High levels of maternal mortality in sub-Saharan Africa remains a challenge. The WHO/UNICEF/UNFPA estimated maternal mortality ratio in Kenya at 1,000 maternal deaths per 100,000 live births in 2000 Of the two indicators (maternal mortality ratio and proportion of births with skilled attendants) for measuring progress towards the fifth Millennium Development Goal (MDG5) of reducing maternal mortality between 1990 and 2015 by three quarters, maternal mortality ratio is generally more difficult to measure compared to the proportion of births with skilled birth attendants (doctors, midwives, or nurses) which can readily be measured in national surveys[3, 4]. Knowing the proportion of women who deliver with skilled assistance is not enough. Mere presence of skilled attendants at birth is unlikely to reduce maternal mortality if there is no supportive environment with essential drugs and supplies, equipment, and appropriate referral and communication system .
Increasingly it is being recognized that availability and access to emergency obstetric care improves maternal morbidity and mortality[6, 7]. Based on functionality and ability to provide lifesaving emergency obstetric procedures, a health facility can be classified as either basic or comprehensive emergency obstetric care facility (EmOC)  Basic EmOC facilities are expected to provide the following six services: administration of parenteral antibiotics; parenteral oxytocic drugs; parenteral anticonvulsants for pre-eclampsia; manual removal of retained placenta; removal of retained products of conception; and assisted vaginal delivery (vacuum extraction or forceps delivery). Comprehensive EmOC facilities are expected to provide caesarean section and blood transfusion in addition to those services provided by the basic EmOC facilities.
In 2004, the Kenya Service Provision Assessment (KSPA) survey among other things examined the availability of emergency obstetric care and quality of delivery services . The KSPA categorized EmOC facilities in Kenya as basic EmOC "minus 1" (excluding assisted vaginal delivery) and comprehensive EmOC "minus 1" (excluding assisted vaginal delivery). Out of 1,882 health facilities (hospitals, maternity clinics and health centers) in Kenya at the time of the survey, it was estimated that 9% offered basic EmOC "minus 1" while 6% offered comprehensive EmOC "minus 1". There was geographical variation among the 8 provinces with Nairobi province having the lowest number of comprehensive EmOC "minus 1" per 500,000 population (0.4) while the Coast province had the highest at 3.8 comprehensive EmOC "minus 1" per 500,000 population. The low coverage in Nairobi province might be partly due to the ever growing population in the city's slums without concomitant expansion of health services. It is estimated that over 70% of the population of Nairobi city live in slums . The KSPA did not provide a break down on the status of EmOC in Nairobi slums.
Recent studies show that the urban poor are increasingly becoming disadvantaged in terms of health outcomes. A study conducted by the African Population and Health Research Center (APHRC) in 2000 showed that most health indicators in the Nairobi slums were worse than other parts of Kenya including rural areas. Under-five mortality in Nairobi's slums was 151 deaths per 1000 live births compared to 84 deaths per 1000 live births in other urban areas of Kenya, and 113 in rural areas. Forty-four percent of children received full vaccination in Nairobi slums compared to 69% in other urban areas and 64% in rural Kenya . Typical characteristics of Nairobi slums include high unemployment; poor access to social amenities such as housing, water, education; and inadequate health provision[10, 12]. Rapid growth of the urban poor population, which has surpassed growth in social services including health facilities, poses a challenge to planners. Whereas physical distance might be the biggest hindrance to accessing health care in rural areas, other factors including cost and congestion in government facilities are often major barriers to the utilization of services in urban areas. Thus, if progress in health and development is to be achieved in Africa, the global community needs to pay attention to the growing urban poor population. This paper assesses quality of emergency obstetric services available to women in two typical Nairobi slums, Korogocho and Viwandani with specific reference to staffing levels and skills, equipment, drugs and supplies, information management, and referral facilities.