Developing an intervention to improve the quality of childcare centers in resource-poor urban settings: a mixed methods study in Nairobi, Kenya
BackgroundGlobally, 350 million under-5s do not have adequate childcare. This may damage their health and development and undermine societal and economic development. Rapid urbanization is changing patterns of work, social structures, and gender norms. Parents, mainly mothers, work long hours for in...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-07-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1195460/full |
| _version_ | 1797778298396213248 |
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| author | Linda Oloo Helen Elsey Mary Abboah-Offei Mary Abboah-Offei Martin Kiyeng Patrick Amboka Kenneth Okelo Patricia Kitsao-Wekulo Elizabeth Kimani-Murage Nelson Langa't Margaret Nampijja |
| author_facet | Linda Oloo Helen Elsey Mary Abboah-Offei Mary Abboah-Offei Martin Kiyeng Patrick Amboka Kenneth Okelo Patricia Kitsao-Wekulo Elizabeth Kimani-Murage Nelson Langa't Margaret Nampijja |
| author_sort | Linda Oloo |
| collection | DOAJ |
| description | BackgroundGlobally, 350 million under-5s do not have adequate childcare. This may damage their health and development and undermine societal and economic development. Rapid urbanization is changing patterns of work, social structures, and gender norms. Parents, mainly mothers, work long hours for insecure daily wages. To respond to increasing demand, childcare centers have sprung up in informal settlements. However, there is currently little or no support to ensure they provide safe, nurturing care accessible to low-income families. Here, we present the process of co-designing an intervention, delivered by local government community health teams to improve the quality of childcare centers and ultimately the health and development of under-5 children in informal settlements in Kenya.MethodsThis mixed methods study started with a rapid mapping of the location and basic characteristics of all childcare centers in two informal settlements in Nairobi. Qualitative interviews were conducted with parents and grandparents (n = 44), childcare providers, and community health teams (n = 44). A series of 7 co-design workshops with representatives from government and non-governmental organizations (NGOs), community health teams, and childcare providers were held to design the intervention. Questionnaires to assess the knowledge, attitudes, and practices of community health volunteers (n = 22) and childcare center providers (n = 66) were conducted.ResultsIn total, 129 childcare centers were identified −55 in Korogocho and 77 in Viwandani. School-based providers dominated in Korogocho (73%) while home-based centers were prevalent in Viwandani (53%). All centers reported minimal support from any organization (19% supported) and this was particularly low among home-based (9%) and center-based (14%) providers. Home-based center providers were the least likely to be trained in early childhood development (20%), hence the co-designed intervention focused on supporting these centers. All co-design stakeholders agreed that with further training, community health volunteers were well placed to support these informal centers. Findings showed that given the context of informal settlements, support for strengthening management within the centers in addition to the core domains of WHO's Nurturing Care Framework was required as a key component of the intervention.ConclusionImplementing a co-design process embedded within existing community health systems and drawing on the lived experiences of childcare providers and parents in informal settlements facilitated the development of an intervention with the potential for scalability and sustainability. Such interventions are urgently needed as the number of home-based and small center-based informal childcare centers is growing rapidly to meet the demand; yet, they receive little support to improve quality and are largely unregulated. Childcare providers, and government and community health teams were able to co-design an intervention delivered within current public community health structures to support centers in improving nurturing care. Further research on the effectiveness and sustainability of support to private and informal childcare centers in the context of low-income urban neighborhoods is needed. |
| first_indexed | 2024-03-12T23:15:14Z |
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| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-03-12T23:15:14Z |
| publishDate | 2023-07-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Public Health |
| spelling | doaj.art-39b4c1d08da14d0db597f05fbecbd4752023-07-17T08:27:18ZengFrontiers Media S.A.Frontiers in Public Health2296-25652023-07-011110.3389/fpubh.2023.11954601195460Developing an intervention to improve the quality of childcare centers in resource-poor urban settings: a mixed methods study in Nairobi, KenyaLinda Oloo0Helen Elsey1Mary Abboah-Offei2Mary Abboah-Offei3Martin Kiyeng4Patrick Amboka5Kenneth Okelo6Patricia Kitsao-Wekulo7Elizabeth Kimani-Murage8Nelson Langa't9Margaret Nampijja10African Population and Health Research Centre, Nairobi, KenyaHull and York Medical School and Department of Health Sciences, University of York, York, United KingdomHull and York Medical School and Department of Health Sciences, University of York, York, United KingdomSchool of Health and Social Care, Edinburgh Napier University, Edinburgh, United KingdomKidogo Early Years, Nairobi, KenyaAfrican Population and Health Research Centre, Nairobi, KenyaAfrican Population and Health Research Centre, Nairobi, KenyaAfrican Population and Health Research Centre, Nairobi, KenyaAfrican Population and Health Research Centre, Nairobi, KenyaAfrican Population and Health Research Centre, Nairobi, KenyaAfrican Population and Health Research Centre, Nairobi, KenyaBackgroundGlobally, 350 million under-5s do not have adequate childcare. This may damage their health and development and undermine societal and economic development. Rapid urbanization is changing patterns of work, social structures, and gender norms. Parents, mainly mothers, work long hours for insecure daily wages. To respond to increasing demand, childcare centers have sprung up in informal settlements. However, there is currently little or no support to ensure they provide safe, nurturing care accessible to low-income families. Here, we present the process of co-designing an intervention, delivered by local government community health teams to improve the quality of childcare centers and ultimately the health and development of under-5 children in informal settlements in Kenya.MethodsThis mixed methods study started with a rapid mapping of the location and basic characteristics of all childcare centers in two informal settlements in Nairobi. Qualitative interviews were conducted with parents and grandparents (n = 44), childcare providers, and community health teams (n = 44). A series of 7 co-design workshops with representatives from government and non-governmental organizations (NGOs), community health teams, and childcare providers were held to design the intervention. Questionnaires to assess the knowledge, attitudes, and practices of community health volunteers (n = 22) and childcare center providers (n = 66) were conducted.ResultsIn total, 129 childcare centers were identified −55 in Korogocho and 77 in Viwandani. School-based providers dominated in Korogocho (73%) while home-based centers were prevalent in Viwandani (53%). All centers reported minimal support from any organization (19% supported) and this was particularly low among home-based (9%) and center-based (14%) providers. Home-based center providers were the least likely to be trained in early childhood development (20%), hence the co-designed intervention focused on supporting these centers. All co-design stakeholders agreed that with further training, community health volunteers were well placed to support these informal centers. Findings showed that given the context of informal settlements, support for strengthening management within the centers in addition to the core domains of WHO's Nurturing Care Framework was required as a key component of the intervention.ConclusionImplementing a co-design process embedded within existing community health systems and drawing on the lived experiences of childcare providers and parents in informal settlements facilitated the development of an intervention with the potential for scalability and sustainability. Such interventions are urgently needed as the number of home-based and small center-based informal childcare centers is growing rapidly to meet the demand; yet, they receive little support to improve quality and are largely unregulated. Childcare providers, and government and community health teams were able to co-design an intervention delivered within current public community health structures to support centers in improving nurturing care. Further research on the effectiveness and sustainability of support to private and informal childcare centers in the context of low-income urban neighborhoods is needed.https://www.frontiersin.org/articles/10.3389/fpubh.2023.1195460/fullchildcare centersurban informal settlementsintervention developmentcommunity of practiceco-creation |
| spellingShingle | Linda Oloo Helen Elsey Mary Abboah-Offei Mary Abboah-Offei Martin Kiyeng Patrick Amboka Kenneth Okelo Patricia Kitsao-Wekulo Elizabeth Kimani-Murage Nelson Langa't Margaret Nampijja Developing an intervention to improve the quality of childcare centers in resource-poor urban settings: a mixed methods study in Nairobi, Kenya Frontiers in Public Health childcare centers urban informal settlements intervention development community of practice co-creation |
| title | Developing an intervention to improve the quality of childcare centers in resource-poor urban settings: a mixed methods study in Nairobi, Kenya |
| title_full | Developing an intervention to improve the quality of childcare centers in resource-poor urban settings: a mixed methods study in Nairobi, Kenya |
| title_fullStr | Developing an intervention to improve the quality of childcare centers in resource-poor urban settings: a mixed methods study in Nairobi, Kenya |
| title_full_unstemmed | Developing an intervention to improve the quality of childcare centers in resource-poor urban settings: a mixed methods study in Nairobi, Kenya |
| title_short | Developing an intervention to improve the quality of childcare centers in resource-poor urban settings: a mixed methods study in Nairobi, Kenya |
| title_sort | developing an intervention to improve the quality of childcare centers in resource poor urban settings a mixed methods study in nairobi kenya |
| topic | childcare centers urban informal settlements intervention development community of practice co-creation |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1195460/full |
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