Preferences and utilization of health services by slum residents: A case study of Mathare, Nairobi
Owino, George Evans
MetadataShow full item record
Health-seeking behaviour is a very important variable in understanding the health conditions of the urban slum dwellers. This study was conducted in the Mathare Valley slum in Nairobi. Mathare Valley was selected purposively because it is reputed as one of the largest, most well known and the most favoured of the slums due to its closeness to the city centre and industrial area and since it is one of the oldest, it is expected that the impact of the location will have an impact on the behaviour of the people. The main objective of the study was to find out the health facility preference and utilization patterns of slum residents in Mathare with the specific objectives being to: identify the health care services they prefer and utilize; establish the relationship between health facility preference and health facility utilization; determine the factors that are significantly related to the preference for and utilization of health facilities among slum residents; and finally, draw up relevant policy recommendations arising from the study. The study was guided by three theoretical models; the sociological interactionist theory, the health belief model and the social learning theory. The study was a cross-sectional social survey and it sampled 220 households. The respondents were the heads of households, male and female, single and married. Simple and systematic random sampling methods were used to draw the sample and the research instrument was an interview schedule. Data analysis was done using the Statistical Package for the Social Sciences (SPSS). Frequencies were used for univariate analysis whereas cross tabulations were used to represent bivariate relationships. The two-way chi-square, also known as test of indepedence was used to establish statistical independence with the contingency coefficient being used to test the strength of relationships between independent and dependent variables. Two-Way Chi-square, the test of independence is the procedure used when data consists of frequencies of subjects belonging to categories in each of two variables (Heiman, 1996). The findings of the study revealed that the residents of Mathare valley slums mostly prefer and utilize private health facilities (over 50%) followed by public health facilities (about 23%) and finally mission health facilities (about 17%) in that order. The relationship between health facility preference and utilization was found to be statistically significant (X2 = 208.72, Df.=9, p<.OOI) and a strong association (Contingency Coefficient=O. 71, p<.OO1) was identified. Several socio-economic, demographic and socio-cognitive factors were found to be significantly related to and associated with health seeking behaviour. Income (30.42, Df=12,p<O.O, association, 0.37. p<O.OI);; occupation (15.23, Df. =6, p<0.05; association, 0.26. p<0.05) and gender (8.266, Df.=3, p< 0.05; O.l96.p<0.05) were significantly related to health facility preference while education (14.50, Df.=6, p<0.05; 0.26 p<0.05), income (35.01, Df.=12 p<O.OOl), occupation (13.78, Df=6 p<0.05; 0.25. p<0.05, gender (15.564, Df.=3, p<O.OOI; 0.268. p<O.OOl, and perceived cost of care (14.98, Df.=6 p<0.05 ; 0.26. p<0.05) were significantly related to health facility utilization. The main conclusion of the study was that the majority of Mathare Valley slums residents prefer and utilize a variety of health services prominent among which are private facilities, public health facilities and mission clinics. The other conclusion is that there is a significant relationship between health facility preference and health facility utilization. Based on the findings, the study recommended a strengthyening of the health delivery system by either government encouraging private sector participation while reducing its role and providing a conducive environment for these providers to operate or increase its own role by improving its services. The other recommendation is the need to create more employment opportunities since income was found to be an important determinant of health care utilization.