Beyond water, sanitation, and hygiene facilities: social accountability and co-creation in early childhood centres in informal settlements in Nairobi, Kenya.

Chumo, Ivy (2024) Beyond water, sanitation, and hygiene facilities: social accountability and co-creation in early childhood centres in informal settlements in Nairobi, Kenya., Thesis (Doctoral), Liverpool School of Tropical Medicine.

Text I Chumo Final Thesis_00368704_SUBMITTED (1).pdf - Accepted Version Restricted to Repository staff only until 2 January 2025. Download (2MB)

Abstract

Children are paramount in human development, health, and overall wellbeing, as adverse conditions in early life can severely limit their future opportunities. Access to adequate water, sanitation, and hygiene (WASH) is universally recognized as a fundamental human right. In Kenya, the government has implemented policies and guidelines to ensure the delivery of quality services in pre-primary schools, with the approval of the Kenya Integrated Early Childhood Development Policy Framework in 2017. These policies, developed in collaboration with stakeholders including the Ministry of Education (MoE) and County Governments, aims to operationalize the National Pre-Primary Education Policy (NPEP) and Integrated Early Childhood Education (IECD). Additionally, the Early Childhood Education Act of 2021 provides a legal framework for the administration of early childhood education within counties. Despite these efforts, children in childcare centres, particularly those in informal settlements, continue to face poor access to WASH services. Furthermore, there is a lack of effective inter-stakeholder accountability mechanisms to ensure the implementation of policies and practices for improved WASH services. This gap in data and accountability has hindered efforts to address the needs of marginalized urban poor, including children under 5 years old in informal settlements. To address these knowledge gaps, this thesis examines social accountability mechanisms for WASH service provision in childcare centres in informal settlements in Nairobi, Kenya. The study employed an exploratory sequential mixed-methods research approach across three levels: governance diaries, surveys and observations, and focus group discussions and workshops. Data were collected from parents, childcare managers, and providers in two informal settlements in Nairobi. The findings revealed that key actors in WASH in childcare centres include both primary actors responsible for day-to-day service provision and non-key actors operating in the WASH sector but not directly involved in childcare centres. Parents and childcare providers emerged as key actors who have devised informal social accountability mechanisms (iSAMs) to enhance WASH service delivery. These mechanisms include discretionary actions, norms and values, and facilitative behaviours. The study also identified relatively high levels of access to basic WASH services in childcare centres, with some disparities between different settlements. Importantly, there was an association between the use of iSAMs and the provision of basic WASH services, indicating the effectiveness of these mechanisms in improving service delivery. The research highlights the need for enhanced accountability mechanisms and routine monitoring of WASH services. It underscores the importance of collaboration among stakeholders and the development of more direct networks to ensure the success of WASH service delivery. Additionally, the study emphasizes the role of iSAMs in promoting WASH service delivery and recommends that the public sector provide incentives to childcare centres operating on these principles.

Item Type:	Thesis (Doctoral)
Subjects:	WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Problems of Special Population Groups > WA 320 Child Welfare. Child Health Services. WA Public Health > Sanitation. Environmental Control > General Sanitation and Environmental Control > WA 670 General works WA Public Health > Water > WA 675 Water. Water supply. Sources
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Depositing User:	Lynn Roberts-Maloney
Date Deposited:	02 Oct 2024 12:21
Last Modified:	02 Oct 2024 12:27
URI:	https://archive.lstmed.ac.uk/id/eprint/25428

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