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 in Nairobi, Lusaka and Ouagadougou.

BackgroundIn 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 womens experience of person-centered maternity care (PCMC), and we compared facilities serving and not serving informal settlements in Nairobi, Lusaka and Ouagadougou cities. MethodsWe 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 labor 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 womens self-reported PCMC scores to the labor 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. ResultsFacility 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. ConclusionsAll 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.