Life for women and girls living in low-income urban settlements is characterised by exclusion, and this is reflected in poor access to basic health care and services. The thematic review and several case studies observed women’s poor access to appropriate, efficient and confidential health services. In some cases, it was a physical lack of access – health-care services were scarce, difficult to get to, or inappropriate. In Shillong, India, research revealed little SRH service provision in the low-income urban settlements. Similarly, in Kibera and Majengo, Nairobi, women and health-care workers reported a lack of HIV-related health services, stock-outs of essential drugs and faulty equipment, leading to time-consuming referrals.
Even where health services are available and physically accessible, poverty in various forms can hinder women’s and girls’ access. Income poverty can make health care prohibitive. For example, in Shillong, India, despite the close proximity of urban health centres, some women reported that out-of-pocket expenses put them off seeking health care for themselves.
Time-poverty can also be a barrier to access. In Khayelitsha, South Africa, prior to the implementation of a community-based intervention to address the burden of NCDs, people would lose a day’s work due to waiting at the clinics all day. One of the successes of the intervention was that Community Health Workers (CHWs) provided services to the community, allowing people to access services in a more timely fashion.
Lack of patient confidentiality and absence of political will also affected access to services. Some women in Kibera and Majengo did not feel that health-care workers respected confidentiality, which prevented them from accessing HIV-related services. Additionally, it was found that ensuring access to and quality of health services was not a priority for some county-level policymakers, who felt it was not their role.
- Women and girls in low-income urban settlements face layers of exclusion that act as barriers to access to health services, and these layers can have a reinforcing effect on each other. Policymakers, governments, donors and those involved in the implementation of interventions need to acknowledge this and ensure that policies and programmes work towards addressing these barriers. This includes finding creative ways to facilitate access to services and to overcome the constraints to access – including time, health-care costs, lack of transport, etc. This may rely on government partnerships with community-based services and involve decentralised initiatives.