Determinants of Effective Child Immunization Delivery: A Study of Community Health Units in Informal Settlements in Nairobi County, Kenya

Abstract

The effectiveness of Community Health Units (CHU) in delivering child im- munization services is a critical component of public health in urban informal

settlements. In Nairobi County, CHU are tasked with ensuring that all chil- dren receive necessary immunizations. However, the effectiveness of these

units is influenced by several factors, including the Accountability System and Human Resource Management practices. Despite the implementation of

CHU, a significant proportion of children in these informal settlements re- main unimmunized. Previous studies have not sufficiently explored how the

clarity of accountability systems and adherence to human resource practices impact the effectiveness of CHU in delivering child immunization services. This gap necessitates an in-depth examination to enhance the performance of CHU in such vulnerable populations. We aimed to examine the influence of the accountability system and Human Resource Management practices on the

effectiveness of CHU in delivering child immunization services in urban in- formal settlements in Nairobi County, Kenya. The study adopted a cross-sec- tional descriptive design, utilizing an interpretivist research philosophy to ex- plore the depth of the relationship between the independent variables (Ac- countability System and Human Resource Management) and the dependent

variable (effectiveness of CHU delivery of child immunization services). A

sample of 354 Community Health Workers was selected from 449 fully func- tional CHU in the informal settlements using stratified simple random sam- pling. Data was collected via a structured questionnaire and analyzed using

descriptive statistics and binary logistic regression to determine the relationship between variables using SPSS version 26. The findings revealed that a clear

accountability system significantly increased the effectiveness of CHU in de- livering child immunization services, with an odds ratio of 0.140. Similarly, ad- herence to standard human resource practices significantly improved CHU

performance, with an odds ratio of 0.207. The logistic regression model indi- cated that 43.1% of the variance in CHU effectiveness could be explained by

the independent variables. The results underscored the importance of clear

communication channels, community involvement in monitoring and evalua- tion, and consistent support supervision as vital elements in enhancing CHU

performance. We conclude that strengthening accountability systems and ad- hering to standard human resource practices are essential for improving the

delivery of child immunization services by CHU in informal settlements. These results imply that policymakers and health administrators should prioritize these factors to achieve full immunization coverage and improve public health outcomes in underserved urban areas.