Adapting Care Groups to Urban Slums: A Case Study of a Church-Based Effort to Improve Maternal and Child Health Outcomes in Mathare, Nairobi, Kenya

Abstract

In many places in Africa, progress on maternal and child health has been slow and uneven, with widening geographic and socio-economic disparities, despite economic growth and continued investments in health systems. In Kenya, modest national-level gains mask wide disparities in progress, with near stagnation among the very poor, those with the least education, and those living in either extremely rural contexts or dense informal urban slums. Progress toward Kenya’s maternal and child health Sustainable Development Goals (SDGs) will depend on finding new ways to work effectively in dense urban slums, where poverty and ill-health are increasingly concentrated, and older program models have failed to deliver. Effective approaches will require addressing significant knowledge, behavior, and trust gaps, especially with the poorest and most vulnerable residents of slum communities like Nairobi’s Mathare. Care Groups were designed to address these specific types of gaps but have only been effectively tested and scaled in rural and peri-urban environments. The Kenya Mennonite Church’s Center for Peacebuilding and Nationhood’s maternal and child health Care Group project in Mathare, Nairobi, one of the largest informal settlements in Kenya, is the first to adapt the Care Group model to an urban slum environment. However, significant adaptation of the model was required by the uniquely challenging nature of a context characterized by high population density, crowding, extremely transient and unstable populations, low social trust, lack of traditional social structures, high vulnerability to crime, political disruption, and frequent rapid onset disasters. This case study explores the contextual complexity of adapting a model like Care Groups to the realities of a dense African urban slum, the innovative strategies the project has used, its successes, challenges, and the unique benefits of doing this work on a small scale rooted in a local church organization.