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


  • Judith Siambe Opiyo Center for Peacebuilding and Nationhood (CPN)
  • Paul Shetler Fast Mennonite Central Commitee



maternal health, child health, social and behavior change communication, care groups, urban, slum, kenya


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.

Author Biographies

Judith Siambe Opiyo, Center for Peacebuilding and Nationhood (CPN)

Program Officer, Center for Peacebuilding and Nationhood (CPN), Kenya Mennonite Church

BS in Public Health Nutrition and Dietetics

Paul Shetler Fast, Mennonite Central Commitee

Global Health Coordinator, Mennonite Central Committee

Master of Public Health, Master of International Development


Black R, Laxminarayan R, Temmerman M, Walker N, editors. Disease control priorities, : reproductive, maternal, newborn, and child health [vol 2]. Washington, DC: The World Bank; 2016.

Cerf M. The sustainable development goals: contextualizing Africa's economic and health landscape. Global Challenges. 2018;2(8):1800014.

Keats E, Ngugi A, Macharia W, Akseer N, Khaemba E, Bhatti Z, et al. Progress and priorities for reproductive, maternal, newborn, and child health in Kenya: a countdown to 2015 country case study. Lancet Glob Health. 2017;5(8):e782-95.

Ezeh A, Oyebode O, Satterthwaite D, Chen Y, Ndugwa R, Sartori J, et al. The history, geography, and sociology of slums and the health problems of people who live in slums. Lancet. 2017;389(10068): 547-58.

Kenya Ministry of Devolution and Planning. Implementation of the agenda 2030 for sustainable development in Kenya [Internet]. Government of Kenya, Ministry of Devolution and Planning; 2017. Available from

Kenya Ministry of Health Kenya. Strategy for community health 2014 – 2019: transforming health: accelerating the attainment of health goals [Internet] [pdf]. Government of Kenya, Ministry of Health; 2014.

Perry H, Morrow M, Borger S, Weiss J, DeCoster M, Davis T, et zl. Care Groups I: an innovative community-based strategy for improving maternal, neonatal, and child health in resource-constrained settings. Global Health: Sci Prac. 2015;3(3):358-69.

Perry H, Morrow M, Davis T, Borger S, Weiss J, DeCoster M, et al. Care groups II: a summary of the child survival outcomes achieved using volunteer community health workers in resource-constrained settings. Glob Health: Sci Prac. 2015;3(3):370-81.

George C, Vignola E, Ricca J, Davis T, Perin J, Tam Y, et al. Evaluation of the effectiveness of care groups in expanding population coverage of key child survival interventions and reducing under-5 mortality: a comparative analysis using the lives saved tool (LiST). BMC Public Health. 2015;15(1):835.

Kenya National Bureau of Statistics. Population distribution by type of residence and type of settlement: Nairobi. Government of Kenya, Kenya National Bureau of Statistics; 2013.

Fassbender K, Uebernickel F. Human centered design for open community fields in Kenya: learnings from a design thinking project in informal settlements in Nairobi with the Mathare Youth Center. University of St. Gallen; 2017. Available from:

Spatial Collective. Mathare demographic study [Internet]. Spatial Collective; 2014. Available from

Corburn J, Hildebrand C. Slum sanitation and the social determinants of women’s health in Nairobi, Kenya. J Environ Public Health. 2015;2015(1):6.

UN Habitat. Capacity building for county governments under the Kenya Municipal Programme: support to sustainable urban development in Kenya. UN Habitat; 2016. Available from:

Olack B, Burke H, Cosmas L, Bamrah S, Dooling K, Feikin D, et al. Nutritional status of under-five children living in an informal urban settlement in Nairobi, Kenya. J Health, Popul Nutr. 2011; 29(4):357.

Mwase I, Mutoro A, Owino V, Garcia A, Wright C. Poor infant feeding practices and high prevalence of malnutrition in urban slum child care centres in Nairobi: a pilot study. J Trop Pediatrics. 2015; 62(1): 46-54.

African Population and Health Research Center. Population and health dynamics in Nairobi’s informal settlements: report of the Nairobi cross-sectional slums survey (NCSS) 2012. Nairobi: African Population and Health Research Center; 2014. Available from

FAO and FHI 360. Minimum dietary diversity for women: a guide for measurement. Rome: FAO; 2016. Available from:

World Health Organization. Indicators for assessing infant and young child feeding practices: Part 1: Definitions. Geneva: World Health Organization; 2008. Available from:;jsessionid=75865A9916E10B5DFCA2E93A67C1B697?sequence=1

World Health Organization. Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice, 3rd edition. Geneva: World Health Organization; 2015a. Available from:

World Health Organization. Postnatal care for mothers and newborns: Highlights from the World Health Organization 2013 Guidelines. Geneva: World Health Organization; 2015b. Available from: WHO-MCA-PNC-2014-Briefer_A4.pdf

UN Water. Integrated monitoring guide for Sustainable Development Goal 6 on water and sanitation: targets and global indicators. Geneva: UN Water; 2017. Available from:




How to Cite

Opiyo, J. S., & Fast, P. S. (2019). 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. Christian Journal for Global Health, 6(2), 33–43.