Hidden Cities, Hidden Gaps: Measuring Facility Readiness for Maternal and Newborn Health Services and its Association with Person-Centered Maternity Care in Urban Informal Settlements of Nairobi, Lusaka and Ouagadougou Cities.

Abstract

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-centered maternity care (PCMC), and we compared facilities serving and not serving informal settlements in Nairobi, Lusaka and Ouagadougou cities. Facility readiness scores were computed among 18, 38 and 138 facilities offering delivery services in Nairobi, Lusaka and Ouagadougou respectively. Mean labor 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.