LVCT Health

Health Systems Strengthening Research

Accountability for Informal Urban Equity Hub: A survey of slums in Nairobi, Kenya


ARISE is a five-year research study that aims at increasing accountability for health and wellbeing among vulnerable people in urban informal settlements. The objective of the study is to understand the role of social accountability in addressing socio-economic, health and wellbeing inequities of vulnerable populations living in urban slums in Nairobi, Kenya.  It is being implemented by three partners, namely, APHRC, SDI-Kenya, and LVCT Health in three informal settlements of Nairobi, namely, Korogocho, Viwandani and Mathare.

LVCT Health’s role is to conduct a photovoice study to understand experiences of vulnerability and marginalization by the three categories of persons identified as most vulnerable by the social mapping. These are children heading households, older persons and persons with disability (PWD). The photovoice study is being conducted in two informal settlements, Korogocho and Viwandani using a Community Based Participatory Research approach (CBPR).

This study employs a mixed methods approach that consists photovoice, governance diaries, in-depth interviews, key informant interviews, focus group discussions and household surveys. The results from the photovoice will be used to inform the implementation of the third phase that consists of addressing gaps identified through a co-creation process that involves the study communities in the three informal settlements.

Team members: Dr Lilian Otiso, Robinson Karuga, Inviolata Njeri, Linet Okoth  Link to researcher profiles

Research partners: Africa Population Health Research Council, SDI-Kenya, LSTM

Funder: UKRI

Links to publications:

1.    Egid, B.R.; Roura, M.; Aktar, B.; Amegee Quach, J.; Chumo, I.; Dias, S.; Hegel, G.; Jones, L.; Karuga, R.; Lar, L.; et al. ‘You want to deal with power while riding on power’: Global perspectives on power in participatory health research and co-production approaches. BMJ Glob Health 2021; 6, doi:10.1136/bmjgh-2021-006978.

2.    Teixeira de Siqueira-Filha, N., J. Li, E. Kibuchi, Z. Quayyum, P. Phillips-Howard, A. Awal, M. I. H. Mithu, F. Manzoor, R. Karuga, S. Saidu, J. Smith, V. Sai, S. Garimella, I. Chumo, B. Mberu, R. Tolhurst, S. Mazumdar, V. Rao, N. Farnaz, W. Alam and H. Elsey (2021). “Economics of healthcare access in low-income and middle-income countries: A protocol for a scoping review of the economic impacts of seeking healthcare on slum-dwellers compared with other city residents.” BMJ Open. 2021; 11(7): e045441.

3.    Aktar B, Alam W, Ali S, Awal A, Bayoh M, Chumo I, Karuga R, et al. How to prevent and address safeguarding concerns in global health research programmes: Practice, process and positionality in marginalised spaces. BMJ Global Health. 2020; 5(5): e0

SQALE: Sustaining quality approaches for locally embedded community health services


The USAID SQALE Community Health Services Program was a three-year project (2016-2019) to improve maternal and child health through a focus on community health systems. The study involved a partnership of Kenya’s Ministry of Health, Liverpool School of Tropical Medicine, LVCT Health and URC. We conducted implementation research on how to institutionalise a focus on quality in local level services. USAID SQALE supported this effort through a process of capacity building and community engagement.

Our aim was to strengthen leadership and coordination at national, county and community levels by embedding a culture of quality improvement in community health programs. This was done through training, set up and mentorship of Quality Improvement Teams at county and sub-county levels and Work Improvement Teams at community level.  This resulted in:

1.    Leadership and communities of quality improvement embedded at national and county levels resulting in strengthened national and county coordination for improved quality of community health programs;

2.    Increased capacity of county decision makers to prioritize and budget for community health programs in an equitable manner;

3.    Improved community health program performance in Maternal and Child Health; and

4.    Stronger community engagement and increased community participation in decision making

This project was implemented in at least six high priority Maternal, Newborn and Child Health counties. We conducted the research in Nairobi, Migori and Kitui counties.

Team members: Dr Lilian Otiso, Linet Okoth, Meghan Kumar, Prof Miriam Taegtmeyer  Link to researcher profiles

Research partners: Ministry of health, LSTM, University Research Council

Funder: USAID

Links to publications:

1.    Regeru RN, Chikaphupha K, Bruce Kumar M, Otiso L, Taegtmeyer M. ‘Do you trust those data?’—a mixed-methods study assessing the quality of data reported by community health workers in Kenya and Malawi. Health Policy and Planning. 2020.

2.    Hussein S, Otiso L, Kimani M, Olago A, Wanyungu J, Kavoo D, et al. Institutionalizing Community Health Services in Kenya: A Policy and Practice Journey. Global Health: Science and Practice. 2021;9(Supplement 1):S25.

3.    Otiso L, Gitahi G, Nambiar B, Kumar MB, Doyle V. The missing piece: quality in community health programmes. The Lancet Global Health. 2019;7(3):e306.

4.    More resources:

4byFour Pilot – An acceptability, feasibility and effectiveness study in selected Antenatal Care sites in Migori County, Kenya


This was an observational study using process evaluation for complex interventions. Some of the methods used during the study pilot included: Community mapping, testing, referral and tracking of pregnant women and adolescents; Antenatal and laboratory register data reviews and community and facility surveys.

The study findings were that: There was a significant increase of initial ANC attendance based on the practice of community pregnancy testing that improved early detection; Mothers referred had preference of the facilities to seek medical services; availability of commodities enabled uptake of 4byFour.

Recommendations included the need for further strengthening of the linkage between community, facility and county government; an electronic solution to data capture; training on respectful care improve patient-provider relationship at facilities; greater involvement of community leaders and target beneficiaries; promoting male partner involvement; training Community Health Volunteers (CHVs) on communication skills, data recording and reporting; consider performance-based pay for CHVs.

Team members: Dr Lilian Otiso, Prof Miriam Taegtmeyer, Linet Okoth, Dr Meghan Kumar  Link to researcher profiles

Research partners: LSTM

Funder: MRC UK

Links to publications: