increase the number of facilities providing high-quality MNCH services
Persistent environmental challenges and the barriers to deployment of solutions are understood within the context of target informal settlements
To achieve these results, Kuboresha Afya Mitaani is conducting the following activities with regular feedback cycles to strengthen implementation throughout the life of the project:
1. Empowering women, households and communities to demand higher quality MNCH care by deploying an mHealth ‘PROMPTS’ platform for women, community scorecards and mass media tools.
2. Building capacity of health facilities and frontline providers to deliver high-quality, life-saving care through an in-facility clinical mentorship program and cross-facility quality improvement initiatives.
3. Optimizing the ability of the health system to increase the number of facilities providing high quality MNCH services. Actionable data from the ecosystem will be accessible and fed to all relevant stakeholders, including regulatory teams who are mandated to license facilities and monitor safety and quality challenges.
4. Engaging community and health-system stakeholders in a participatory platform that shares knowledge and potential solutions for health-system and environmental challenges. A multi-stakeholder forum (MSF) will be a problem-solving platform that uses knowledge products from the implementation research process to be a model for addressing direct (health-system) and indirect (environmental) challenges, those related to including sanitation and air pollution, that constrains the system.
For more information, contact: Sathy Rajasekharan, PhD, Executive Director (Africa) of Jacaranda Health (firstname.lastname@example.org)
- Beguy, Donatien, et al. “Health & demographic surveillance system profile: the Nairobi urban health and demographic surveillance system (NUHDSS).” International journal of epidemiology 44.2 (2015): 462-471.
- African Population and Health Research Center (APHRC). 2014. Population and Health Dynamics in Nairobi’s Informal Settlements: Report of the Nairobi Cross-sectional Slums Survey (NCSS) 2012. Nairobi: APHRC.