Health System Factors Affecting Community Health Units’ Perfomance In Delivery of Child Immunization Services in Urban Informal Settlements in Nairobi County

Abstract

Health systems are complex, and in a complex real world setting a health system needs system’s thinking approach to operate more successfully and effectively. Community Health Unit delivers a structured child immunization services at household and community level. Full Immunization Coverage in Nairobi slums is at 55%. Nairobi hosts one of the largest informal settlement in Africa where approximately 56% of urban population in Kenya lives. Therefore the study sought to establish Accountability; Human resource; Logistics & supplies; and Incentives factors influencing Community Health Units’ performance in the delivery of child immunization services in Nairobi County urban Informal Settlement. This study was a cross-sectional descriptive research which adopted Interpretivist research philosophy. It used survey methodology to obtain data and used both systematic and simple random sampling to get a sample size of 354 respondents drawn from 4490 functional Community Health Units. The data collection instrument used was a structured questionnaire. Methods of data analysis used were descriptive statistic which included percentages, frequencies and cross-tabulation; and inferential statistics which involved logistic regression and logistic model was fitted to the data. The findings revealed that firstly, 1.967, Wald =42.893, df =1 which is associated with a p-value of 0.000 and Odds ratio=0.140 for the Accountability factors. Secondly, 1.574, Wald =16.000, df =1 which is associated with a p-value of 0.000 and Odds ratio =0.207 for the Human Resource factors. Thirdly, 1.115, Wald =12.866, df =1 which is associated with a p-value of 0.000 and Odds ratio =0.328 for the Logistics &supplies. Fourthly, 1.336, Wald =9.634, df =1 which is associated with a p-value of 0.002 and Odds ratio =0.113 for the Incentive factors. Lastly CHU showed 71.2% effectiveness in the delivery of child immunization services. It was concluded that Accountability, Human resource practices, Logistics & supplies; and Incentives factors significantly influenced the odds of Community Health Units’ performance in the delivery of child immunization services in Nairobi County Informal Settlements. This study recommendations included: selection of more male Community Health Promoter; Communication channel to be strengthened; Support supervision to be enhanced; Friendly and relevant and not restrictive job aids to be provided; and Incentives to be provided for Community Health Promoter. Further research should be done to establish the ways to have more males as Community Health Promoter; to establish strategies to have effective toiler made community monitoring and evaluation and the best and affordable, suitable and sustainable incentives for Community Health Promoter.