Background and rationale

Place of residence is a major determinant of key reproductive, maternal, neonatal and child health outcomes, with those living in rural areas traditionally having worse health outcomes than those in urban areas. In recent years, however, many countries in sub-Saharan Africa have seen massive rural to urban migration, mostly to the capital cities. As a result, there has been a surge in informal settlements, accompanied by a decline in previous improvement of essential intervention coverage and child mortality in urban areas. The latest United Nations estimates indicate that 54% of the sub-Saharan African urban population lives in informal settlements. Deceleration in urban intervention coverage, along with the projection that close to half of the population in sub-Sahara Africa will be urban by 2030, called for action to produce evidence addressing coverage trends and inequities in large cities.

Part One - Secondary Analysis

Countdown collaborations in 14 countries conducted secondary analysis of survey and health facility data to analyze coverage trends, inequities, health services and utilization related to maternal, newborn and child health. The cities included were Accra, Ghana; Lusaka, Zambia; Dakar, Senegal; Bamako, Mali; Ouagadougou, Burkina Faso; Kampala, Uganda; Nairobi, Kenya; Dar es Salaam, Tanzania; and Addis Ababa, Ethiopia. In addition, two analyses examined trends are across 38 countries with recent survey data.

These analyses were published as a supplement in the Journal of Urban Health in 2024, while others are still in peer review. The papers are:

Part Two – Primary data collection in four cities

Primary data were collected in four cities: Nairobi (Kenya), Lusaka (Zambia), Ouagadougou (Burkina Faso) and Dakar (Senegal). In Nairobi, Lusaka and Ouagadougou, the study objective was to evaluate the quality of maternal and newborn health services available to the urban poorest populations living in slums and informal settlements, specifically focusing on experience of person-centered maternity care, and readiness of facilities to offer essential maternal and newborn health services. In Dakar, the aim was to assess the spatial and financial accessibility of cesarean sections among urban slum dwellers.

Click here to read key findings and recommendations from the primary research and download the policy briefs.

Key resources:

Ouagadougou, Burkina Faso

Nairobi, Kenya

Dakar, Senegal

Lusaka, Zambia

2024 HSR Global Symposium on Health Systems Research