Peer-reviewed article
Hidden cities, hidden gaps: measuring facility readiness for maternal and newborn health services and its association with person-centred maternity care in sub-Saharan Africa's urban informal settlements.
Jiwani SS, Mutua MK, Cisse K, Jacobs C, Njeri A et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study measured how well healthcare facilities in poor urban neighborhoods of Nairobi, Lusaka, and Ouagadougou are equipped to provide maternal and newborn care. Facilities serving informal settlements were generally less ready than others, with particularly low readiness for caring for sick or small newborns. The study found that facility readiness was not linked to whether women felt they received respectful, person-centred care, suggesting that equipment and staffing alone do not guarantee good patient experience.
Key points
- Labour and delivery readiness in informal settlement facilities ranged from 55.9% (Ouagadougou) to 73.6% (Lusaka); newborn care readiness ranged from 37.2% to 61.3%
- Facilities serving informal settlements had significantly poorer readiness than other facilities in Lusaka and Ouagadougou
- Critical items were missing across all facilities, including newborn caps, registers, guidelines, and staff trained in Kangaroo Mother Care
- No significant association was found between facility readiness scores and women's experience of person-centred maternity care
- All facilities studied had substandard readiness for essential maternal and newborn health services
Limitations
The study measures facility readiness but cannot explain why better-equipped facilities did not result in improved patient experience. The cross-sectional design cannot establish causal relationships, and existing data sources for two cities may differ in collection methods from the primary data collected in Nairobi.
Abstract
Background In sub-Saharan Africa, maternal and newborn deaths remain disproportionately higher among low-income populations, and they are associated with delivery in poorly equipped facilities and a shortage of staff to manage birth complications. We measured facility readiness to provide essential maternal and newborn health services and its association with women's experience of person-centred maternity care (PCMC), and we compared facilities serving and not serving informal settlements in Nairobi, Lusaka and Ouagadougou cities. Methods We conducted a health facility assessment in public and private facilities serving select urban informal settlements in Nairobi, and we used existing data in Lusaka and Ouagadougou. We computed readiness indices for labour and delivery care, and small and/or sick newborn care (SSNC) in each city, and used t tests to compare them across facilities serving and not serving informal settlements. We linked women's self-reported PCMC scores to the labour and delivery readiness score of the facility they attended and ran 2-level linear regression models testing the association between facility readiness and PCMC scores. Results Facility readiness scores were computed among 18, 38, and 138 facilities offering delivery services in Nairobi, Lusaka and Ouagadougou respectively. Mean labour and delivery readiness scores in facilities serving informal settlements ranged from 55.9% in Ouagadougou to 73.6% in Lusaka; SSNC readiness ranged from 37.2% in Ouagadougou to 61.3% in Nairobi. While facilities serving informal settlements had statistically significantly poorer readiness in Lusaka and Ouagadougou, key items such as newborn caps, registers, guidelines, and staff trained in Kangaroo Mother Care were lacking across both areas. We found no significant association between facility readiness and PCMC. Conclusions All facilities have substandard readiness for essential maternal and newborn health services, but those serving informal settlements are more disadvantaged. Investments in service readiness and quality of care remain critical.