Resource Allocation, Health Inequities and Access to Public Health Services in Kibera, Kenya

Equitable access to public health services remains a persistent challenge in informal settlements, where population density, socioeconomic disadvantage and constrained resources intersect. This study examined the relationship between resource allocation and equitable access to public health services in Kibera Informal Settlement, Nairobi City County, Kenya. A convergent parallel mixed-methods design was employed. Quantitative data were collected from 399 adults using structured questionnaires, while qualitative data were obtained from 100 health-sector and service-delivery actors and three resident interview sessions. Eight public health facilities were purposively selected. Quantitative data were analysed using descriptive statistics, Spearman's correlation, Kruskal-Wallis tests and multiple linear regression, while qualitative data underwent thematic analysis. Perceived resource inadequacy was evident across key dimensions. Only 39.4% of respondents agreed that health facilities had sufficient doctors and nurses, compared with 43.3% who disagreed (M=2.67, SD=1.24). Similarly, 34.6% reported that medicines and supplies were available when needed, compared with 45.8% who disagreed (M=2.94, SD=1.23). Perceptions of facility adequacy were divided (39.8% agreed; 39.0% disagreed; M=2.88, SD=1.13). Only 36.2% perceived unfair geographical resource distribution. Qualitative findings identified 60 references on equipment/infrastructure, 24 on medicine stockouts, 11 on staffing shortages and 11 on SHA/insurance barriers. Equitable access requires needs-based, population-responsive and geographically sensitive resource allocation that addresses both service capacity and financial accessibility. Keywords: Resource Allocation; Equitable Access; Public Health Services; Informal Settlements; Health Equity